32 - Panic disorder

Summary

Editor's note

Panic disorder is a relatively new diagnosis that did not exist formally before 1980, when it was first introduced into DSM-III. Its introduction divided the primary anxiety disorders into panic and generalized anxiety disorder. The assets of the diagnosis are also its handicaps. The experience of a panic attack is so profound that it cannot but be remembered starkly and clearly, and so the definition of a panic attack is remarkably easy. However, most psychiatrists never see someone having a severe panic attack, and so the reporting of symptoms is for the most part retrospective and possibly distorted by the experience. This has led to difficulty in defining panic disorder, and the official classifications of DSM and ICD differ to some extent in that ICD-10 maintains that the panic attacks in panic disorder ‘are not consistently associated with a specific symptom or object’ (as when they are symptoms forming part of a phobic disorder), whereas in DSM IV, the exclusion clause that ‘they are not better accounted for by another mental disorder’ is much more open to interpretation. Panic attacks are said to be ‘uncued’ (i.e. they come ‘out of the blue’), but increasingly, as this chapter illustrates, they are often associated with a variety of cues. It is a condition which is not so much treated, but prevented, as the successful treatments prevent the disorder (i.e. stop) the panic attacks rather than treat them.