Presenting Complaints

• Patients present a sudden attack of anxiety accompanied with one or more physical symptoms (chest pain, dizziness, shortness of breath). Further inquiry shows the full pattern described below.

Diagnostic Features

• Sudden, unexplained attacks of anxiety or fear.
• Often occur with physical symptoms such as palpitations, chest pain, choking feeling, churning stomach, dizziness, feelings of unreality, and fears of disaster (losing control or going mad, heart attack, sudden death).
• They begin suddenly, build rapidly, and only last a few minutes.
• Often lead to fear of further attacks and avoidance of places where attacks have occurred. Patients may avoid exercise or other activities which produce physical sensations like panic.

Differential Diagnosis

• Many medical conditions may cause symptoms similar to panic attacks (arrhythmia, transient ischemic attacks, unstable angina, thyrotoxicosis). History and physical examinations should be sufficient to exclude many of these.
• If attacks occur only in specific feared situations, see section on Phobic Disorders.
• If low or sad mood is also present, see section on Depression.