panic attack

Panic Attack Specifier and Related DSM- 5 Diagnostic Information




Panic Attack Specifier:

Panic attacks can be referred to as a specifier and do not have their own diagnostic code. They are abrupt and intense fears which can occur with other mental disorders such as anxiety and depressive disorders along with physical or medical conditions. The panic attack specifier can be used for both physical and mental disorders. The actual symptoms are detailed below but also are contained within the criteria of panic disorder.

Main Features of the Panic Attack Specifier:

Panic attacks are defined as very intense fears or severe discomfort that occurs and peaks rapidly. The predominating symptoms are physical and must include at least four of the 13 symptoms identified below. These intense symptoms occur and reach their peak usually within several minutes. Panic attacks are very common and have a prevalence rate in the United States of about 11.2%.

A feature that distinguishes panic attacks from normal everyday anxiety is that they reach a high level of intensity within a very short period of time. They are also associated with higher risks for suicidal thoughts and attempts. They are very rare among children and are more frequently experienced by women than men. Panic attacks are not usually treated specifically but are treated within the context of a panic disorder with medications and psychosocial and psychotherapeutic interventions.See below for more specific criteria for the panic attack specifier.




Panic Attack Specifier:

Note: Symptoms are presented for the purpose of identifying a panic attack; however, panic attack is not a mental disorder and cannot be coded. Panic attacks can occur in the context of an anxiety disorder as well as other mental disorders such as depressive disorders, posttraumatic stress disorder, substance use disorders and some medical conditions such as cardiac, respiratory, vestibular, and gastrointestinal. When the presence of a panic attack is identified, it should be noted as a specifier such as in posttraumatic stress disorder with panic attacks. For panic disorder, the presence of panic attack is contained within the criteria for the disorder and panic attack is not used as a specifier.

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, during which time four (or more) of the following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, lightheaded, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from one’s self).
12. Fear of losing control or “going crazy.”
13. Fear of dying.

Note: Culture specific symptoms such as tinnitus, neck soreness, headache, or uncontrollable screaming or crying may be seen. Such symptoms should not count as one of the four required symptoms.

Diagnostic Information and Criterion adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



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