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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


  • 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


  • 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)

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