Fast Five Quiz: Anxiety

Stephen Soreff, MD


August 09, 2021

Patients with panic disorder have recurring episodes of panic, with the fear of recurrent attacks resulting in significant behavioral changes (eg, avoiding certain situations or locations) and worry about the implications or consequences of the attack (eg, losing control, going crazy, fear and belief that one is dying). The fear of another panic attack governs patients' lives. That fear results in both social and vocational impairment. Panic disorder may result in changes in personality traits, characterized by the patient becoming more passive, dependent, or withdrawn.

DSM-5 criteria for panic disorder include four or more attacks in a 4-week period, or one or more attacks followed by at least 1 month of fear of another panic attack. A panic attack generally lasts 20-30 minutes from onset and rarely more than an hour. Somatic concerns of death from cardiac or respiratory problems may be a major focus of patients during an attack. Patients may end up in the ED. The following are symptoms of a panic attack in the DSM-5:

  • Palpitations, pounding heart, or accelerated heart rate

  • Sweating

  • Trembling or shaking

  • Sense of shortness of breath or smothering

  • Feeling of choking

  • Chest pain or discomfort

  • Nausea or abdominal distress

  • Feeling dizzy, unsteady, lightheaded, or faint

  • Derealization or depersonalization (feeling detached from oneself)

  • Fear of losing control or going crazy

  • Fear of dying

  • Numbness or tingling sensations

  • Chills or hot flashes

  • During the episode, patients have the urge to flee or escape and have a sense of impending doom (as though they are dying from a heart attack or suffocation)

Read more about panic disorder.


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