Panic disorder & agoraphobia

A panic attack feels like a heart attack, a suffocation, and impending doom all at once — and it peaks in minutes. Examiners want you to know the attack itself, the fear of the next one, and the avoidance that grows around it.

A panic attack is an abrupt surge of intense fear or discomfort that peaks within minutes, with 4 or more physical/cognitive symptoms: pounding heart/palpitations, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, dizziness/lightheadedness, chills or heat, numbness/tingling (paresthesias), derealization or depersonalization, fear of losing control or going crazy, and fear of dying. Panic attacks can occur in many disorders — they are a specifier, not a diagnosis by themselves.

Panic disorder is recurrent, unexpected panic attacks PLUS at least 1 month of one or both: persistent worry about additional attacks or their consequences (anticipatory anxiety), or a maladaptive behavior change meant to avoid attacks. The fear of fear — dreading the next attack — is the engine that keeps panic disorder running.

Agoraphobia is marked fear or anxiety about two or more of five situations: public transportation, open spaces, enclosed spaces, standing in line/crowds, or being outside the home alone. The core worry is that escape might be difficult or help unavailable if panic-like symptoms strike. These situations are actively avoided, require a companion, or are endured with dread — for 6 months or more. In DSM-5-TR, agoraphobia is a separate diagnosis and can be coded alongside panic disorder.

Clinical Pearl: A panic attack = abrupt surge peaking in minutes, 4+ symptoms. Panic disorder = unexpected attacks + 1 month of anticipatory anxiety or avoidance. Agoraphobia = fear of 2+ situations where escape is hard, lasting 6+ months — driven by fear of being trapped without help.