284 TREATMENT OF SPECIFIC ANXIETY DISORDERS
without a history of panic disorder (AWOPD; 300.22). The first two diagnoses are dis-
tinguished on the basis of presence or absence of situational avoidance. If a more inclu-
sive definition of agoraphobic avoidance is used to include experiential and interoceptive
(internal) cues (White et al., 2006), then practically no one would receive a diagnosis of
panic disorder without agoraphobia.
Psychiatric Comorbidity
Panic disorder is associated with a high rate of diagnostic comorbidity. Based on a large
clinical sample (N = 1,127), Brown, Campbell, et al. (2001) found that 60% of individu-
als with a principal diagnosis of panic disorder with agoraphobia (n = 360) had at least
one other Axis I disorder. The most common comorbid conditions were major depres-
sion (23%), GAD (22%), social phobia (15%), and specific phobia (15%). PTSD (4%)
and OCD (7%) were relatively less common comorbid disorders. In the NCS 55.6%
of individuals with lifetime panic disorder met criteria for lifetime major depression,
whereas only 11.2% of those with lifetime major depression were comorbid for lifetime
panic disorder (Roy-Byrne et al., 2000). Panic disorder is more severe in those with
comorbid major depression (Breier, Charney, & Heninger, 1984). In terms of temporal
relationships, another anxiety disorder is more likely to precede panic with or without
agoraphobia (Brown, DiNardo, Lehman, & Campbell, 2001; Newman et al., 1996).
table 8.3. Dsm-iv Diagnostic Criteria for panic Disorder
Criterion A. Both (1) and (2):
(1) recurrent unexpected Panic Attacks (i.e., at least two)
(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 panic attacks
Criterion B.
Presence of agoraphobia is necessary for a diagnosis of Panic Disorder with Agoraphobia (300.21)
or absence of agoraphobia for a diagnosis of Panic Disorder without Agoraphobia (300.01)
Criterion C.
The Panic Attacks are not due to the direct physiological effects of a substance (e.g., drug of abuse,
a medication) or a general medical condition (e.g., hyperthyroidism)
Criterion 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).
Note. From American Psychiatric Association (2000). Copyright 2000 by the American Psychiatric Association.
Reprinted by permission.