Panic and Other Anxiety Disorders: Diagnosis and Treatment

Abstract

Anxiety, phobic and hysterical disorders have long been areas of distressing diagnostic confusion. In an attempt to clarify some of the confusion in this area the DSM III¹ classification attempted to operationalise definitions for anxiety and related disorders with precisely defined criteria in a way that reflected then current views about these disorders. The result was a significant proliferation in the number of anxiety related disorders that were felt to be distinct. What was anxiety neurosis in previous classifications was broken up into two groups 1) generalised anxiety disorder and 2) panic disorder. What was previously phobic neurosis was broken down into 1) simple phobia 2) social phobia 3) agoraphobia with panic attacks 4) agoraphobia without panic attacks. And there were many others. The rationale behind breaking up anxiety neurosis into two groups appeared to be that the severe anxiety disorder associated with spontaneous panic attacks responded well to antidepressant medication^2,3 and poorly to benzodiazepines, while the milder anxiety disorder associated with chronic tension and autonomic hyperactivity appeared to respond to benzodiazepines and antidepressants were not needed. The evidence behind this distinction was merely suggestive but on close examination does not inspire much confidence. In the absence of any definitive evidence one way or another it was decided to create 2 disorders where one existed before and to study the apparent differences over the following years.