300.21 Panic Disorder

Overview

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (2000), the number 300.21 is the code for Panic Disorder with Agoraphobia. Both panic disorders and agoraphobia are anxiety disorders. While panic disorders are characterized by recurrent panic attacks, agoraphobia is characterized by the fear of being embarrassed in public by a panic attack. Agoraphobia and panic attacks can be diagnosed in isolation; however, sometimes they are symptoms of another anxiety disorder. Therefore, careful review of the symptoms is needed before any diagnosis is made.

Panic Disorder

The main feature of a panic disorder is reoccurring panic attacks. At least two panic attacks must occur to meet the criteria for this disorder. Many people who have panic attacks worry that they are a symptom of a serious medical condition, such as heart disease or cardiac arrest. According to the American Psychiatric Association, incidents of panic disorders in medical settings range from 10 to 30 percent and in cardiac clinics can be as high as 60 percent. This is compared to only 1 to 2 percent in the general population. Although this suggests that there is a relationship, it is unclear if panic disorders actually cause higher rates of medical problems, or if those with medical problems are more likely to develop a panic disorder.

Panic Attack Features

Panic attacks are characterized by feelings of intense fear or discomfort when there is no real threat of danger. Symptoms come without warning and can include rapid heartbeat, excessive sweating, trembling or shaking, feeling short of breath, chest pain, nausea, dizziness, feeling like you are not in your own body, fear of losing control or doing something “crazy,” fear of dying, and sudden paralysis. Symptoms build in intensity and are usually accompanied by a strong urge to escape. The experience is intense but typically lasts a maximum of 10 minutes. In order for panic attack symptoms to meet the criteria for a panic disorder, there must also be a period of time lasting at least a month after the attack in which the individual worries about the implications of having panic attacks, or worries about having another panic attack.

Types of Panic Attacks

There are three different kinds of panic attacks: unexpected, situationally bound and situationally predisposed. In order for a diagnosis of panic disorder, unexpected panic attacks must occur. An unexpected panic attack comes without warning and is not associated with any specific stimuli or environment. The other types of panic attacks are typically triggered by a specific circumstance or thoughts about a specific circumstance.

Agoraphobia

Although all individuals with panic disorder think about the implications of their panic attacks, agoraphobia refers to the fear of being embarrassed or caught in public while having a panic attack. This anticipation and fear of having a panic attack can result in individuals’ complete refusal to leave their homes or even a refusal to be at home alone.

Differential Diagnosis

Because both panic attacks and agoraphobia can be symptoms of other anxiety disorders, a professional must review the symptoms carefully to make the proper diagnosis. Certain types of panic attacks, like those that are brought on by specific stimuli such as a spider, can indicate a phobia rather than a panic disorder. Likewise, agoraphobia can be a symptom of a social phobia, depending on the history of agoraphobic behavior.

About this Author

Dr. Elizabeth Halper obtained her B.A. from Bryn Mawr College and her M.A. and Ph.D. from Gallaudet University. Areas of interest include the deaf community, research, and psychological assessment. Dr. Halper has publications in the “Behavior Analyst Today,” “The Gallaudet Chronicle of Psychology,” and at LIVESTRONG.