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Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision | Anxiety Disorders > Introduction > | Panic Disorder Sections: Associated laboratory findings., Associated physical examination findings and general
medical conditions.. Topics Discussed: panic disorder; panic disorder with agoraphobia; panic disorder without agoraphobia.
Excerpt:
"The essential feature of Panic Disorder is the presence of
recurrent, unexpected Panic Attacks (see Panic Attack) followed by at least 1
month of persistent concern about having another Panic Attack, worry
about the possible implications or consequences of the Panic Attacks,
or a significant behavioral change related to the attacks (Criterion
A). The Panic Attacks are not due to the direct physiological effects
of a substance (e.g., Caffeine Intoxication) or a general medical
condition (e.g., hyperthyroidism) (Criterion C). Finally, the Panic
Attacks are not better accounted for by another mental disorder
(e.g., Specific or Social Phobia, Obsessive-Compulsive Disorder,
Posttraumatic Stress Disorder, or Separation Anxiety Disorder) (Criterion
D). Depending on whether criteria are also met for Agoraphobia (see
Criteria for Agoraphobia), 300.21
Panic Disorder With Agoraphobia or 300.01 Panic Disorder Without
Agoraphobia is diagnosed (Criterion B).An unexpected (spontaneous, uncued) Panic Attack is defined
as one that an individual does not immediately associate with a
situational trigger (i.e., it is perceived as occurring "out
of the blue"). Situational triggers can include stimuli
that are either external (e.g., a phobic object or situation) or
internal (e.g., physiological arousal) to the individual. In some
instances, although a situational trigger may be apparent to the
clinician, it may not be readily identifiable to the individual
experiencing the Panic Attack. For example, an individual may not
immediately identify increased autonomic arousal induced by a hot,
stuffy room, or feelings of faintness produced by quickly sitting
up as triggers for a Panic Attack, and as such, these attacks are
considered at the time to be unexpected. At least two unexpected
Panic Attacks are required for the diagnosis, but most individuals
have considerably more. Individuals with Panic Disorder frequently
also have situationally predisposed Panic Attacks (i.e., those more
likely to occur on, but not invariably associated with, exposure
to a situational trigger). Situationally bound attacks (i.e., those
that occur almost invariably and immediately on exposure to a situational
trigger) can occur but are less common...."
DOI: 10.1176/appi.books.9780890423349.15250; 10.1176/appi.books.9780890423349.15264
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