New Diagnostic Criteria for Panic Disorder, Agoraphobia

Panic Disorder and the DSM-5

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The DSM-5 is the handbook used to diagnose mental health disorders. Photo © Microsoft

The newest edition of the DSM includes changes to the diagnostic criteria for numerous mental health conditions. These adjustments now alter how different disorders are categorized and diagnosed. The following describes the DSM-5 and the recent changes that have occurred to the diagnosis of panic disorder, panic attacks, and agoraphobia.

What is the DSM?

The Diagnostic and Statistical Manual of Mental Disorders, or simply the DSM, is a handbook published by the American Psychiatric Association (APA) for the use of diagnosing mental health disorders.

The DSM contains all of the specific diagnostic criteria for every mental illness, giving it the reputation as the “bible” of mental health diagnosis.

The DSM-5 marks the first major revision of the manual since 1994. With this newest edition out, there have been numerous changes made in mental health diagnoses, including disorders added and omitted. Plus, many adjustments were made to the diagnostic criteria of various conditions. Panic disorder is one of the mental health disorders that has changed in this latest edition of the DSM.

Changes in How Panic Disorder is Diagnosed

The most notable change that has occurred to the diagnosis of panic disorder is the way in which it is now classified in relation to agoraphobia. In the last edition of the DSM, panic disorder was diagnosed as occurring with or without agoraphobia. In the new DSM-5, panic disorder and agoraphobia will be listed as two separate and distinct mental health disorders.

Some additional changes have also occurred to the types of panic attacks defined in the DSM.

Panic Disorder. Panic disorder has remained classified as an anxiety disorder with the main symptom being the experience of persistent and typically unanticipated panic attacks. The diagnostic criteria also specifies that these panic attacks are marked by continual fear of having future attacks, shifts in one’s behaviors to avoid these attacks, or both of these issues for at least one month.

Panic Attacks. The previous edition of the DSM distinguished the types of panic attacks as belonging to one of three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued. The DSM-5 has removed some of this jargon and simplified panic attacks as fitting into two simplified types: expected or unexpected.

Expected panic attacks are those that occur due to a specific fear, such when a person with a fear of flying and has a panic attack when on an airplane. Unexpected panic attacks occur suddenly or out-of-the-blue without any external cue that the attack is about to occur. These unanticipated attacks are the hallmark feature of panic disorder.

Agoraphobia. In the current updated edition of the DSM, agoraphobia now stands apart from panic disorder as its own separate and codable diagnosis. The diagnostic criteria for agoraphobia now includes the experience of intense fear or anxiety in at least two agoraphobic situations, such as being outside the home alone, public transportation (i.e. airplanes, buses, subways, etc.), open spaces, public places (i.e. stores, theaters, or cinemas), crowds or standing in a line with other people, or a combination of two or more of these scenarios.

To be diagnosed with agoraphobia, the person will also need to be exhibiting avoidance behaviors. These avoidances occur out of a fear of experiencing a panic attack or anxiety-related symptoms in a situation from which it would be difficult to flee or no help would be available. Agoraphobics are greatly affected by avoidance behaviors, as these issues tremendously impair the sufferer’s quality of life and overall functioning.

DSM-5 Controversy

Many mental health professionals have expressed dissatisfaction with the changes that occurred in the latest edition of the DSM. Added disorders, including the diagnosis of disruptive mood dysregulation disorder which may be construed to include temper tantrums, gambling addiction, and hoarding — along with the removal of some diagnoses, such as Asperger disorder — has been met with some opposition. Many practitioners have come forward expressing concern that the changes represented in the DSM-5 lack adequate scientific evidence and may also contribute to over diagnosing clients.

Other mental health specialists defend the DSM-5, arguing that these changes can help more clients receive the proper care and treatment they need. For example, professionals who treat panic disorder and researchers who have studied this condition have found that clients can experience agoraphobia without panic disorder. Distinguishing between panic disorder and agoraphobia can help those with these conditions get the most effective help and treatment that will be geared towards each unique condition.

Sources:

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

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

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