"I'm in a panic to get this project finished.""I saw the flashing lights and just panicked."
"That was a total panic."
We hear the word "panic" thrown around in everyday speech. But when are we experiencing a feeling (panic), and when is it diagnosable (panic disorder)?
Everyone experiences panic at one time or another.
- You are in a busy store and realize your child is not with you.
- You are asleep on an airplane and suddenly hear a loud voice announcing the airplane has lost cabin pressure and you should prepare for an emergency. (I experienced this. That definitely was a feeling of panic! Luckily, the announcement was apparently due to flight attendant error. It was NOT a U.S. airline, by the way.)
- You realize you've just locked your keys inside your car. With your baby still inside the car.
- You are almost finished with your term paper (due in a half-hour) and your laptop crashes.
- You are driving during a storm and a large tree falls right in front of you. (This has happened to me as well. You know what they say about your life flashing in front of you? That actually happens. Luckily I wound up just driving through the very top branches of the fallen tree.)
So when does a feeling of panic cross the line into a panic attack, and panic disorder?
The diagnostic criteria for a panic attack, according to the DSM-IV-TR(2000):
A panic attack is characterized by four or more of the following symptoms, developing abruptly and reaching a peak within 10 minutes:
- 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
- Feelings of unreality (derealization) or being detached from oneself (depersonalization)
- Fear of losing control or going crazy
- Fear of dying
- Numbness or tingling sensations (paresthesias)
- Chills or hot flashes
The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack.
And here is the diagnostic criteria for panic disorder, according to theDSM-IV-TR:
A) Both (1) and (2):
(1) Recurrent unexpected panic attacks
(2) At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) Persistent concern about having additional attacks
(b) Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
(c) A significant change in behavior related to the attacks
B) The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
C) The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
Panic disorder is also diagnosed with and without agoraphobia.
As you can see, panic disorder is a culmination of symptoms. Hopefully this clarified whether or not you are experiencing a sensation of panic that is appropriate for the situation at hand. If you have a feeling of panic only in a situation that warrants it, you are most likely feeling a normal human emotion. However, if you are feeling a sense of panic "out of the blue", if you have a family history of panic disorder (it does have a 40% heritability rate), or if your feelings of panic match the diagnostic criteria above, you may want to see a mental health professional for an evaluation.
Reference: American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
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