Recurrent and unexpected panic attacks with 4+ following symptoms:
Chest pain, palpitations, SOB, choking
Trembling, sweating, nausea, chills
Fear of losing control or dying
There is also worry about additional attacks and avoidance behavior. Patients usually develop anticipatory anxiety about subsequent attacks, which may develop into chronic anxiety.
An isolated panic attack can occur in many situations, but for a diagnosis of panic disorder to be made, recurrent and unprovoked panic attacks must occur, followed by excessive concern or behavioral changes aimed at avoiding further attacks.
Patients with panic disorder frequently have cardiorespiratory symptoms and may fear they are having a heart attack (thus repeatedly seeking medical care). Given possible preoccupation with symptoms and fears of having an undiagnosed condition, it may be difficult to differentiate panic disorder from a somatic symptoms disorder. Both conditions are associated with:
Multiple physical symptoms
High healthcare use
Preoccupation with symptoms
However, in somatic symptom disorder, physical symptoms are persistent over time, while the recurrent abrupt onset of characteristic physical symptoms that resolve within minutes should raise clinical suspicion for panic disorder.
SSRI/SNRI +/- CBT