Agoraphobia 217
Functional Consequenc es of Panic Attacks
In the context of co-occurring mental disord ers, including anxiety disorders, depressive
disorders, bipolar disorder, substance use disorders, psychoti c disorders, and personality
disorders, panic attacks are associated with  increased symptom severity, higher rates of
comorbidity and suicidality, and poorer trea tment response. Also, full-symptom panic at-
tacks typically are associated wi th greater morbidity (e.g., gr eater health care utilization,
more disability, poorer quality of life) than limited-symptom attacks. 
Differential Diagnosis
Other paroxysmal episodes (e.g., “anger attacks”). Panic attacks should not be diag-
nosed if the episodes do not involve the essent ial feature of an abrupt surge of intense fear
or intense discomfort, but rather other emotional states (e.g ., anger, grief).
Anxiety disorder due to another medical condition. Medical conditions that can cause
or be misdiagnosed as panic attacks include hyperthyroidism, hyperparathyroidism, pheo-
chromocytoma, vestibular dysfunctions, se izure disorders, and cardiopulmonary con-
ditions (e.g., arrhythmias, supraventricular  tachycardia, asthma, chronic obstructive
pulmonary disease). Appropriate laboratory tests (e.g., serum calcium levels for hyperpara-
thyroidism; Holter monitor for arrhythmias) or  physical examinations (e.g., for cardiac con-
ditions) may be helpful in determining the etiological role of another medical condition. 
Substance/medication-induced anxiety disorder. Intoxication with central nervous
system stimulants (e.g., coca ine, amphetamines, caffeine) or cannabis and withdrawal