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Introduction: What is panic? What is anxiety? And when is it a disorder? - Understanding classification

The definition of Panic Attacks is a discrete period in which there is the sudden onset of the intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of "going crazy" or losing control are present (DSM-4). Anxiety Disorders, which are often associated with Panic Attacks, are characterized by a severe increase in the level of stress or anxiety. This increase can be related to the presence of particular events or items (triggers) and can also exists without being prompted by any known triggers.

Contrary to the popular misconceptions about Anxiety Disorders today, Anxiety Disorder is not a purely biochemical or medical disorder. Currently there are three main schools of thought regarding the etiology of Anxiety Disorders: The Biological Theory, (includes the genetic predisposition in panic disorder and presupposes a chemical imbalance in the brain), The Psychodynamic Theory (looks at childhood issues as being the cause), and the Behavioral Theory (sees the cause as learned behavior, including our negative thought patterns). (Fox, Barker 1997)

Anxiety Disorders include the following specific disorders: Anxiety Disorder with or without Agoraphobia, Agoraphobia without History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due To a General Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified. Of this list there are five major Anxiety Disorders, which are; Panic Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder, Obsessive-Compulsive Disorder, and Generalized Anxiety Disorder.

Panic Attacks and Agoraphobia, or "Avoidant Personality Disorder" are of the most prevalent, occurring in the context of several of these disorders.

Description of Categories and Types of Panic Attacks

DSM-4 (Diagnostic And Statistical Manual of Mental Disorders, fourth edition) recognizes three different types of Panic Attacks:

1. Un-cued (spontaneous) Panic Attacks (relates to Panic Disorder).
2. Cued (specific) Panic Attacks (relates to Social Anxiety Disorder, Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder).
3. Situationally predisposed Panic Attacks (may occur on exposure to the situational cue or trigger, but do not necessarily occur immediately after the exposure).

Panic Disorder is defined as the recurrent experience of "un-cued" spontaneous panic attacks, which is often intensified by the resulting fear of the next impending attack. The fear itself of having a spontaneous panic attack often leads to Panic Disorder. The spontaneous panic attack is generally NOT prompted by a "trigger", and is now recognized as not being associated with specific situations and places. The intensity of the attack can be extremely severe; resulting in the feeling of having a heart attack along with intense feelings that one is going to die. Criteria for Panic Attack is defined as a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes. List of symptoms are as follows:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling Dizzy, unsteady lightheaded, or faint
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. Fear of losing control or going crazy
11. Fear of dying
12. Paresthesias (numbness or tingling sensations)
13. Chills or hot flushes

Attacks that have fewer than 4 symptoms are referred to as "limited symptom attacks".