Panic Disorder

Panic disorder and panic attacks are two of the most common problems seen in the world of psychiatry. Panic disorder is a separate entity from panic attacks, although it is characterized by recurrent, unexpected panic attacks. Panic attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an abrupt surge of intense fear or discomfort” reaching a peak within minutes. Four or more of a specific set of physical symptoms accompany a panic attack. These symptoms include; palpitations, pounding heart or accelerated heart rate, sweating, trembling or shaking, sensations of shortness of breath or smothering, feelings of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, light-headedness, or faint, chills or heat sensations, paresthesias (numbness or tingling sensations), derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of losing control or "going crazy," and fear of dying. Panic attacks occur as often as several times per day or as infrequently as only a few attacks per year. A hallmark feature of panic disorder is that attacks occur without warning. There is often no specific trigger for a panic attack. Patients suffering from these attacks self-perceive a lack of control. Panic attacks, however, are not limited to panic disorder. They can occur alongside other anxiety, mood, psychotic, and substance use disorder.  In order to make an accurate diagnosis of panic disorder, it is important to differentiate the two entities from each other. According to DSM 5, panic disorder can be diagnosed if recurrent unexpected panic attacks are happening, followed by one month or more of persistent concern over having more attacks, along with a change in the behavior of the individual to avoid a situation in which they attribute the attack. Although panic attacks may originate from the direct effects of substance use, medications, or a general medical condition like hyperthyroidism or vestibular dysfunction, they must not derive solely from these. Panic disorder is not diagnosed when the symptoms are attributable to another disorder.  For example, when panic attacks occur in the presence of a social anxiety disorder in which the attacks are triggered by social situations like public speaking, it cannot be considered a part of panic disorder. A distinctive finding in patients with panic disorder is related to the fear and anxiety that they experience in a physical manner as opposed to a cognitive one. Panic disorder is not a benign disease, it can significantly affect the quality of life and lead to depression and disability. In addition, these patients are also at a higher risk for alcoholism and substance abuse compared to the general population.