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.