Panic attacks and panic disorder (Diagnosis)

How panic attack or disorder is diagnosed?

Many people who develop panic attack especially for the first time, visits hospital emergency, a general practitioner or a cardiac specialist.
This happens due to severity of the physical symptoms and sense of intense fear which makes them believe in the worst outcome.

Moreover, some of the symptoms experienced during the attack resembles that of cardiac complications like chest discomfort, sweating, palpitation or sense of anxiety/fear and others.

Clinical History:

The doctors take a detailed history noting down the aggravating factors, personal history of any other issue and family history.

Physical examination and vitals:

To look for any signs of physical disease or its complication. To understand the basic condition of the body.

Blood tests:

To rule out any possibility of physical disease or problem and to check the general health of the body. These tests could be whole blood count, hemogram, thyroid test, cardiac markers and others.

Electrocardiogram (ECG):

To rule out any possibility gross cardiac issue.

Once the physical disease is ruled out or in a known case of panic attack/disorder, the patient is referred to psychiatrist/psychologist for further assessment and help.

A psychiatrist/psychologist would take a detailed history evaluating the fears, physical symptoms,family history,any major stressful event or situations bothering you or any perceived triggering factor that makes you avoid certain situations. A personal history of substance or alcohol abuse and a family history of someone facing any kind of psychological issue would also be asked by the doctor.

The diagnosis of panic attack or disorder is made on the basis of the guidelines made by the American Psychiatric Association published in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which is as follows:

Diagnostic criteria for panic attack

Person experiences sudden surge of intense fear or discomfort that reaches its peak within minutes, associated with at least four of the following physical symptoms:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Derealization (feelings of unreality) or depersonalization (being detached from oneself)

• Fear of losing control or “going crazy”

• Fear of dying

• Paresthesias (numbness or tingling sensation)

• Chills or heat sensations

Diagnostic criteria for panic disorder

Panic attack doesn’t always lead to panic disorder and only some people go on to develop panic disorder which is diagnosed by the following criteria:

• When a person develops repeated panic attacks with at least one of the attacks leading to a period of constant worry lasting for a month or more.

• The period is marked by anxiety and fear of the results of attack. Person may fear of loss of control or development of worse outcome with the attack like heart attack.

• During this period a person may develop significant changes in the behavior, such as avoiding situations which may be perceived to trigger a panic attack.

• And when these panic attacks aren’t found to be caused by any substance abuse, disease, other mental heath issue, like social phobia

If panic attacks are recurrent and still left unattended, they can eventually develop into panic disorder or other mental issues which become much more difficult to treat.