Year: 2013
Type: editorial
Abstract: In DSM-IV, panic attack is defined ‘‘as a discrete periodof intense fear or discomfort, in which four or more of thefollowing symptoms developed abruptly and reached apeak within 10 minutes.’’ There follows 13 well-recog-nized associated symptoms. This definition raises majordifficulties. For instance, the term ‘‘intense’’ is quantita-tively ambiguous, but plainly means more than slight.Conversely, in the definition of panic used in the twopapers, the mere presence of a symptom counts. Also, itis not clear whether the symptoms recorded in a diary areor not restricted to panic occurrence.Another major problem is the minimum cutoff at foursymptoms. This was selected to ensure coverage, so thatpatients will not be left out. However, this increase insensitivity results in decreased specificity. It should benoted that panic attacks, as occurring in longitudinallyestablished cases of panic disorder, regularly endorse farmore than four symptoms. Therefore, other conditionsare often confused with panic.Many different anxiety disorders are associated withstrong anticipatory anxiety. In these cases, when con-fronted with a feared situation, there may be a crescendoof anticipatory anxiety. For instance, the social phobicwho has to enter a crowded party may have a rush ofpalpitations, sweating, and tremor, as also occurs inordinary fear, which may be confused with panic. It isstriking that air hunger (dyspnea) is not associated withsocial phobia or ordinary fear. However, it is the panicthat occurs ‘‘out of the blue’’ that is defining for panicdisorder. Therefore, the minimum of four associatedsymptoms is a clinical estimate aiming at high sensitivity,but it is not scientifically definitive.Freire et al.
Source: Brazilian Journal of Psychiatry
Author: Donald F. Klein
Institution: New York University
Language: English
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W2050925997