A panic attack is a discrete period of intense fear or discomfort emerging from either a calm or anxious state, in which four (or more) of the following symptoms develop abruptly and reach a peak within minutes:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias (numbness or tingling sensations)
- Chills or heat sensations
Panic attacks often occur in people who are diagnosed with panic disorder.
Panic attack is not considered a stand-alone mental disorder and so cannot be coded as a diagnosis. Because they represent a constellation of co-occurring symptoms that tend to arise together in certain contexts, disorders, and patients (i.e., those with anxious distress), a panic attack is seen by clinicians as clinically important to document. Panic attacks can occur in the context of any anxiety disorder as well as other mental disorders (e.g., depressive disorders, post-traumatic stress disorder, substance use disorders) and some medical conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal). When the presence of a panic attack is identified, it is noted as a specifier to another diagnosis (e.g., a clinician will document, “post-traumatic stress disorder with panic attacks”). For panic disorder, the presence of panic attack is contained within the criteria for the disorder, and therefore, panic attack is not used as a specifier to prevent redundancy.
Certain culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) are not linked to panic attacks and should not count as one of the four required symptoms.
This criteria has been updated for the current DSM-5 (2013).