Panic Disorder Definition

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The key feature of panic disorder in DSM-III is the occurrence of three or more panic attacks within a three week period. These attacks cannot be precipitated only by exposure to a feared situation, cannot be due to a physical disorder, and must be accompanied by at least four of the following symptoms: dyspnea, palpitations, chest pain, smothering or choking, dizziness, feelings of unreality, paresthesias, hot and cold flashes, sweating, faintness, trembling or shaking (APA, 1980). In DSM-III-R, the definition was revised to require four attacks in four weeks or one or more attacks followed by a persistent fear of having another attack. In DSM-III-R, the list of potential symptoms was revised to include nausea or abdominal distress and to exclude depersonalization or derealization (APA, 1987).

More important, DSM-III-R changed the diagnostic hierarchy so that panic disorder could be diagnosed as a primary disorder with or without agoraphobia and dropped the category of agoraphobia with panic attacks. This change placed the emphasis on identifying panic disorder as a discrete entity and reflected the clinical experience that panic attacks tended to occur prior to the development of agoraphobia, which was increasingly viewed as a phobic avoidance response to the frightening experience of spontaneous panic attacks, near panic experiences or limited symptom attacks.

TABLE 7. Prevalence Rates per 100 of Panic Disorder Using DSM-III (or DSM-III-R) Criteria

Place

Rate/100 a

6 month

1 year

Lifetime

USA-NCS (DSM-III-R)

2.3

3.5

USA-ECA (5 sites)

1.6

ECA New Haven, CT

0.6

Baltimore, MD

1.0

St. Louis, MO

0.9

Piedmont, NC

0.7

Los Angeles, CA

0.9

Zurich survey

3.1

Edmonton, Canada

0.7

1.2

Puerto Rico

1.1

1.7

New Zealand

1.4

Florence, Italy

1.4

Korea

1.7

Taiwan

Urban

0.20

Small towns

0.34

Rural

0.13

a Rates rounded off to one decimal place in most cases. Source: Adapted from Tsuang et al. (1995).

a Rates rounded off to one decimal place in most cases. Source: Adapted from Tsuang et al. (1995).

Rates. Table 7 shows prevalence rates of panic disorder from community studies using DSM-III or DSM-III-R criteria. For studies using DSM-III, the 6-month prevalence of panic disorder ranged from 0.6 per 100 in New Haven, CT, to 1.1 per 100 in Puerto Rico, representing a remarkable level of consistency across sites. The annual prevalence rate of 3.1 per 100 from the Zurich survey was based upon a definition of panic which only approximated that of DSM-III. The NCS reported a 1-year prevalence of 2.3 per 100 for DSM-III-R panic disorder.

Lifetime rates of DSM-III panic disorder showed good agreement, with prevalence varying from 1.2 per 100 in Edmonton, Canada, to 2.2 per 100 in New Zealand. The exception to this narrow range of lifetime rates was Taiwan, where panic disorder occurred at rates from 0.13 per 100 rural areas to 0.34 per 100 in small towns. The only study that reported on lifetime DSM-III-R panic disorder was the NCS, which found a rate of 3.5 per 100, considerably higher than the lifetime rates based upon DSM-III. This may be due to the broadening of the concept of panic disorder in DSM-III-R or to the differences in memory probes used in the UM-CIDI, as compared to those used in the DIS..

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Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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