USMLE® Step 1 style questions USMLE
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A 28-year-old man comes to the office because of a new symptom he has been experiencing during his panic attacks. He was diagnosed with panic disorder two months ago and is following treatment. However, his panic attacks did not subside and now he feels like the world is drifting away and he is somehow separate from himself and his emotions. Which of the following is the patient experiencing during his panic attacks?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
At some point you’ve probably heard someone say or joke about “having a panic attack,” but panic attacks are very real situations where someone experiences a sudden period of intense fear or discomfort, believing that something bad’s going to happen and that there’s some imminent threat or danger.
These feelings are often so intense that they’re accompanied by physiological symptoms like heart palpitations, dizziness, or shortness of breath.
These symptoms peak within the first 10-20 minutes, but some might last hours.
Sometimes patients having a panic attack might feel as though they’re having a heart attack or some other life-threatening illness.
Panic attacks can happen even in familiar places where there are no real threats, which makes them unpredictable, which can further increase anxiety about when the next panic attack is going to happen.
The DSM-5 outlines the specific criteria required for diagnosis of a panic attack.
Patients need to experience the abrupt onset of at least four of the following 13 symptoms: pounding heart or fast heart rate; chest pain or discomfort; sweating; trembling; shortness of breath; nausea; dizziness; chills; numbness; feelings of choking; feelings of being detached from oneself; fear of losing control; and fear of dying.
Admittedly, some of these symptoms might naturally occur together, so they can be very hard to tease apart.
For example, it would be unusual for a person who’s sweating, feeling dizzy, and feeling chills to also not be trembling.
It’s also important to note that some of these are physical symptoms whereas others are mental, like specific thoughts and ideations.
Panic attacks can happen in the context of several mental disorders including depressive disorders, posttraumatic stress disorder, and substance abuse disorders.
They can also, however, happen in the context of a panic disorder, which is basically identified in someone who has panic attacks that are recurrent—meaning 2 or more—and unexpected.
In addition, the DSM-5 says that for somebody to be diagnosed with a panic disorder, they also need to experience persistent worrying or changes in behavior due to their panic attacks.
Also, the panic attacks can’t be related to the effects of some substance, like an illicit drug or medication.
Patients with a panic disorder can’t predict where the panic attack will happen next, so it’s important to seek treatment before patients develop something called avoidance, which is when they actively avoid the places where a panic attack previously occurred.
They might stop doing activities that they think might trigger the attacks, like going to the park, riding in elevators, or driving.