280 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Clinician Guideline 8.1
Panic attacks involve a sudden onset of intense fear of certain activated physical sensations
that are misinterpreted as indicating an imminent, even catastrophic, threat to one’s physical
or mental health. The misinterpretations of threat increases apprehension of and vigilance
regarding these physical symptoms, and leads to avoidance and safety- seeking responses to
reduce the possibility of future panic attacks.Varieties of Panic
It is generally recognized that there are different types of panic attacks or episodes.
Table 8.2 presents five types of panic experience that may have distinct functional char-
acteristics with implications for treatment.
Spontaneous and Situationally Cued Panic
DSM-IV-TR recognizes three types of panic. With spontaneous or unexpected (uncued)
panic attacks “the individual does not associate onset with an internal or external situ-
ational trigger (i.e., the attack is perceived as occurring spontaneous ‘out of the blue’),
[whereas] situationally bound (cued) panic attacks are defined as those that almost
invariably occur immediately on exposure to, or in anticipation of, the situational cue
or trigger” (APA, 2000, pp. 430–431). Examples of situationally cued panic include the
woman who always has a panic attack whenever she goes alone to a large department
store, the man who always has a panic episode whenever he drives outside the city lim-
its, or the young person who panics at night when left alone in the house. Situationally
predisposed panic attacks are similar to situationally bound episodes but are not always
associated with the situational cues or do not necessarily occur immediately upon expo-
sure to the situational trigger (APA, 2000). An example would be sometimes experi-
table 8.2. various types of panic attacks
Type of panic attack Description
Spontaneous panic Unexpected (“out of the blue”) panic attacks that are not associated with
external or internal situational triggers (DSM-IV-TR; APA, 2000).
Situationally cued panic Panic attacks that occur almost invariably with exposure or anticipated
exposure to a particular situation or cue (DSM-IV-TR; APA, 2000).
Nocturnal panic A sudden awaking from sleep in which the individual experiences a state of
terror and intense physiological arousal without an obvious trigger (e.g., a
dream, nightmares).
Limited-symptom panic A discrete period of intense fear or discomfort that occurs in the absence of a
real danger but involves less than four panic attack symptoms.
Nonclinical panic Occasional panic attacks reported in the general population that often occur
in stressful or evaluative situations, involve fewer panic symptoms, and are
associated with less apprehension or worry about panic (McNally, 1994).