Panic Disorder

Prevalence

  • Females are more frequently affected than males. The gender differentiation occurs in adolescence and is already observable before age 14 years.

  • The overall prevalence of panic disorder is low before age 14 years.

  • The rates of panic disorder show a gradual increase during adolescence, particularly in females, and possibly following the onset of puberty, and peak during adulthood.

  • The prevalence rates decline in older individuals.

Risk factors

Temperamental

  • Negative affectivity (neuroticism) and anxiety sensitivity.

  • History of "fearful spells" may be a risk factor for later panic attacks and panic disorder.

  • Although separation anxiety in childhood, especially when severe, may precede the later development of panic disorder, it is not a consistent risk factor.


Environmental

  • Childhood experiences of sexual and physical abuse.

  • Smoking is a risk factor for panic attacks and panic disorder.

  • Most individuals report identifiable stressors in the months before their first panic attack.


Genetic and physiological

  • It is believed that multiple genes confer vulnerability to panic disorder. However, the exact genes, gene products, or functions related to the genetic regions implicated remain unknown.

  • Respiratory disturbance (e.g., asthma) is associated with panic disorder, in terms of past history, comorbidity, and family history.

Symptoms

  • Recurrent unexpected panic attacks, during which four (or more) of the following symptoms occur:

    1. Palpitations.

    2. Pounding heart, or accelerated heart rate.

    3. Sweating.

    4. Trembling or shaking.

    5. Sensations of shortness of breath or smothering.

    6. Feelings of choking.

    7. Chest pain or discomfort.

    8. Nausea or abdominal distress.

    9. Feeling dizzy, unsteady, light-headed, or faint.

    10. Chills or heat sensations.

    11. Paresthesias (numbness or tingling sensations).

    12. Derealization or depersonalization

    13. Fear of losing control or “going crazy.”

    14. Fear of dying.


  • At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

    1. Persistent concern or worry about additional panic attacks or their consequences.

    2. A significant maladaptive change in behavior related to the attacks.


  • The disturbance is not attributable to the physiological effects of a substance or another medical condition.

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