Diagnosing Panic Disorder According to DSM-5

The Diagnostic Criteria for Panic Disorder and Panic Attacks

Sports woman hyperventilating panic attack
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Panic disorder is classified as an anxiety disorder in DSM-5. According to the guidelines, in order to be diagnosed with a panic disorder, you must experience unexpected panic attacks on a regular basis.

What else does DSM-5 say about a panic disorder? How did the new edition change the way it's diagnosed? Among the updates are clarification on the types of panic attacks and how agoraphobia is associated with panic disorder.

What Is DSM-5?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association (APA) is the system used in the United States to diagnose mental health disorders. The DSM contains diagnostic criteria used by mental health professionals to classify and describe every mental illness.

The 2013 release of DSM-5 is the first significant update since 1994. In this edition, many changes were made and this includes some updates to the diagnosis of panic disorder.

This system is not without controversy. Many disorders have overlapping symptoms, making it difficult to reach a diagnosis within the parameters outlined in the DSM. Some professionals feel this type of classification system is not really scientific and that a diagnosis is greatly subjective.

Despite these reservations, a diagnosis is often necessary for insurance reimbursement. Many professionals feel that this system is far better than no system at all.

How DSM-5 Diagnoses a Panic Disorder

The diagnostic criteria for panic disorder are defined in the DSM-5. It is an anxiety disorder based primarily on the occurrence of panic attacks, which are persistent and often unexpected.

In addition, at least one attack is followed by the person fearing that they will have more attacks for at least one month.

This causes them to change their behavior, which often includes avoiding situations that might induce an attack.

It's important to note that a panic disorder diagnosis must rule out other potential causes for the panic attack or what feels like one. 

  • The attacks are not due to the direct physiological effects of a substance (such as drug use or a medication) or a general medical condition.
  • The attacks are not better accounted for by another mental disorder. These may include a social phobia or another specific phobia, obsessive-compulsive disorder,  post-traumatic stress disorder, or separation anxiety disorder

Defining Panic Attacks With DSM-5

Since panic attacks are key to a panic disorder diagnosis, they are well defined and rather specific. This is where the updates in DSM-5 are significant. The previous version classified panic attacks into three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued. DSM-5 simplifies it into two very clear categories: expected and unexpected panic attacks.

Expected panic attacks are those associated with a specific fear like that of flying. Unexpected panic attacks have no apparent cause, occur suddenly, and are the indication of a panic disorder.

According to DSM-5, a panic attack is characterized by four or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations (paresthesias)
  • Chills or hot flushes

The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack.

Agoraphobia Now Stands Alone

In previous versions of DSM, agoraphobia was associated with panic disorder. With the updates of DSM-5, it is now a separate and codable diagnosis. This is one of the biggest differences in the updates. 

Within the update to agoraphobia, DSM-5 notes that a person must experience intense fear or anxiety in a minimum of two situations. These include being out in public, open spaces, and in crowds, essentially anywhere in which you're not home alone.

It also notes that avoidance behaviors must be exhibited. These are a result of the fear of being in situations that may induce panic attacks or anxiety in which it's difficult to flee.

Only a Professional Can Diagnose Panic Disorder

It is important to know that the symptoms of panic disorder may mimic many other anxiety disorders and/or medical conditions. Only your doctor or mental health professional can diagnose panic disorder.

Source:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.

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