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Related Experiment Videos

The DSM-IV panic disorder field trial: panic attack frequency and functional disability

A J Fyer1, W Katon, M Hollifield

  • 1Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY, USA.

Anxiety
|January 1, 1996
PubMed
Summary

The DSM-IV field trial refined panic disorder diagnostic criteria, improving identification of individuals with panic attacks causing distress or impairment. Modified criteria better capture those with fewer attacks but significant worry, or more attacks without worry.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Epidemiology

Background:

  • Diagnostic criteria for panic disorder have evolved, with significant debate surrounding the number and frequency of panic attacks required for diagnosis.
  • The DSM-IV field trial aimed to provide empirical data to inform these diagnostic threshold decisions.

Purpose of the Study:

  • To compare the DSM-III-R and proposed DSM-IV diagnostic criteria for panic disorder.
  • To evaluate the ability of each criteria set to identify individuals experiencing panic attacks associated with distress, impairment, or help-seeking behavior.

Main Methods:

  • A field trial involving a convenience sample from primary care clinics.
  • Clinician-administered semistructured interviews assessing panic frequency, impairment, diagnoses, and health service utilization.

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  • Assessment of health-related quality of life using the SF-36 Health Survey Questionnaire.

    • Main Results:

    • Both DSM-III-R and proposed DSM-IV criteria identified similar proportions of panic-impaired individuals, but with only partial overlap.
    • The proposed DSM-IV criteria included individuals with fewer attacks but significant worry, while the DSM-III-R criteria included those with more attacks but no related worry.
    • Adjustments to the worry and behavioral change criteria in the DSM-IV proposal improved diagnostic inclusivity for impaired individuals.

    Conclusions:

    • The finalized DSM-IV panic disorder criteria are expected to diagnose a greater proportion of individuals with panic attacks associated with impairment.
    • These criteria aim to achieve this without significantly inflating the diagnostic category or reducing specificity.
    • The study highlights the importance of considering both attack frequency and associated worry/behavioral changes in diagnosing panic disorder.