Worked example 1
A student experiences sudden episodes of racing heart, sweating, and fear of dying, occurring without warning. For two months they have avoided leaving home in case an episode happens again.
(a) Outline diagnostic criteria for panic disorder and apply them to this case. [4 marks] (b) Distinguish panic disorder from a specific phobia. Evaluate comorbidity issues in anxiety diagnosis. [6 marks]
Show solution outline
(a) AO1 — Panic disorder criteria applied:
- Recurrent unexpected panic attacks — sudden surge of fear with physical symptoms (racing heart, sweating, fear of dying).
- Attacks not tied to a specific cue — occur 'without warning'.
- ≥1 month of persistent concern about further attacks OR maladaptive avoidance — two months avoiding leaving home.
(b) AO1 — Distinction from specific phobia:
- Specific phobia: Fear tied to identified object/situation (e.g. spiders, flying) — panic may occur on exposure but fear is focused.
- Panic disorder: Attacks are unexpected; fear centres on attack itself and its consequences (fear of dying, going mad).
AO3 — Comorbidity evaluation:
- Issue: Panic often co-occurs with agoraphobia, GAD, and depression — symptom overlap makes pure diagnosis difficult.
- Validity concern: High comorbidity suggests anxiety disorders may be dimensions on a spectrum rather than discrete categories.
- Clinical impact: Comorbidity worsens prognosis — treatment must address multiple presentations.
- Counter: DSM-5 allows specifiers (e.g. panic with agoraphobia) — improves clinical utility despite overlap.
Judgement: Clear panic presentation here, but clinician must screen for agoraphobia and depression — comorbidity is rule rather than exception.