The video below is the section for Panic Disorder from Part 6 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 6, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Panic Disorder
As defined by the DSM-5, Panic Disorder entails the presence of recurrent, unexpected panic attacks, followed by at least a month of persistent concern about having another panic attack and/or significant maladaptive change in behavior related to the panic attack.
After experiencing unexpected panic attacks, individuals understandably become extremely worried about suffering another attack. They also become concerned about the meaning or consequences of the attacks (e.g., that they are having a heart attack or “going crazy”).
As a result, they tend to change their life patterns in response to the attacks (e.g., avoiding physical exertion or situations in which they have had attacks in the past).
A panic attack is defined as a discrete period beginning with an abrupt surge of intense fear or discomfort, reaching its peak in about 10 minutes, during which four or more physical or cognitive symptoms are present (from a list of 13 symptoms, that include pounding heart, sweating, chest discomfort, nausea, dizziness, chills, tingling sensations, derealization, and fear of losing control).
Although no actual physical danger is usually present when a panic attack occurs, many individuals experience these symptoms as imminent signs of a heart attack or of dying, and as a consequence, can feel extremely fearful and disturbed by the experience. High levels of social, occupational, and physical disability are associated with panic disorder, and constitute the highest number of emergency room and doctor office visits among the anxiety disorders.
The median age of onset for panic disorder in the USA is 20-24 years, with females affected at approximately twice as frequently as males. Only a few cases begin in childhood, and it is unusual for symptoms to appear after age 45. Teenagers may be less open to admitting to symptoms than adults, and lower prevalence in older adults may be due to age-related decrease in autonomic nervous system response. If untreated, the chronic symptoms tend to wax and wane, although a few individuals report continuous severe symptomatology. Latinos, African Americans, Caribbean blacks, and Asian Americans in the United States reported significantly lower rates of panic disorder as compared to non-Latino Whites, while Native Americans have significantly higher rates of this diagnosis.
Increased risk of developing Panic Disorder is associated with a parental history of anxiety, depressive, and bipolar disorders. Respiratory disturbance, such as asthma, may also be associated with panic disorder. Childhood physical or sexual abuse is more common in the history of individuals diagnosed with panic disorder than with other anxiety disorders. Smoking is a known risk for panic attacks and panic disorders. Also in the individual’s history, it is found that many have experienced an identifiable stressor about one month prior to the first panic attack.
Panic Disorder cannot be diagnosed if the panic attacks are better accounted for by another disorder, such as Social Phobia, Specific Phobia, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Separation Anxiety Disorder, or Agoraphobia. In some cases, individuals with Panic Disorder develop a severe anxiety about the possibility of experiencing a panic attack in an environment from which it would be impossible to escape or get help.
It is believed that many people who develop Agoraphobia begin to do so by restricting life activities in the wake of panic attacks. Agoraphobia should be diagnosed in place of Panic Disorder when avoidance behaviors associated with panic attacks extend to avoidance of two or more agoraphobic situations.
1. The occurrence of recurrent, unexpected panic attacks, followed by at least a month of persistent concern about having another one
2. Panic attacks are sudden, intense, short-lived cognitive and physiological episodes
3. Involve frightening sensations of choking, sweating, trembling, being short of breath, feeling dizzy, etc.
4. Often lead sufferer to feel as though he or she is “going crazy” or dying
5. It often leads to great fear of suffering additional attacks and a consequent restriction of life activities, which is diagnosed as Panic Disorder with Agoraphobia
6. Onset typically in late adolescence or mid-30s
7. Comorbidity with other anxiety disorders common
8. Females more likely than males to develop Panic Disorder
9. Children develop Panic Disorder relatively rarely
10. Presentation in children differs from adults. Panic Disorder in children usually manifests itself in the form of shortness of breath, increased heart rate, chest pain, and school refusal
11. Family history of Panic Disorder, Mood Disorders, and personal use of substances, including some prescribed meds (e.g., asthma, heart) increase risk for Panic Disorder
12. Treatment: Combination of cognitive therapy and SSRIs most effective
Lisa, for 8 months has been experiencing pounding heart, sweating, tingling all over her body, and derealization. These characteristics are found in
A. Social Anxiety Disorder
B. Post-Traumatic Stress Disorder
C. Separation Anxiety Disorder
D. Panic Disorder
The correct answer is Panic Disorder (D). Social Anxiety Disorder is an unreasonable fear of social or performance situations, in which the belief is that embarrassment may occur- thereore (A) is incorrect. Post-Traumatic Stress Disorder is an Anxiety Disorder that develops in response to exposure to a traumatic event, characterized by at least one month of symptoms of re-experiencing the traumatic event; avoiding stimuli that recall the event; numbing; and increased levels of arousal, making answer (B) incorrect. Separation Anxiety Disorder is excessive anxiety concerning separation by a child from the home or from those (in adolescents and adults) to whom the person is attached, making answer (C) incorrect.