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Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis

Peter P Roy-Byrne, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Panic attacks and panic disorder are common problems in both primary and psychiatric specialty care. With the revision of DSM-IV-TR to DSM-5, agoraphobia is diagnosed independently of panic disorder [1]. Because this is a recent change, most extant pharmacologic treatment data on agoraphobia focuses on subjects who also have panic attacks.

Panic attacks classically present with spontaneous, discrete episodes of intense fear that begin abruptly and last for several minutes to an hour. In panic disorder, patients experience recurrent panic attacks, at least some of which are not triggered or expected, and one month or more of either worry about future attacks/consequences, or a significant maladaptive change in behavior related to the attacks, such as avoidance of the precipitating circumstances.

This topic will address the epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of panic disorder. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of agoraphobia are discussed separately. The treatment of panic disorder is also discussed separately. (See "Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Pharmacotherapy for panic disorder with or without agoraphobia in adults" and "Psychotherapy for panic disorder with or without agoraphobia in adults".)


The 12-month and lifetime prevalence of panic disorder in the United States (US) population (age 15 to 54 years) was 2.7 percent and 4.7 percent, respectively, in a 2005 nationally representative study [2]. A systematic review of 13 European studies reported a 12-month prevalence rate of panic disorder of 1.8 percent [3]. The prevalence of panic disorder among primary care patients is approximately twice as high as in the general population with rates of 4 to 8 percent [4-6]. Panic attacks (which can occur in disorders other than panic disorder) are much more common than panic disorder, occurring in up to one-third of individuals at some point in their lifetime [7-9].

The disorder has a median age of onset of 24 years [2] and is approximately twice as common in women as among men, with a 5 percent lifetime prevalence among women versus 2 percent among men [10]. The prevalence decreases significantly after age 60 [2].  

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Literature review current through: Nov 2017. | This topic last updated: Aug 01, 2017.
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