22nd February 2024

Diagnosis

There is insufficient evidence to support the use of a diagnostic tool, so a thorough history and clinical judgement is used to make a diagnosis of a panic disorder.  Patients presenting with panic disorders often have a psychiatric co-morbidity of depression or substance misuse, which can make the diagnosis of panic disorders difficult.

If a patient presents to A&E or primary care with symptoms of a panic attack, physical causes such as thyroid or coronary artery disease must be ruled out first. If basic investigations rule out a physical problem, the patient is young, has a history of anxiety, has experienced panic attacks in the past or is known to have atypical chest pain, a diagnosis of panic disorder must be considered. 

DSM-5 diagnostic criteria for panic disorder: 

1. Recurrent panic attacks, at least one without a trigger. 
2. At least 1 month of one or both of the following:
   • Persistent worry about future panic attacks or worry about the consequence of further attacks 
   • Maladaptive behaviours like avoidance or overuse of health services
3. No other physical cause identified 
4. No other psychological disorder involved