Anxiety Disorders 265
de nervios differs from a panic attack not only in the specifi c symptoms experi-
enced, but also because it usually is triggered by a specifi c upsetting event, such as
a funeral or a family confl ict. Panic attacks that are part of panic disorder tend not
to have such an obvious situational trigger. Furthermore, people who have had an
ataque de nervios are usually not worried about recurrences (Guarnaccia, 1997b;
Salmán et al., 1997).
Panic disorder, as well as ataque de nervios and other anxiety disorders, isdiagnosed in at least twice as often in women as in men (American Psychiatric
Association, 2000). A cultural explanation for this gender difference is that men
may be less likely to report symptoms of anxiety or panic because they perceive
them as inconsistent with how men are “supposed” to behave in their culture
(Ginsburg & Silverman, 2000).
In short, panic disorder has a core of common symptoms across the world, cen-tering on frequent, unexpected panic attacks and fear of further attacks, but culture
does affect the specifi cs.
Table 7.5 • Panic Disorder Facts at a Glance
Prevalence- Up to 3% of people worldwide will experience panic disorder at some point in their lives
(Rouillon, 1997; Somers et al., 2006). However, 30% of people will experience at least one
panic attack in their lives. Up to 60% of people seen by cardiologists have panic disorder.
Comorbidity- About 80% of people with panic disorder will have an additional Axis I disorder (Ozkan &
Altindag, 2005). The two Axis I disorders mostly commonly associated with panic disorder are
depression (up to 65% of cases) and substance abuse (up to 30% of cases) (Biederman et al.,
2005; Keller & Hanks, 1994; Magee et al., 1996). - Approximately 15–30% of those with panic disorder also have social phobia or GAD, and
2–20% have some other type of anxiety disorder (Goisman et al., 1995). - Over a third of those with panic disorder also have a personality disorder—an Axis II disorder
(Ozkan & Altindag, 2005).
Onset- Panic disorder is most likely to arise during two phases of life: the teenage years or the mid-30s.
Course- The frequency of panic attacks varies from person to person:
° Some people get panic attacks once a week for months,
° Others have attacks every day for a week. - The frequency of panic attacks can vary over time:
° After having regular panic attacks, a person can experience weeks or even years with less fre-
quent attacks or no attacks at all,
° Other patients come to have limited-symptom attacks—experiencing fewer than the mini-
mum of four symptoms necessary for a diagnosis of panic attack (see Table 7.3),
° Some people have no change over time in the frequency of their attacks.
Gender Differences- Women are two to three times more likely than men to be diagnosed with panic disorder.
Cultural Differences- Symptoms of panic disorder are generally similar across cultures, although people in some
cultures may experience or explain the symptoms differently, such as “wind overload” among
the Khmer (Hinton et al., 2002, 2003).
Source: Unless otherwise noted, information in the table is from American Psychiatric Association, 2000.