Panic Disorder

Key Features

• More likely to present after the onset of puberty with a prevalence rate of 2–3% during adolescence

• Unlike many other anxiety disorders, there is more likely to be a stressor preceding the onset of panic disorder

• Children who experience separation anxiety disorder are at increased risk for panic disorder

Clinical Findings

• Palpitations, sweating, shortness of breath, choking, chest pain or tightness

• Gastrointestinal distress

• Dizziness

• Chills or heat, numbness, or tingling

• Cognitive symptoms can include feelings of unreality, fear of going crazy, or of dying

Diagnosis

• To meet criteria for a panic attack, at least four of the above symptoms must be present

• Youth are most likely to present to the pediatrician with fears related to physical symptoms of autonomic arousal, such as a fear that there is something wrong with their heart

Treatment

• Cognitive behavioral therapy focuses on the cognitions associated with the panic attack as well as the physiologic distressing symptoms

• Exposure targets may include situations that trigger panic attacks or some of the physiologic symptoms experienced during an attack

• Patients who do not respond to therapy alone may benefit from a selective serotonin reuptake inhibitor (SSRI)