Below, you will find criteria that are normally required before a "diagnosis" of "panic attacks" is given.

1) At some time during the disturbance, one or more panic attacks (discrete periods of intense fear or discomfort) have occurred that were (A) unexpected (i.e., did not occur immediately before or on exposure to a situation that almost always caused anxiety) and ( not triggered by situations in which the person was the focus of others’ attention.

2) Either four attacks, as defined by #1 above, have occurred within a 4-week period, or one or more attacks have been followed by a period of at least a month of persistent fear of having another attack.

3) At least four of the following symptoms developed during at least one of the attacks:
a) Shortness of breath (dyspnea) or smothering sensations,
Dizziness, unsteady feelings, or faintness,
c) Palpitations or accelerated heart rate (tachycardia),
d) Trembling or shaking,
e) Sweating,
f) Choking,
g) Nausea or abdominal distress,
h) Depersonalization or derealization,
i) Numbness or tingling sensations (parathesias),
j) Flushes (hot flashes) or chills,
k) Chest pain or discomfort,
l) Fear of dying, and/or
m) Fear of going crazy or of doing something uncontrolled

As a side note, attacks involving four or more symptoms are "panic attacks"; but, attacks involving fewer than four symptoms are known as a "limited symptom attack".

4) During at least some of the attacks, at least four of the symptoms in list #3 developed suddenly and increased in intensity within 10 minutes of the beginning of the first symptom noticed in an attack.

5) You need to determine whether an organic factor initiated and maintained the disturbance (e.g., amphetamine or caffeine intoxication or a medical condition, such as hyperthyroidism or mitral valve prolapse).

6) In case you're wondering, Agoraphobia is a fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of a panic attack. As a result of this fear, the person either restricts travel or needs a companion when away from home or else endures agoraphobic situations despite intense anxiety. Common agoraphobic situations include being outside the home alone, being in a crowd or standing in line, being on a bridge, and traveling in a bus, train, or car.

7) Social Phobia is a fear of exposure to the scrutiny of others, particularly the fear of embarrassment or humiliation due to one’s actions while others are watching.

Anxiety is a part of everyday life and in many situations can be functional. Anxiety is generally considered a normal reaction if it is aroused by a present danger and if it dissipates when the danger is no longer present. If the degree of anxiety is greatly disproportionate to the danger or if no objective danger is present, then the reaction is considered to be abnormal. The precise boundaries between what is considered to be normal and abnormal anxiety are defined to a large degree by social norms. It is generally agreed that the thinking of the anxious client is dominated by themes of danger. The client anticipates threats to self and family, and those threats can be either physical, psychological, or social in nature. In phobias, the anticipation of physical or psychological harm is confined to specific situations. The fears are based on the client’s exaggerated conception of specific harmful attributes of these situations. The phobic is not afraid of the situation or object in and of itself, but rather, is afraid of the consequences of being in the situation or in contact with the object. With Generalized Anxiety Disorder and Panic Disorder, the client anticipates danger in situations that are less specific and therefore more difficult to avoid. Thus, the thinking of the anxious client is characterized by repetitive thoughts about danger that take the form of continuous verbal or pictorial cognitions about the occur-rence of harmful events. A number of cognitive distortions are particularly common in anxious clients and tend to amplify their anxiety:

--Catastrophizing. Anxious clients tend to dwell on the most extreme negative consequences conceivable, assuming that a situation in which there is any possibility of harm constitutes a highly probable danger. Simple phobics tend to expect disaster in the form of phys-ical harm when faced with a specific situation or object, social pho-bics expect more personal disaster in the form of humiliation and embarrassment, and agoraphobics expect disaster as the conse-quence of their own internal experience of anxiety or panic attacks.

--Personalization. Anxious individuals often react as though external events are personally relevant and are indications of a potential danger to him or her. Thus, if an anxious client hears about a car accident, she or he may decide that he or she is likely to have a car accident as well.

--Magnification and minimization. When anxious, individuals tend to focus on signs of danger or potential threat to the exclusion of other aspects of the situation. Thus the anxious client tends to emphasize any aspects of a situation that might be seen as dangerous and minimize or ignore the nonthreatening or rescue factors in a situation.

--Selective abstraction. The anxious person often focuses on the threat-ening elements of a situation and ignores the context.

--Arbitrary inference. The anxious client frequently jumps to dire con-clusions on the basis of little or no data. For example, a client may assume that any unusual feeling in the body must be a heart attack or that any turbulence means the airplane will crash.

--Overgeneralization. The client may view a time-limited situation as lasting forever (i.e., “this panic attack will never end”), may assume that because a particular problem has occurred previously it is bound to reoccur frequently or may assume that if he or she had any difficulty in a particular situation that shows that the situation is dangerous.

Also, there is some research that has demonstrated that certain beliefs are characteristic of anxious individuals, such as:
--believing that if something is or may be dangerous or fearsome, one should be terribly upset about it and continually think and worry about it (anxious overconcern),
--that one has to be thoroughly competent, adequate, and achieving in order to be worthwhile (personal perfection),
--that it is horrible when things are not the way they would like them to be (catastrophizing), and
--that it is easier to avoid than to face life’s difficulties (problem avoidance).

* People who phobia also may typically believe that it is essential to be loved and approved by all significant others (demand for approval),

* Phobic individuals may also have the idea that the past determines present feelings and behav-iors, which cannot be changed (helplessness), and think that one must do well at everything to be worthwhile (high self-expectations).

* Phobic individuals may also be ruled by the belief that it is a dire necessity to be loved by everyone for everything they do, and

* They also seem to hold the underlying assumption that it is essential to appear strong and in control at all times (and that any demonstration of weakness or anxiety is disastrous).

* Agoraphobics seem to be especially concerned with the issue of control and to hold the underly-ing assumption that one must have certain and perfect control over things. Such individuals also tend to hold a generalized belief that the world is threatening if confronted independently and that security from danger must be ensured either through the availability of a loved one or by being extremely cautious.

I know that some of this is "highly technical" information. However, it is helpful to some people and that it provides some insight into what may be going-on inside.

Sincerely,

Dr. Dave