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How Is Panic Disorder Diagnosed?

Panic Attacks and Panic Disorder

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Updated June 26, 2014

Sudden and recurring panic attacks are the hallmark symptoms of panic disorder. But, the context in which the panic attacks occur is important when making a diagnosis. Panic attacks are classified into three types:

  1. Spontaneous or uncued panic attacks occur spontaneously or “out of the blue.” No situational or environmental triggers are are associated with the attack. These types of panic attacks may even occur during one’s sleep.

  2. Situationally bound or cued panic attacks occur upon actual or anticipated exposure to certain situations. These situations become cues or triggers for a panic episode. For example, an individual who fears enclosed spaces experiences a panic attack when entering, or thinking about entering, an elevator.

  3. Situationally predisposed panic attacks don’t always occur immediately upon exposure to a feared situation or cue, but the individual is more likely to experience an attack in such situations. For example, a person who has a fear of social situations but who does not experience a panic episode in every social situation, or who experiences a delayed attack after being in a social environment for an extended period of time.

It is not uncommon for a person who has panic disorder to experience panic attacks in certain situations. But, in order for a diagnosis of panic disorder to be made, recurrent, unexpected or uncued panic attacks must be present.

It may not always be clear which type of panic attack a person is experiencing. Therefore, it is also important to consider one’s focus on the anxiety. In panic disorder, the focus is on the fear of the actual panic attack, sometimes termed the “fear of the fear.” If the focus of the anxiety is not on the actual panic attack, it is less likely to be related to panic disorder.

DSM-IV-TR

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) by the American Psychiatric Association is the system used in the United States to classify, describe and diagnosis mental disorders. The DSM-IV-TR outlines the following diagnostic criteria for panic disorder:

Recurrent unexpected panic attacks and at least one of the attacks have been followed by 1 month (or more) of one (or more) of the following:

If the above criteria are met, the diagnosis is further clarified by the presence or absence of agoraphobia (such as Panic Disorder with Agoraphobia or Panic Disorder without Agoraphobia).

Ruling Out Other Illnesses

The symptoms of panic disorder can mimic many physical or other psychological disorders. Before making a diagnosis of panic disorder, it may be necessary to rule out physical illnesses through examination and testing by a medical doctor or specialist. If a physical cause for the symptoms is not found, a referral to a qualified mental health professional may be made for further assessment and diagnosis.

Source:

American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.

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