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Proposed Changes in Diagnostic Criteria for Panic Disorder

How Changes in the New DSM May Effect Panic Disorder and Agoraphobia

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Updated September 26, 2011

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The new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled to be published in the year 2013. As the American Psychiatric Association (APA) continues to revise and develop the next edition, projected changes are available online and open to public examination.

According to the APA DSM-5 Development Website, there will be changes made to the diagnostic criteria for panic disorder and agoraphobia. One of the most notable changes is that panic disorder and agoraphobia are going to be separated into two distinct mental health disorders.

Here are other changes to expect in the DSM-5 for panic disorder and agoraphobia:

Panic Disorder

The diagnostic criteria for panic disorder is projected to stay the same, with the exception of the mention of agoraphobia. Panic disorder is currently listed in the DSM-IV-TR as occurring with or without agoraphobia. This title will be changed in the new edition to “Panic Disorder” and agoraphobia will be referenced as a separate disorder with its own set of distinct diagnostic criteria.

Panic disorder will continue to be defined by recurrent panic attacks. Diagnostic criteria will also require that panic attacks are followed by either relentless concern about facing another attack, changes in behaviors in an attempt to avoid future attacks, or a combination of both of these actions for a month or longer. For example, a person who has experienced panic attacks may become preoccupied with worry that they will go crazy or lose control during their next attack. Or a person with panic disorder may avoid behaviors that remind them of the physical symptoms of having a panic attack, such as exercising.

Like the current version of the DSM, the newly proposed diagnostic criteria for panic disorder also mentions that the panic attacks are not caused by side effects of a substance, such as drug abuse or prescribed medication. The panic attacks also cannot be related to a medical condition, such as hyperthyroidism, nor can they be limited to the symptoms of a different mental health condition, such as a person with a specific phobia who responds to that fear with panic symptoms, or when a person with social anxiety disorder is faced with social situations.

Agoraphobia

Agoraphobia will be considered a codable diagnosis in the DSM-5, meaning that it will be a separate mental health disorder from panic disorder and have its own set of diagnostic criteria.

The proposed criteria for agoraphobia in the DSM-5 include:

Criterion A: Extreme fear or anxiety concerning two or more following agoraphobic situations: 1) being outside the home alone, 2) public transportation, such as airplanes, buses, subways, etc., 3) open spaces, including large parking lots or markets, 4) being in stores, theaters, or cinemas, or 5) standing in a line with other people or being in a crowd of people.

Criterion B: The person has become afraid of and may additionally be avoiding these situations because they feel it would be difficult to escape or help would not be available if they were to experience a panic attack or pass out.

Criterion C: These situations always cause the person to experience high levels of fear and worry.

Criterion D: To deal with these feared situations, the person needs to be accompanied by a friend, will suffer through the situation with intense worry and alarm, or will completely stay away from these situations.

Criterion E: Most people with similar cultural backgrounds would believe that the person’s fear is much larger than the possible risks or danger associated with the situation.

Criterion F: The person has been struggling with these fears and concerns for 6 months or more.

Criterion G: These fears and avoidance behaviors have negatively impaired the person’s overall functioning, including at work and in relationships.

Criterion H: These issues are not related to the use of a substance or a medical issue.

Criterion I: The symptoms are not related to a separate mental health condition. For example, people with social anxiety disorder may avoid being in public or people with a specific phobia may portray excessive anxiety about their particular fear.

Potential Benefits of Changes in Diagnosis

The current DSM-IV-TR was originally published in 1994. Since that time, researchers have conducted numerous studies that affect the way in which mental health disorders are defined. Through research studies on these conditions, it has become evident that panic disorder and agoraphobia need to be distinguished as two separate disorders. Studies have concluded that panic disorder and agoraphobia are related conditions that have differing courses of development, causes, and symptoms.

Changing the diagnostic criteria for panic disorder and agoraphobia can allow for mental health professionals to make a more accurate diagnosis of each condition. By more clearly identifying these separate conditions, mental health professionals can then focus on providing the most effective treatment options for each disorder.

Since these proposed changes have not been finalized yet, more changes in diagnostic criteria for panic disorder and agoraphobia may come before the DSM-5 is published in 2013. Visit the APA’s website on the development of the DSM-5 to find more information on these potential changes.

Sources:

American Psychiatric Association (1994). “Diagnostic and statistical manual of mental disorders (4th ed.).” Washington, DC: Author.

American Psychiatric Association DSM-5 Development Website:http://www.dsm5.org

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