Panic attacks

DSM-V criteria for panic attacks

Panic attacks which are recurrent and unexpected are defined by the DSM-V as Panic Disorder. A panic attack involves an abrupt surge of intense fear or discomfort which reaches a peak within minutes, and during which time four or more of the following symptoms are experienced:

  1. heart palpitations accelerated heart rate
  2. sweating
  3. trembling or shaking
  4. shortness of breath
  5. sensation of choking
  6. chest pain or discomfort
  7. nausea or abdominal distress
  8. dizziness, light-headed, faint
  9. Chills or sensations of heat
  10. paresthesias (numb or tingling sensations)
  11. derealisation (feelings of unreality) or depersonalisation (feeling detached from oneself)
  12. fear of losing control or “going crazy”
  13. fear of dying

A diagnosis of panic disorder is warranted if at least one of the attacks has been followed by a month or more of one of the following:

  • persistent concern or worry about additional panic attacks or their consequences; or
  • a significant maladaptive change in behaviour related to the attacks (e.g. behaviours designed to avoid having panic attacks such as avoiding exercise or unfamiliar situations);
  • the disturbance cannot be attributed to the physiological effects of a substance or another medical condition (such as hyperthyroidism); and
  • the disturbance is not better explained by another mental disorder.


Prevalence of panic disorder

Many people suffer from panic disorder. The National Comorbidity Survey-Replication study found that approximately 4.7 percent of the adult population has had panic disorder at some time in their lives.

Panic disorder often begins in the late teens, but the average age of onset is 23 to 34 years. However, it can begin, especially for women, in a person’s 30s or 40s. Once panic disorder develops, it tends to be chronic and disabling, although the intensity of symptoms often fluctuates over time.

Panic disorder is about twice as prevalent in women as in men.


Comorbidities with panic attacks

Many symptoms of a panic attack are physical and mimic the sensations of cardiac, respiratory or neurological problems, causing some sufferers to seek help in emergency rooms. A panic attack induces the body’s fight or flight response, which relies upon the sympathetic nervous system. The body exerts considerable energy during a panic attack and thus an individual often requires a lengthy period of recovery afterwards, making it difficult for them to immediately return to whatever activity they were engaged in prior.