210 Anxiety Disorders
Associated Features Supporting Diagnosis
One type of unexpected panic attack is a nocturnal panic attack (i.e., waking from sleep in
a state of panic, which differs from panicking after fully waking from sleep). In the United
States, this type of panic attack has been es timated to occur at leas t one time in roughly
one-quarter to one-third of individuals with  panic disorder, of whom the majority also
have daytime panic attacks. In addition to  worry about panic attacks and their conse-
quences, many individuals with panic disorder report constant or intermittent feelings of
anxiety that are more broadly related to heal th and mental health concerns. For example,
individuals with panic disorder often antici pate a catastrophic outc ome from a mild phys-
ical symptom or medication side effect (e.g., thinking that they may have heart disease or
that a headache means presence of a brain tumo r). Such individuals often are relatively in-
tolerant of medication side effects. In ad dition, there may be pe rvasive concerns about
abilities to complete daily tasks or withstand daily stressors, excessive use of drugs (e.g.,
alcohol, prescribed medications or illicit drugs)  to control panic attacks, or extreme behav-
iors aimed at controlling panic attacks (e.g., seve re restrictions on food intake or avoidance
of specific foods or medications because of concerns about physical symptoms that pro-
voke panic attacks). 
Prevalence
In the general population, the 12-month prevalen ce estimate for panic disorder across the
United States and several European countries is about 2%–3% in adults and adolescents. In
the United States, significantly lower rates of  panic disorder are reported among Latinos,
African Americans, Caribbean blacks, and As ian Americans, compared with non-Latino