A 25-year-old presents with episodes of intense fear lasting 10–15 minutes, with palpitations, shortness of breath, paraesthesias, and fear of dying. Medical workup is normal. She now avoids crowded places fearing having an episode. According to DSM-5, which diagnosis best captures the combination of panic attacks AND avoidance behaviour?
- A Panic Disorder without Agoraphobia
- B Panic Disorder (which in DSM-5 can be diagnosed with or without Agoraphobia as a separate comorbid diagnosis) ✓
- C Specific Phobia, situational type
- D Social Anxiety Disorder
Explanation
A critical DSM-5 change was the separation of Panic Disorder and Agoraphobia into two independent diagnoses. In DSM-IV, 'Panic Disorder with Agoraphobia' was a single diagnosis. DSM-5 now codes them separately: Panic Disorder and Agoraphobia each have independent criteria. A patient can have both co-occurring (requiring both diagnoses), Panic Disorder alone, or Agoraphobia without panic disorder. Panic Disorder requires recurrent unexpected panic attacks plus at least 1 month of persistent concern or maladaptive behaviour change. This patient meets criteria for both Panic Disorder AND Agoraphobia (avoidance of ≥2 situations based on fear of panic), so both diagnoses should be assigned.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.