1. Recurrent unexpected panic attacks occur, during which four of the following symptoms begin abruptly and reach a peak within 10 minutes in the presence of intense fear:
a. Palpitations, increased heart rate b. Sweating c. Trembling or shaking d. Sensation of shortness of breath e. Feeling of choking f. Chest pain or discomfort g. Nausea or abdominal distress h. Feeling dizzy, lightheaded or faint i. Derealization or depersonalization j. Fear of losing control or going crazy k. Fear of dying l. Paresthesias m. Chills or hot flushes
2. At least one of the attacks has been followed by one month of one of the following:
a. Persistent concern about having additional attacks.
b. Worry about the implications of the attack, such as fear of having a heart attack or going crazy.
c. A significant change in behavior related to the attacks.
B. The presence of agoraphobia which has the following three components:
1. Anxiety about being in places or situations where escape might be difficult or embarrassing, or in which help might not be available.
2. Situations are avoided or endured with marked distress, or these situations are endured with anxiety about developing panic symptoms, or these situations require the presence of a companion.
C. Panic attacks are not due to the effects of a substance or medical condition.
D. The panic attacks are not caused by another mental disorder such as panic on exposure to social situations in social phobia, or panic in response to stimuli of a severe stressor, such as with post-traumatic stress disorder.
II. DSM-IV Criteria for Panic Disorder without Agoraphobia. The DSM-IV diagnostic criteria are the same as panic disorder with agoraphobia, except there are no symptoms of agoraphobia.
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