According to the ICD-10 (WHO, 1992), for a diagnosis of Panic Disorder, several severe attacks of autonomic anxiety should have occurred within a period of about 1 month. The symptoms typically include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality. There is also a secondary fear of dying, losing control, or going mad. These usually occur in circumstances where there is no objective danger.
An individual in a panic attack often experiences a crescendo of fear and autonomic symptoms which results in an exit from wherever they may be. If this occurs in a specific situation they may subsequently avoid that situation. Similarly, frequent and unpredictable panic attacks produce fear of being alone or going into public places. A panic attack is often followed by a persistent fear of having another attack.
In this classification, a panic attack that occurs in an established phobic situation is regarded as an expression of the severity of the phobia, which should be given diagnostic precedence. Panic disorder should be the main diagnosis only in the absence of any of the phobias.
NICE (CG113, January 2011) guidelines for Panic Disorder reccomend a stepped care approach. Click here for more information.