Introduction

Given these conditions, a diagnosis of GAD is confirmed if three or more of the following symptoms are present (only one for children) on most days for 6 months:

• Being on edge or very restless
• Feeling tired
• Having difficulty with concentration
• Being irritable
• Having muscle tension
• Experiencing disturbed sleep

Symptoms should cause significant distress and impair normal functioning and not be due to a medical condition, another mood disorder, or psychosis. It should be noted that pure GAD is uncommon. It typically occurs with other mood disorders (anxiety or depression) or substance use. In one 8-year study, nearly three-quarters of GAD patients experienced depression at some point during the course of the study. A third of GAD patients had at least two other disorders of mood, substance use, or both.

Panic Disorder

Panic disorder is characterized by periodic attacks of anxiety or terror (panic attacks). They usually last 15 - 30 minutes, although residual effects can persist much longer. The frequency and severity of acute states of anxiety determine the diagnosis. (It should be noted that panic attacks can occur in nearly every anxiety disorder, not just panic disorder. In other anxiety disorders, however, there is always a cue or specific trigger for the attack.) A diagnosis of panic disorder is made under the following conditions:

• A person experiences at least two recurrent, unexpected panic attacks.
• For at least a month following the attacks, the person fears that another will occur.

Symptoms of a Panic Attack. During a panic attack a person feels intense fear or discomfort with at least four or more of the following symptoms:

• Rapid heart beat
• Sweating
• Shakiness
• Shortness of breath
• A choking feeling or a feeling of being smothered
• Dizziness
• Nausea
• Feelings of unreality
• Numbness
• Either hot flashes or chills
• Chest pain
• A fear of dying
• A fear of going insane

Women may be more likely than men to experience shortness of breath, nausea, and feelings of being smothered. More men than women have sweating and abdominal pain. Panic attacks that include only one or two symptoms, such as dizziness and heart pounding, are known as limited-symptom attacks. These may be either residual symptoms after a major panic attack or precursors to full-blown attacks. (It should be noted that panic attacks can also accompany other anxiety disorders, such as phobias and post-traumatic stress disorder. In such cases, however, additional characteristics differentiate these disorders from panic disorder.)