Psychiatrically referred adolescents with panic attacks: presenting symptoms, stressors, and comorbidity

This study examined presenting symptoms, precipitants and comorbidity in a sample of 28 adolescents (21 females, 7 males) who met criteria for clinically significant panic attacks.

A semistructured psychiatric interview was used to gather information about symptoms and precipitants, from which probable diagnoses were derived for each case. Thirteen subjects also completed a computerized version of the Diagnostic Interview for Children and Adolescents.

The majority of cases (64%) were referred for anxiety related problems, although 36% presented with other symptoms that obscured the presence of panic attacks. Refusal to eat associated with nausea was noted in one third of the females. Psychosocial stressors regularly precipitated the onset of panic attacks. Phobic avoidance was present in more than three quarters of the sample and affective disorder preceded or occurred independently of panic attacks in half. Six cases met criteria for attention-deficit hyperactivity disorder and six for oppositional disorder.

Clinicians need to inquire about the presence of panic attacks, especially in adolescents who present with concerns about eating. Management of adolescents with panic attacks should address coexisting symptomatology, including behavioral and attentional difficulties.