The determination of whether a panic attack is expected or unexpected is best determined by:

Panic disorder is classified as an anxiety disorder in DSM-5. According to the guidelines, in order to be diagnosed with a panic disorder, you must experience unexpected panic attacks on a regular basis.

What else does DSM-5 say about a panic disorder? How does the way it's diagnosed in DSM-5 compare to previous editions of the manual? Among the updates are clarification on the types of panic attacks and how agoraphobia is associated with panic disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA) is the system used in the United States to diagnose mental health disorders. The DSM contains diagnostic criteria used by mental health professionals to classify and describe every known mental illness.

The 2013 release of DSM was the first significant update since 1994. Many changes were made in this fifth edition (DSM-5), including some updates to the diagnosis of panic disorder.

This system is not without controversy. Many disorders have overlapping symptoms. Some professionals question the validity of this type of classification system, while others feel there is a great deal of subjectivity in its application.

Despite these reservations, a diagnosis is often necessary for treatment, research, and insurance reimbursement. Many professionals feel that this system is far better than no system at all.

The diagnostic criteria for panic disorder are defined in the DSM-5. It is an anxiety disorder based primarily on the occurrence of panic attacks, which are recurrent and often unexpected.

In addition, at least one panic attack is followed by one month or more of the person fearing that they will have more attacks and causing them to change their behavior, which often includes avoiding situations that might induce an attack.

It's important to note that a panic disorder diagnosis must rule out other potential causes for the panic attack (or event that feels like one):

• The attacks are not due to the direct physiological effects of a substance (such as drug use or a medication) or a general medical condition.
• The attacks are not better accounted for by another mental disorder. These may include a social phobia or another specific phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or separation anxiety disorder.

Since panic attacks are key to a panic disorder diagnosis, they are well-defined and specific. This is where the updates in the DSM-5 are significant.

The previous version (DSM-IV) classified panic attacks into three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued. The DSM-5 simplifies the approach to classifying panic attacks by providing just two very clear categories: expected and unexpected panic attacks.

Expected panic attacks are those associated with a specific fear, like that of flying. Unexpected panic attacks have no apparent trigger or cue and may appear to occur out of the blue. According to DSM-5, a panic attack is characterized by four or more of the following symptoms (the presence of fewer than four symptoms may be considered a limited-symptom panic attack):

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• A feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations (paresthesias)
• Chills or hot flushes

In previous versions of DSM, agoraphobia was associated with panic disorder. With the updates of DSM-5, agoraphobia is now a separate and codable diagnosis. This is one of the biggest differences in the updates.

Within the update to agoraphobia, DSM-5 notes that a person must experience intense fear or anxiety in a minimum of two situations. These include being out in public, open spaces, and in crowds—essentially anywhere in which you're outside of the home.

It also notes that avoidance behaviors must be exhibited. These are a result of the fear of being in situations that may induce panic attacks or anxiety in which help may not be available or that it's difficult to flee.

It is important to know that the symptoms of panic disorder may mimic many other anxiety disorders and/or medical conditions. Only your doctor or mental health professional can diagnose panic disorder.

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Anxiety disorders such as panic disorder are among the most prevalent types of mental health conditions, but only around 20% of people who have symptoms of anxiety seek treatment. Because anxiety disorders are more common in women than men, experts now recommend that clinicians screen women and girls aged 13 and older for anxiety conditions.

When seeking professional help in order to evaluate your symptoms and potentially reach a diagnosis, remember that honesty is key. You may even see one therapist and decide you'd like to see a different one instead. Remember to do what you are comfortable with.

Although it may feel difficult at first to discuss your feelings, remember that your doctor is there to help you and that speaking openly about your condition is the first step toward managing your symptoms in a healthy way.

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