Panic Attack

Features

Because Panic Attacks can occur in the context of any Anxiety Disorder as well as other mental disorders (e.g., Mood Disorders, Substance-Related Disorders) and some general medical conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal), the text and criteria set for a Panic Attack are provided separately in this section.

The essential feature of a Panic Attack is a discrete period of intense fear or discomfort in the absence of real danger that is accompanied by at least 4 of 13 somatic or cognitive symptoms. Symptoms can be somatic or cognitive in nature and include palpitations, sweating, trembling or shaking, sensations of shortness of breath or smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealization or depersonalization, fear of losing control or "going crazy," fear of dying, paresthesias, and chills or hot flushes.

The attack has a sudden onset and builds to a peak rapidly (usually in 10 minutes or less) and is often accompanied by a sense of imminent danger or impending doom and an urge to escape. The anxiety that is characteristic of a Panic Attack can be differentiated from generalized anxiety by its discrete, almost paroxysmal, nature and its typically greater severity. Attacks that meet all other criteria but that have fewer than 4 somatic or cognitive symptoms are referred to as limited-symptom attacks.

There are three characteristic types of Panic Attacks: unexpected (uncued), situationally bound (cued), and situationally predisposed. Each type of Panic Attack is defined by a different set of relationships between the onset of the attack and the presence or absence of situational triggers that can include cues that are either external (e.g., an individual with claustrophobia has an attack while in a elevator stuck between floors) or internal (e.g., catastrophic cognitions about the ramifications of heart palpitations). Unexpected (uncued) Panic Attacks are defined as those for which the individual does not associate onset with an internal or external situational trigger (i.e., the attack is perceived as occurring spontaneously "out of the blue"). Situationally bound (cued) Panic Attacks are defined as those that almost invariably occur immediately on exposure to, or in anticipation of, the situational cue or trigger (e.g., a person with Social Phobia having a Panic Attack upon entering into or thinking about a public speaking engagement). Situationally predisposed Panic Attacks are similar to situationally bound Panic Attacks but are not invariably associated with the cue and do not necessarily occur immediately after the exposure (e.g., attacks are more likely to occur while driving, but there are times when the individual drives and does not have a Panic Attack or times when the Panic Attack occurs after driving for a half hour).