How Is Panic Disorder Diagnosed?

Question: How Is Panic Disorder Diagnosed?

Answer: Currently, there is not a medical or laboratory diagnostic test for panic disorder. Health-care providers generally make a diagnosis of panic disorder after ruling out (or treating) possible medical and/or other psychiatric conditions, and then evaluating current symptoms.

Medical Evaluation and Testing

Panic attacks may be caused by certain medical conditions or may resemble symptoms of certain medical conditions. Therefore, it is important to have a complete physical and to discuss your medical history with your doctor before a diagnosis of panic disorder is made. Many people who experience panic attacks for the first time do end up in their doctors' offices or an emergency room, where various tests usually are performed. If this is not your case, make an appointment for a physical exam with your doctor.

Testing for medical conditions may become complicated for a person with panic disorder for a couple of reasons. Both patient and doctor should be aware of these possibilities ahead of time, and keep the lines of communication open.

• Many of these medical conditions coexist with panic disorder, so, even after treatment for the medical condition, the panic attacks may continue. The panic disorder may require additional treatment with medication and/or therapy. It is important for the patient and doctor to communicate about whether or not treatments are working.

• Health anxiety is a frequent component of panic disorder. Because of this, the patient might be dissatisfied with medical test results. As a patient, it is up to you to develop a good relationship with your health-care providers. It is up to you to find a doctor whom you can trust. Bring questions to your appointments, write down what your doctor tells you, and follow your doctor's instructions (and your doctor should be willing to communicate with you, as well). If you do have health anxieties, be aware that panic attacks rarely are the only symptom of a medical condition. This information may be reassuring to you, if tests rule out medical conditions and you do not have other symptoms, and your doctor goes on to make a diagnosis of panic disorder.

Conditions your doctor may (but may not) test or evaluate for include (but are not limited to) the following: thyroid disease; hypoglycemia; mitral valve prolapse; asthma; gastrointestinal disorders (such as irritable bowel syndrome and inflammatory bowel disease); vertigo and inner ear disorders; and hormonal changes or problems (premenstrual syndrome, premenstrual dysphoric disorder, perimenopause, menopause).

Psychiatric Evaluation

What happens next depends on what type of treatment provider you are seeing and what that provider's treatment philosophies are. If you are seeing your regular doctor (general practitioner), he or she probably will talk to you about your psychiatric history (past treatments for any psychiatric disorders) and evaluate your current psychiatric symptoms. Panic disorder frequently coexists with other psychiatric disorders (such as depression and other anxiety disorders). Additionally, panic attacks may indicate a different psychiatric disorder (particularly another anxiety disorder). Therefore, it is important for other psychiatric disorders to either be ruled out or diagnosed and treated. It is important, also, to be honest about any alcohol or drug use as these may cause or worsen the symptoms of panic disorder.

Your doctor may refer you (or you may decide on your own to go) to a psychiatrist for evaluation and treatment. A psychiatrist is a doctor who specializes in the pharmaceutical treatment of psychiatric disorders (in other words, psychiatric medications). Although trained in psychology, many psychiatrists do not provide therapy but may refer you to a therapist (many work closely with therapists). A psychiatrist generally will do a more extensive psychiatric evaluation, perhaps including a family psychiatric history (as many psychiatric disorders run in families). Symptoms are evaluated based on the criteria in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (for more about panic disorder symptoms according to the DSM-IV, please see What Are the Symptoms of Panic Disorder?). The psychiatrist may use a symptom inventory, such as the Hamilton Anxiety Scale or the Anxiety Disorders Interview Schedule (ADIS), to help with symptom evaluation.

Doctors and psychiatrists most likely will prescribe a medication(s), once panic disorder has been diagnosed. Some also will refer patients to a therapist. Note that a combination of medication and therapy has been found to be the best treatment for long-term recovery from panic disorder, and cognitive-behavioral therapy (CBT) alone has been found to be as effective as treatment with both medication and therapy. Therefore, if your doctor or psychiatrist do not mention therapy, it is in your best interest to ask for information about it as well as for a referral to a therapist qualified in CBT. A therapist will perform a similar psychiatric evaluation as a psychiatrist would perform: psychiatric history, family psychiatric history, and current symptom evaluation.

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