panic disorder

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A panic attack is discrete paroxysm of severe anxiety which is associated with unpleasant symptoms of autonomic arousal.

Panic disorder is diagnosed when panic attacks occur:

  • regularly
  • without an obvious precipitant
  • in the absence of other psychiatric illness

NICE suggest that there is a stepped care for panic disorder (2)

  • Step 1 - recognition and diagnosis
  • Step 2 - treatment in primary care
  • Step 3 - review and consideration of alternative treatments
  • Step 4 - review and referral to specialist mental health services
  • Step 5 - care in specialist mental health services


  • according to the DSM-IV-TR , a fundamental characteristic of panic disorder is the presence of recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another panic attack and concern about the consequences of a panic attack, or a significant change in behaviour related to the attacks
    • at least two unexpected panic attacks are necessary for diagnosis and the attacks should not be accounted for by the use of a substance, a general medical condition or another psychological problem
  • panic disorder can be diagnosed with or without agoraphobia.


Last reviewed 01/2018