DSM-5 Criteria for Diagnosing Panic Disorder

Having a panic attack can be a terrifying experience. Research suggests that around 13.2% of people experience panic attacks at least once. However, that doesn't necessarily mean that they have panic disorder. Among people who have had panic attacks, 66.5% have experienced them recurrently. However, just 12.8% of these individuals meet the diagnostic criteria for panic disorder.

Panic disorder is classified as an anxiety disorder in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR). According to the guidelines, to be diagnosed with panic disorder, you must experience unexpected panic attacks on a regular basis.

What Is the DSM-5?

The "Diagnostic and Statistical Manual of Mental Disorders" (DSM), published by the American Psychiatric Association (APA), is the system used in the United States to diagnose mental health disorders.

The 2013 release of DSM was the first significant update since 1994. Many changes were made in this fifth edition (DSM-5), including some updates to the diagnosis of panic disorder. An updated version of the DSM, the DSM-5-TR (text revision) was published in 2022.

The system in the DSM-5 is not without controversy. Many disorders have overlapping symptoms. Some professionals question the validity of this type of classification system, while others feel there is a great deal of subjectivity in its application.

Despite these reservations, a DSM diagnosis is often necessary for treatment, research, and insurance reimbursement.

Diagnosing Panic Disorder in DSM-5

The DSM outlines certain criteria that must be met to diagnose panic disorder. The diagnostic manual categorizes panic disorder as an anxiety disorder based primarily on the occurrence of panic attacks, which are recurrent and often unexpected.

It's important to note that a panic disorder diagnosis must rule out other potential causes for the panic attack (or the event that feels like one):

• The attacks must not be due to the direct physiological effects of a substance (such as drug use or medication) or a general medical condition.
• The attacks must not be better accounted for by another mental disorder. These may include a social anxiety diosrder or another specific phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or separation anxiety disorder.

Defining Panic Attacks

Since panic attacks are key to a panic disorder diagnosis, they are well-defined and specific. This is where the details in the DSM-5 are significant.

The previous version (DSM-IV) classified panic attacks into three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued. The DSM-5 simplifies the approach to classifying panic attacks by providing just two very clear categories: expected and unexpected panic attacks.

According to DSM-5, a panic attack is characterized by four or more of the following symptoms (the presence of fewer than four symptoms may be considered a limited-symptom panic attack):

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• A feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations (paresthesias)
• Chills or hot flushes

Agoraphobia vs. Panic Disorder in DSM-5

In previous versions of the DSM, agoraphobia was associated with panic disorder. With the updates included in the DSM-5, agoraphobia is now a separate and codable diagnosis.

Within the update to agoraphobia, the DSM-5 notes that a person must experience intense fear or anxiety in a minimum of two situations. These include being out in public, open spaces, and in crowds—essentially anywhere in which you're outside of the home.

Agoraphobia also involves avoidance behaviors. These are a result of the fear of being in situations that may induce panic attacks or anxiety in which help may not be available or in which it would be difficult to flee. For example, a person with agoraphobia might avoid crowds, public transportation, or other public spaces where escape is difficult.

Getting a Panic Disorder Diagnosis

If you've ever had a panic attack, you might be wondering exactly how to determine if you have panic disorder. It is important to know that the symptoms of panic disorder may mimic many other anxiety disorders and/or medical conditions. Only your doctor or mental health professional can diagnose panic disorder.

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Anxiety disorders such as panic disorder are among the most prevalent types of mental health conditions, but only around 20% of people who have symptoms of anxiety seek treatment. Because anxiety disorders are more common in women than men, experts now recommend that clinicians screen women and girls age 13 and older for anxiety conditions.

When seeking professional help in order to evaluate your symptoms and potentially reach a diagnosis, remember that honesty is key. You may even see one therapist and decide you'd like to see a different one instead. Remember to do what you are comfortable with.

Although it may feel difficult at first to discuss your feelings, remember that your doctor is there to help you and that speaking openly about your condition is the first step toward managing your symptoms in a healthy way.

Takeaways

To be diagnosed with panic disorder, you much have recurrent, unexpected panic attacks. They must not be the result of a medical condition, other mental health condition, or substance use. If you think you might have panic disorder, talk to a doctor or mental health professional for more information. They can evaluate your symptoms, make a diagnosis, and recommend treatments that can help you manage your symptoms.