As I wrote recently, I am in the strange position of boning up on the soon-to-be-obsolete diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders IV-TR.

The structure of Panic and Agoraphobia Disorders diagnostic criteria in the DSM-IV-TR is similar to that of Mood Disorders; there are the “ingredients” of Panic Attack (which I have quoted below from p. 432 of the DSM-IV-TR) and Agoraphobia (quoted from p. 433), and then the Disorders are like recipes, including or excluding the ingredients in different ways. The Disorders are Panic Disorder Without Agoraphobia (quoted from p. 440), Panic Disorder With Agoraphobia (quoted from p. 441), and Agoraphobia Without History of Panic Disorder (quoted from p. 443).

Please remember that you cannot ethically or accurately diagnose yourself or anyone you know, even if you are a mental health professional. I am posting these criteria for general interest, not diagnosis:
Criteria for Panic Attack

Note: A Panic Attack is not a codable disorder. Code the specific diagnosis in which the Panic Attack occurs (e.g., 300.21 Panic Disorder With Agoraphobia [p. 441]).

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

(1)    palpitations, pounding heart, or accelerated heart rate

(2)    sweating

(3)    trembling or shaking

(4)    sensations of shortness of breath or smothering

(5)    feeling of choking

(6)    chest pain or discomfort

(7)    nausea or abdominal distress

(8)    feeling dizzy, unsteady, lightheaded, or faint

(9)    derealization (feelings of unreality) or depersonalization (being detached from oneself)

(10)  fear of losing control or going crazy

(11)  fear of dying

(12)  paresthesias (numbness or tingling sensations)

(13)  chills or hot flushes

Criteria for Agoraphobia

Note: Agoraphobia is not a codable disorder. Code the specific diagnosis in which the Panic Attack occurs (e.g., 300.21 Panic Disorder With Agoraphobia [p. 441] or 300.22 Agoraphobia Without History of Panic Disorder [p. 441]).

A.      Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpe3cted or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crows or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.

Note: consider the diagnosis of Specific Phobia if the avoidance is limited to one or only a few specific situations, or social Phobia if the avoidance is limited to social situations.

B.      The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.

C.      The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).

Diagnostic criteria for 300.01 Panic Disorder Without Agoraphobia

A.      Both (1) and (2):

(1)    recurrent unexpected Panic Attacks (see p. 432)

(2)    at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

(a)    persistent concern about having additional attacks

(b)   worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)

(c)    a significant change in behavior related to the attacks

B.      The absence of Agoraphobia (see p. 433)

C.      The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D.      The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety disorder (e.g., in response to being away from home or close relatives).

Diagnostic criteria for 300.21 Panic Disorder With Agoraphobia

A.       Both (1) and (2):

(1)    recurrent unexpected Panic Attacks (see p. 432)

(2)    at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

(a)   persistent concern about having additional attacks

(b)   worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)

(c)     a significant change in behavior related to the attacks

B.       The presence of Agoraphobia (see p. 433)

C.     The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D.      The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety disorder (e.g., in response to being away from home or close relatives).

Diagnostic criteria for 300.22 Agoraphobia Without History of Panic Disorder

A.      The presence of Agoraphobia (see p. 433) related to fear of developing panic-like symptoms (e.g., dizziness or diarrhea).

B.      Criteria have never been met for Panic Disorder

C.      The disturbance is not due to the direct physiological effects of a substance (e.g.,  a drug of abuse, a medication) or a general medical condition.

D.      If an associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition.

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