Part Two of Anxiety Disorders
Part Two of Anxiety Disorders describes Panic Disorder, Panic Attack Specifier, and Selective Mutism. Anxiety Disorders is the fifth diagnostic class being covered in the Mental Health Diagnosis! blog series. If you missed the introduction to the series click HERE to learn how the Diagnostic and Statistical Manual-5 works. Click HERE to read the Introduction to Anxiety Disorders.
Panic Attack Specifier: What is a Panic Attack?
A panic attack is not a mental disorder; they are symptoms that can occur within or outside the context of mental disorders. The Diagnostic and Statistical Manual 5 (2013) defines a panic attack as “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes”. It is important to note that this surge of feelings can begin while the person is in a calm or an anxious state. An individual typically experiences four or more of the following symptoms during a panic attack:
- “Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesias, [which are] numbness or tingling sensations
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying
(Diagnostic and Statistical Manual of Mental Disorders, 2013). The intensity and combination of the previously mentioned symptoms can cause the person who is experiencing a panic attack to think and feel that they are about to die.
An individual is diagnosed with Panic Disorder when they meet four criteria: one, the individual has reoccurring unexpected panic attacks; two, the individual makes maladaptive changes to avoid panic attacks and/or they are persistently worried about having additional panic attacks; three, the panic attacks are not caused by the physiological effects of a drug of abuse or another medical condition; and four the panic attacks are “not better explained by another mental disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).
Differential diagnosis involves the clinician distinguishing the individual’s panic attack symptoms from the individual’s response to feared social situations, phobias, obsessions, traumatic events, and separation from attachment figures.
Selective Mutism is less prevalent than Panic Disorder and panic attacks, which are more common experiences. The Selective Mutism diagnosis is reserved for persons who consistently fail to speak in social situations, regardless of their knowledge on a topic of conversation, their level of comfort in the social setting, or their spoken language skills. Individuals with Selective Mutism are not “mute”; they use spoken language in some, but not all social situations. These failures to speak occur in “specific social situations in which there is an expectation for speaking,” such as in school or during extracurricular activities (Diagnostic and Statistical Manual of Mental Disorders, 2013).
Diagnosis with Selective Mutism requires that the failure to speak disturbance last at least one month; that the disturbance interferes with the individual’s “educational or occupational achievement or with social communication”; and, that the disturbance is “not better explained by a communication disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013). Although Selective Mutism is most often seen in children, both adolescents and adults can experience the symptoms and subsequent diagnosis.
Differential diagnosis involves the clinician ruling out Autism Spectrum Disorder, Schizophrenia, and/or another psychotic disorder.
Part Three of Anxiety Disorders, which details Agoraphobia, Social Anxiety Disorder (Social Phobia), and Specific Phobia.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 16 June 2018]. dsm.psychiatryonline.org