214 Anxiety Disorders
with alcohol or medications. Comorbidity wi th other anxiety disorders and illness anxiety
disorder is also common. 
Panic disorder is significantly comorbid  with numerous general medical symptoms
and conditions, including, but not limited to, dizziness, ca rdiac arrhythmias, hyperthy-
roidism, asthma, COPD, and ir ritable bowel syndrome. However, the nature of the asso-
ciation (e.g., cause and effect) between pani c disorder and these conditions remains
unclear. Although mitral valve prolapse and thyroid disease are more common among in-
dividuals with panic disorder than in the ge neral population, the differences in prevalence
are not consistent.
Panic Attack Specifier
 
Note: Symptoms are presented for the purpose of identifying a panic attack; however,
panic attack is not a mental disorder and cannot be coded. Panic attacks can occur in the
context of any anxiety disorder as well as other mental disorders (e.g., depressive disor-
ders, posttraumatic stress disorder, substanc e use disorders) and some medical condi-
tions (e.g., cardiac, respiratory, vestibular, gastrointestinal). When the presence of a panic
attack is identified, it should be noted as a specifier (e.g., “posttraumatic stress disorder
with panic attacks”). For panic disorder, the pr esence of panic attack is contained within
the criteria for the disorder and panic attack is not used as a specifier.
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes,
and during which time four (or more) of the following symptoms occur:
Note:  The abrupt surge can occur from a calm state or an anxious state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.