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 The content above is only an excerpt. For full access subscribe now or log into your account below. You can also purchase 24- or 48-hour access; learn more Username: Password:   FORGOT your subscriber username and/or password? Get a reminder via email: The email I registered with is:  Not a subscriber? Subscribe Today PsychiatryOnline is a powerful website that features DSM-IV-TR® and The American Journal of Psychiatry as the cornerstones of an unsurpassed collection of psychiatric references, including books, journals, and self-assessment tools. PsychiatryOnline’s innovative platform makes these resources easy and convenient to use, offering Precise and powerful searching across books and journals. Quick pathways to related material. Mobile access from any computer with a Web connection. Ability to download any book section to PDA. Links from bibliographic references to the full text of journal articles. References to material not located in the PsychiatryOnline collection lead you to PubMed. Learn more about PsychiatryOnline Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).