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Panic Disorder

Suggested Diagnostic Criteria For Panic Disorder In Children

The two most common documents used for the diagnosis of Panic Disorder are the DSM IV and ICD 10. The DSM IV is used mostly in the United States though it has been used elsewhere, including the U.K., whereas the ICD 10 is more commonly used in Europe. We have included the descriptions of both, as below.

DSM IV
ICD 10 (European Description)

Note: Consider a criterion met only if the behaviour is considerably more frequent than that of most people of the same mental age.



DSM IV (Diagnostic & Statistical Manual) Panic Disorder Diagnostic Criteria:

A. Recurrent unexpected Panic Attacks

Criteria for Panic Attack:

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

A. palpitations, pounding heart, or accelerated heart rate
B. sweating
C. trembling or shaking
D. sensations of shortness of breath or smothering
E. feeling of choking
F. chest pain or discomfort
G. nausea or abdominal distress
H. feeling dizzy, unsteady, lightheaded, or faint
I. derealization (feelings of unreality) or depersonalization (being detached from oneself)
J. fear of losing control or going crazy
K. fear of dying
L. paresthesias (numbness or tingling sensations)
M. chills or hot flushes

B. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

A. persistent concern about having additional attacks
B. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
C. a significant change in behavior related to the attacks

C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

Panic Disorder With Agoraphobia

A. Meets the criteria for Panic Disorder

B. The presence of Agoraphobia:

A. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. Note: Consider the diagnosis of Specific Phobia if the avoidance is limited to one or only a few specific situations, or Social Phobia if the avoidance is limited to social situations.
B. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
C. The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).

Panic Disorder Without Agoraphobia

A. Meets the criteria for Panic Disorder
B. Absence of Agoraphobia

Differential Diagnosis Anxiety Disorder Due to a General Medical Condition; Substance-Induced Anxiety Disorder; other Anxiety Disorder; Psychotic Disorders; Social Phobia; Specific Phobia; Obsessive-Compulsive Disorder; Posttraumatic Stress Disorder; Separation Anxiety Disorder; Delusional Disorder.



Panic Disorder - European Description:

The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992

F41.0 Panic Disorder (Episodic Paroxysmal Anxiety)

The essential features are recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set of circumstances, and which are therefore unpredictable. As in other anxiety disorders, the dominant symptoms vary from person to person, but sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization) are common. There is also, almost invariably, a secondary fear of dying, losing control, or going mad. Individual attacks usually last for minutes only, though sometimes longer; their frequency and the course of the disorder are both rather variable. An individual in a panic attack often experiences a crescendo of fear and autonomic symptoms which results in an exit, usually hurried, from wherever he or she may be. If this occurs in a specific situation, such as on a bus or in a crowd, the patient may subsequently avoid that situation. Similarly, frequent and unpredictable panic attacks produce fear of being alone or going into public places. A panic attack is often followed by a persistent fear of having another attack.

Diagnostic Guidelines

In this classification, a panic attack that occurs in an established phobic situation is regarded as an expression of the severity of the phobia, which should be given diagnostic precedence. Panic disorder should be the main diagnosis only in the absence of any of the phobias in F40.

For a definite diagnosis, several severe attacks of autonomic anxiety should have occurred within a period of about 1 month:

(a) in circumstances where there is no objective danger;

(b) without being confined to known or predictable situations; and

(c) with comparative freedom from anxiety symptoms between attacks (although anticipatory anxiety is common).

Includes:

* panic attack

* panic state

Differential Diagnosis

Panic disorder must be distinguished from panic attacks occurring as part of established phobic disorders as already noted. Panic attacks may be secondary to depressive disorders, particularly in men, and if the criteria for a depressive disorder are fulfilled at the same time, the panic disorder should not be given as the main diagnosis.

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ICD-10 copyright © 1992 by World Health Organization. Internet Mental Health (www.mentalhealth.com) copyright © 1995-1997 by Phillip W. Long, M.D.

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