A 40-year-old man presents with recurrent episodes of palpitations, shortness of breath, derealization, and fear of dying lasting 10 minutes. Between episodes he worries persistently about having a heart attack. Cardiology workup is normal. He now avoids exercise and crowded places. According to DSM-5 criteria for Panic Disorder, which feature distinguishes this from a simple panic attack?
- A The severity of somatic symptoms during each episode
- B Recurrent unexpected attacks PLUS at least 1 month of persistent concern or significant maladaptive behavioral change ✓
- C The presence of agoraphobia concurrently
- D The duration of each individual panic attack
Explanation
A panic attack is a symptom (can occur in many disorders), not a diagnosis. Panic Disorder (DSM-5) requires recurrent UNEXPECTED panic attacks PLUS at least 1 month of: (a) persistent concern or worry about additional attacks or their consequences, OR (b) significant maladaptive behavioral change related to attacks (e.g., avoidance of exercise or unfamiliar situations). This patient has both persistent worry (fear of heart attack) and behavioral change (avoidance). In DSM-5, Panic Disorder and Agoraphobia are now listed as separate diagnoses—the patient may have both, but comorbid agoraphobia alone does not define panic disorder.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.