Panic Disorders and Generalized Anxiety Disorders

Abstract

The third edition of the Diagnostic and Statistical Manual (DSM-III) (American Psychiatric Association, 1980) distinguishes between two principal types of “Anxiety States of Anxiety Neuroses,” namely, (1) “Panic Disorders,” and (2) ‘’Generalized Anxiety Disorders.” Panic disorders are defined as transient episodes lasting from several minutes to several hours and characterized by “intense apprehension, fear, or terror [with symptoms of] dyspnea; palpitations; chest pain, or discomfort; choking or smothering sensations; dizziness, vertigo, or unsteady feelings; feelings of unreality (depersonalization or derealization); parasthesias; hot and cold flashes; sweating; faintness; trembling or shaking; and fear of dying, going crazy or doing something uncontrolled during the attack” (p. 230). Unlike simple phobias, the attacks do not occur in the presence of any clearly defined stimulus, nor are they a response to an identifiable life stress. Unlike in agoraphobia, there is no strong avoidance of social situations, nor is there marked interference in social or occupational pursuits. In generalized anxiety disorders, “persistent anxiety of at least one month’s duration” is in evidence, with symptoms including motor tension (e.g., shakiness and muscle aches); autonomic hyperactivity (e.g., sweating and heart pounding); apprehensive expectation; and hypervigilance (insomnia, irritability). As in panic disorders, no discernible external stress or feared object is in evidence. The presence of panic attacks precludes a diagnosis of generalized anxiety disorders. The absence of an external stimulus does not eliminate the possibility of internal stimuli as elicitors of anxiety since internal stimuli are clearly suggested by the cognitive fears of “dying, going crazy or doing something uncontrolled.”