Panic Disorder

Panic disorders (synonyms: panic; panic attack; panic neurosis; panic syndrome; ICD-10 F41.0: panic disorder [episodic paroxysmal anxiety]) belong to the group of anxiety disorders. Panic disorders describe recurrent severe anxiety attacks (panic) that are not confined to a specific situation or particular circumstances and are therefore unpredictable. In ICD-10 F41.0, panic disorder is described as follows: “The essential characteristic is recurrent severe anxiety attacks (panic) that are not limited to a specific situation or special circumstances and are therefore also unpredictable. As with other anxiety disorders, the essential symptoms include sudden heart palpitations, chest pain, feelings of suffocation, dizziness, and feelings of alienation (depersonalization or derealization). Fear of dying, loss of control, or fear of going insane often develops secondarily. Panic disorder should not be used as the primary diagnosis if the individual is suffering from a depressive disorder at the onset of the panic attacks. In these circumstances, the panic attacks are likely secondary to the depression.” Panic disorders are among the most common anxiety disorders and therefore among the most common disorders in the field of psychiatry. There are panic disorders with and without agoraphobia (fear to the point of panic in certain places; anticipatory anxiety). A true panic attack requires that at least three attacks occur within three weeks that are not triggered by a phobic stimulus (e.g., spiders, elevators) and are not the result of physical exhaustion or a life-threatening illness. There must be relatively anxiety-free periods between panic attacks. Panic disorder can be classified into the following severity levels:

• Mild panic disorder: less than 4 panic attacks in 4 weeks.
• Moderate panic disorder: at least 4 panic attacks in 4 weeks.
• Severe panic disorder: at least 4 panic attacks per week over a period of 4 weeks.

Sex ratio:panic disorder with agoraphobia (fear to panic in certain places; anticipatory anxiety): males to females is 1: 2-3.Panic disorder without agoraphobia: balanced ratio. Frequency peak: the maximum occurrence of panic disorder is during adolescent age (15 to 19 years), usually not before puberty, and between the 3rd and 4th decade of life (median age 24 years). Anxiety disorders occur much less frequently after the 5th decade of life. Lifetime prevalence (frequency of illness throughout life) is approximately between 1.5 and 3.5%. The prevalence (frequency of illness) is 3-4% (in Germany). The following table shows the 12-month prevalence of panic disorder [in %] adults (in Germany).

Course and prognosis: The disorder is characterized by recurrent (recurring) panic attacks and is often associated with agoraphobia, which severely affects affected individuals in their daily lives, including leisure activities. Panic disorder can be well controlled with adequate therapy. Without therapy, the disorder does not disappear.The following table shows the mental comorbidity in panic disorder [in %] (in Germany).