The presence of recurrent panic attacks is an essential feature of panic disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), panic attacks feature prominently within the anxiety disorders, of which panic disorder is one.
In panic disorder, the individual experiences recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or changes his or her behavior in maladaptive ways because of the panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time 4 or more of the following symptoms occur:
Accelerated heart rate
Shortness of breath
Feelings of choking
Feeling dizzy or faint
Chills or heat sensations
Fear of losing control or “going crazy”
Fear of dying
The attack has a sudden onset and typically reaches a peak within 10 minutes. Panic attacks can be (1) unexpected, that is, not associated with a specific trigger; (2) situationally bound, that is, almost always occurring on exposure to, or in anticipation of, a specific trigger; or (3) situationally predisposed, which means they are more likely to occur on exposure to a trigger but are not invariably associated with that trigger. Situationally bound panic disorder is very similar to specific phobia except for the degree of the reaction. Unexpected and situationally predisposed panic attacks are the most frequent types in panic disorder. (See Etiology and History.)
In 1994, the American Psychiatric Association included panic disorder with agoraphobia and panic disorder without agoraphobia in the DSM-IV. (In prior DSM editions, the terms panic disorder and agoraphobia with panic attacks had been used to describe similar conditions.) In DSM-5, panic disorder and agoraphobia are two separate and distinct disorders.
Although panic disorder is more frequent in older adolescents and adults, it does occur in children. It is an important disorder to consider, because unrecognized and untreated panic disorder can have a devastating impact on a child’s life and can interfere with normal development, schoolwork, and relationships. (See Epidemiology and Prognosis.)
Somatic symptoms of panic disorder may lead to excessive and invasive examinations when appropriate mental health professional assessment is delayed.
Reluctance to go to school or engage in other age-appropriate activities may result from panic disorder.
Comorbid depression is not uncommon, and, in severe cases, children and adolescents may become suicidal.
Adolescents with panic disorder may self-medicate, leading to substance abuse.