from central nervous system depressants (e.g ., alcohol, barbiturat es) can precipitate a
panic attack. A detailed histor y should be taken to determin e if the indivi dual had panic
attacks prior to excessiv e substance use. Features such as  onset after age 45 years or the
presence of atypical symptoms during a panic attack (e.g., vertigo, loss of consciousness,
loss of bladder or bowel contro l, slurred speech, or amnesia)  suggest the possibility that a
medical condition or a substance may be causing the panic attack symptoms.
Panic disorder. Repeated unexpected panic attacks are required but are no t sufficient for
the diagnosis of panic disorder (i .e., full diagnostic criteria fo r panic disorder must be met). 
Comorbidity
Panic attacks are associated with increased likelihood of various comorbid mental dis-
orders, including anxiety disorders, depressi ve disorders, bipolar disorders, impulse-
control disorders, and substanc e use disorders. Panic attacks are associated with increased
likelihood of later developing anxiety disorder s, depressive disorders, bipolar disorders,
and possibly other disorders.
Agoraphobia
Diagnostic Criteria 300.22 (F40.00)
A. Marked fear or anxiety about two (or more) of the following five situations: 
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations because of thoughts that escape might
be difficult or help might not be available in the event of developing panic-like symp-