Panic Disorder

Panic disorder is a condition where there are recurrent unexpected panic attacks, in the absence of triggers. It is marked by persistent concern about additional panic attacks and/or maladaptive change in behaviour related to the attacks.

Criterion A

Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time at least 4 of the following symptoms occur (Note: The abrupt surge can occur from a calm state or an anxious state):

  1. Sweating
  2. Trembling or shaking
  3. Unsteady, dizziness, light-headed, or faint
  4. Derealization (feelings of unreality) or depersonalization (being detached from one self)
  5. Excessive/accelerated heart rate, palpitations, or pounding heart
  6. Nausea or abdominal distress
  7. Tingling, numbness, parathesesias
  8. Shortness of breath
  9. Fear of losing control or “going crazy”
  10. Fear of dying
  11. Choking feelings
  12. Chest pain or discomfort
  13. Chills or heat sensations

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

Criterion B

At least one of the attacks has been followed by at least 1 month of at least 1 of the following:

  1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
  2. A significant maladaptive change in behavior-related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
Criterion C

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

Criterion D

The disturbance is not better explained by another mental disorder:


STUDENTS FEAR the 3 C's can be used to remember panic disorder criteria:

  • S Sweating
  • T Trembling
  • U Unsteadiness, dizziness
  • D Depersonalization, derealization
  • E Excessive heart rate, palpitations
  • N Nausea
  • T Tingling
  • S Shortness of breath
  • FEAR of dying
  • FEAR of losing control
  • FEAR of going crazy
  • C Chest Pain
  • C Chills
  • C Choking

It is often helpful to explain to patients that having panic disorder is like having a car with an oversensitive alarm system: every car has an alarm system that activates when a window is smashed, but sometimes the alarm system can be hypersensitive, and even a small bump or breeze can activate it.