This article covers what else the DSM-5 says about panic disorder, how panic disorder was diagnosed in previous editions of the manual, and how agoraphobia is associated with panic disorder.
What Is the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA) is the system used in the United States to diagnose mental health disorders. The DSM contains diagnostic criteria used by mental health professionals to classify and describe every known mental illness. 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 diagnosis using the DSM is often necessary for treatment, research, and insurance reimbursement.
Diagnosing Panic Disorder in DSM-5
The diagnostic criteria for panic disorder are defined in the DSM-5. It is an anxiety disorder based primarily on the occurrence of panic attacks, which are recurrent and often unexpected. In addition, at least one panic attack is followed by one month or more of the person fearing that they will have more attacks and causing them to change their behavior, which often includes avoiding situations that might induce an attack. 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 a medication) or a general medical condition. The attacks must not be better accounted for by another mental disorder. These may include a social phobia 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. Expected panic attacks are those associated with a specific fear, like that of flying. Unexpected panic attacks have no apparent trigger or cue and may appear to occur out of the blue. 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. It also notes that avoidance behaviors must be exhibited. 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.
Professional Diagnosis
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. 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. There was an error. Please try again. 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. For more mental health resources, see our National Helpline Database.
