PANIC DISORDER: symptoms, DSM V criteria and treatment

  • Jul 26, 2021
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Panic Disorder: Symptoms, DSM V Criteria, and Treatment

Anxiety disorders affect a large number of people, causing great discomfort and affecting their daily life. In recent years there has been a notable increase in panic disorder and agoraphobia, being one of the most frequent reasons why people come to the consultations of psychology.

That is why in this Psychology-Online article we explain in detail the symptoms, causes, and treatment of panic disorder.

You may also like: Major depression: DSM-V criteria, symptoms, causes and treatment


  1. What is panic disorder: definition
  2. Symptoms of panic disorder
  3. DSM V criteria for panic disorder
  4. Differences between panic disorder with agoraphobia and without agoraphobia
  5. Causes of panic disorder
  6. What happens to the body in a panic attack
  7. Treatment of panic disorder

What is panic disorder: definition.

It is considered that there is a panic disorder when the subject suffers recurring unforeseen panic attacks.

The main characteristic of a panic attack is the isolated and temporary appearance of intense fear or discomfort

, which is accompanied by at least 4 out of a total of 13 somatic or cognitive symptoms. The crisis begins abruptly and reaches its maximum expression quickly (usually within 10 minutes or less), often accompanied by a sense of danger or imminent death and an urgent need to escape.

Panic Disorder Symptoms.

The symptoms of panic disorder are anxiety, panic attacks, and fear of them. The 13 symptoms of a somatic or cognitive panic attack are as follows:

  • Palpitations, pounding of the heart, or rapid heart rate.
  • Sweating
  • Shaking or shaking.
  • Feeling of shortness of breath or suffocation.
  • Feeling of suffocation
  • Pain or discomfort in the chest.
  • Nausea or abdominal discomfort.
  • Feeling dizzy, unsteady, light-headed, or fainting.
  • Chills or feeling hot
  • Paresthesias (numbness or tingling sensation).
  • Derealization (feeling of unreality) or depersonalization (separating from oneself).
  • Fear of losing control or "going crazy."
  • Affraid to die.

Seizures that meet the remaining criteria, but have fewer than 4 of these symptoms, are called limited symptomatic seizures. The sudden onset can occur from a state of calm or from a state of anxiety.

DSM V criteria for panic disorder.

The criteria that appear in DSM V to diagnose panic disorder are:

1. Recurring unforeseen panic attacks

A panic attack It is the sudden appearance of intense fear or intense discomfort that reaches its maximum expression in minutes and during this time four (or more) of the symptoms of the previous section occur. The sudden onset can occur from a state of calm or from a state of anxiety. Culture-specific symptoms (eg, tinnitus, neck pain, headache, screaming, or uncontrollable crying) may be observed. These symptoms do not count as one of the four required symptoms.

2. Restlessness, worry, or maladaptation

At least one of the attacks has been followed by a month (or more) by one or both of the following events

  • Ongoing restlessness or worry about other panic attacks or their consequences (eg, loss of control, having a heart attack, “going crazy”).
  • A significant maladaptive change in attack-related behavior (for example, behaviors intended to avoid panic attacks, such as avoidance of exercise or unfamiliar situations).

3. The alteration cannot be attributed to another cause

As to the physiological effects of a substance (eg, drug, medication) or other medical condition (eg, hyperthyroidism, cardiopulmonary disorders).

4. The disturbance is not better explained by another mental disorder

For example, panic attacks do not occur solely in response to feared social situations, as in the social anxiety disorder; in response to specific phobic objects or situations, as in specific phobia; in response to obsessions, as in the obsessive compulsive disorder; in response to memories of traumatic events, as in the post traumatic stress disorder; or in response to the separation of attachment figures, as in the separation anxiety disorder.

Differences between panic disorder with agoraphobia and without agoraphobia.

In the previous section we have seen the criteria for the diagnosis of panic disorder without agoraphobia. The fundamental difference of panic disorder without agoraphobia and with agoraphobia is the appearance of anxiety in situations where escape is difficult or embarrassing in the event of a panic attack.

The essential characteristic of agoraphobia is the appearance of anxiety when being in places or situations where escape can be difficult (or embarrassing) or where, in the event of a panic attack or panic-like symptoms, there may not be available help.

This anxiety typically leads to permanent avoidance behaviors multiple situations. The most common situations that are avoided in panic disorder with agoraphobia are:

  • Being alone inside or outside the home
  • Mingling with people
  • Traveling by car, bus, or plane
  • Finding yourself on a bridge or in an elevator

Some people are capable of exposing themselves to feared situations, but this experience produces considerable terror. They often find it easier to deal with feared situations when they are in the company of an acquaintance. Avoidance behavior in these situations can lead to a impaired ability to travel for work or to carry out household responsibilities (for example, going to the supermarket, taking the children to the doctor). This anxiety or avoidance behavior cannot be better explained by the presence of another mental disorder.

Differential diagnosis between agoraphobia and social or specific phobia and separation anxiety disorder severe can be difficult, as all of these entities are characterized by situation avoidance behaviors specific.

Causes of panic disorder.

Throughout history there have arisen various explanatory models of panic and agoraphobia. The first models insisted on its biological character, considering the existence of a genetically predisposed physical alteration. However, each of the arguments of the biological models is debatable in some respect, so alternative explanatory models such as the cognitive one began to emerge.

One of the most accepted models is that of Clark and Salkovskis (1987). According to this model, various internal or external stimuli can be perceived as threatening, causing fear or apprehension. This fear manifests itself in a series of bodily sensations (physiological anxiety response) such as acceleration of the heart rate. When interpreted in a catastrophic way, anxiety increases, confirming the catastrophic thoughts that elicit the most fear, and we enter the fear-anxiety loop. The crisis continues until a few minutes later the mechanism responsible for restoring the body's balance acts or until the subject uses some coping strategy.

When a person has developed the tendency to interpret sensations in a catastrophic way, there are two processes that contribute to the maintenance of the disorder:

  • Hypervigilance and control of bodily sensations. He becomes hyper-vigilant and is able to recognize the smallest variations in his body. These changes that other people go unnoticed, for them with confirmations that they suffer from a serious mental or physical illness. This would explain the apparently spontaneous seizures, which are actually triggered by the perception of bodily sensations.
  • Avoidance of situations. Avoidance behaviors eliminate discomfort in the short term, but contribute to the maintenance of the disorder because reinforce the belief in danger when in fact there is no opportunity to check if the situation is really dangerous by not exposing yourself to it.

The model we have just seen explains panic attacks and maintenance of anxiety, but why does the first attack appear? Research indicates that the first attack may appear after a life situation of intense stress, for example:

  • family problems
  • labor difficulties
  • couple affairs
  • consumption of drugs
  • concern about a medical problem

What happens to the body in a panic attack.

During a panic attack, our body mobilizes to give a emergency response: fight or flight. Initially, through the activation of the sympathetic nervous system (SNS), which is responsible for mobilizing the resources of our body for immediate and intense action. Here you can see more information about the sympathetic nervous system.

And if the situation lasts longer, the neuroendocrine system that increases the production of adrenaline and norepinephrine. This activation mainly produces:

  • Increased blood pressure
  • increased heart rate
  • tension in skeletal muscles
  • increased breathing rate
  • glucose release

Treatment of panic disorder.

For panic disorder with or without agoraphobia, an effective treatment has been developed and has become the treatment of first choice in healthcare systems around the world.

It is a cognitive-behavioral intervention that is composed of:

  • Psychoeducation. Treatment begins by explaining to the patient what a panic attack is, what its symptoms are, and what the disorder consists of.
  • Muscle relaxation training. Muscle tension is a very common physiological reaction in anxiety and panic attacks. Hence the importance of having resources to deal with this annoying symptom. There are various relaxation techniques and one of the most used in the treatment of anxiety is the Jacobson's progressive muscle relaxation.
  • Anti-panic breathing training. During panic attacks, breathing is normally disturbed by hyperventilation, which often causes dizziness and lightheadedness. Breathing training is a self-control strategy to regulate breathing in states of anxiety. Here you will find relaxation techniques through breathing.
  • Cognitive intervention. Through the A-B-C model, the patient learns to identify the maladaptive automatic thoughts that provoke undesirable emotions in order to replace them with more realistic and adaptive ones. This is known as cognitive restructuring.
  • Interoceptive exposure. The exposure technique It consists of exposing oneself to the stimuli that generate anxiety until the symptoms of this are reduced or disappear. It can be done in imagination or live and intensively or gradually. The live exposure being the one that offers the best results.
  • Exposure to agoraphobic situations. If the panic disorder is with agoraphobia, the feared stimuli are environmental situations, so the exposure would be in these. Like interoceptive exposure, exposure to agoraphobic situations can be done intensively (directly to the feared situation) or gradually. For the second, we will use a hierarchy of situations that cause fear to the patient and we will make the exposure from less to more.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Panic Disorder: Symptoms, DSM V Criteria, and Treatment, we recommend that you enter our category of Clinical psychology.


  • American Psychiatric Association (1995). Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Barcelona: MASSON
  • American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Fifth Edition). Madrid: Editorial Médica Panamericana.
  • Buela-Casal, G. Sierra, J.C. (2009). Psychological evaluation and treatment manual. Madrid: New Library.
  • Martín, J; Moreno, P. (2011). Psychological Treatment of Panic Disorder and Agoraphobia: A Handbook for Therapists. Bilbao: Psychology Library.
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