The Problem with Using the Terminology "Panic" for Social Anxiety Disorder

People in general, as well as clinicians and university researchers, are  typically confused when using the term "panic" or the phrase "panic attack".  At present, this terminology is not used in a consistent, clearly defined manner. 

Thus, in the research literature, abundant problems exist when this  terminology is used. 

A researcher may be describing one set of behaviors defined as "panic", whereas another writer may be meaning something entirely different in a discussion of "panic".

This illustrates the importance of defining terms well.  If we do not clearly define terms, then patients with this problem are not going to be understood by professionals, and stand a greater risk of being misdiagnosed and treated incorrectly.

The definitional problems concerning the word "panic" in mental health care have existed in the literature, and in successive versions of the DSM since its inception.  It is time for a clear cut, definable, and clinically accurate change to be made; a change that is consistent with appropriate research.

Panic, panic attacks, and panic disorder should be terms that refer to what is currently labeled "panic disorder with and without agoraphobia" (DSM-IV: 300.01).  These terms and their definitions should be part of this distinct classification.

Thus, panic disorder, with and without agoraphobia, should be defined clearly in such a way that it cannot in any way be confused with other DSM-IV related disorders, particularly other anxiety disorders.

This has been a major problem in making distinctions between the clinical anxiety disorders and has led many professionals and their patients to false and misleading diagnoses.

In the past, this problem mainly affected people with social anxiety disorder (DSM-IV: 300.23) who routinely, but incorrectly, were diagnosed as having "panic disorder".  Part of the problem stemmed from the fact that people with social anxiety disorder used the term "panic" and "panic attack" interchangeably with "anxiety attack" or "high amounts of anxiety".   Because of the general way this term is used in conversational English, it is normal that people with social anxiety disorder have adopted these phrases.

However, when translating conversational and idiomatic language to research definitions, we must be more clear.  Is the person with social anxiety disorder talking about the same kind of "panic" that the person with panic disorder is referencing?  Is the experience the same?  Is the cause (i.e, the triggers) the same?  Is the duration and outcome of the "panic attack" the same? Does the patient attribute the same causes to their "panic attack"?  

The general public cannot be expected to be precise in their wording when it comes to these matters.  On the other hand, the research and clinical community in mental health, are obligated to provide clear and concise definitions which allow the clinician to make a clear and concise diagnosis of the condition. 

My contention is that this is not difficult to do.  If we define the word panic correctly, in reference to panic disorder, with and without agoraphobia, we are on the right track.

The DSM-IV defines panic and panic disorder well.  Its language is fairly concise, and it describes a condition that has a distinct pattern across the millions of people who live with this disorder (i.e., panic disorder is estimated to affect approximately 4% of the American population, according to government epidemiological estimates). 

Professionals should ask the question, "What is the root cause of the self-defined panic attack"? If the panic causes feelings of physical problems (i.e, a heart attack, the loss of control, especially in public), and the person feels like a visit to the doctor or the hospital is the solution, then the person is likely experiencing a panic attack.

Again, this leads us to the importance of defining the word "panic"  clearly and carefully.

After the advent of the recent multi-million dollar Paxil campaign  people with panic disorder (DSM-IV: 300.01) also became confused as to their diagnosis due to the lack of understanding of the existing clinical definition of panic disorder as best verbalized in the DSM-IV. 

Mental health care workers, when hearing patients panicked in some social situations, and, as a result, became anxious, attributed this "panic" to the "disorder" that the drug companies were pushing, a larger, but much less know anxiety disorder, "social anxiety disorder".

This lack of clarification causes great difficulty and often leads to misdiagnosis.

People with panic disorder, with and without agoraphobia, have panic attacks. 

People with other anxiety disorders may have very high levels of anxiety, and some people may use the term "panic" to define this anxiety.   However, people with other anxiety disorders pinpoint anxiety as the culprit, and do not feel that physical, medical problems cause the "panic".