Which of the following is the defining feature that distinguishes panic attacks from generalized anxiety in panic disorder?

Explanation

## Panic Attacks: Clinical Characteristics ### Defining Features of Panic Attacks **Key Point:** Panic attacks are characterized by **sudden, unexpected onset** with **rapid escalation to peak intensity within 5–10 minutes**, accompanied by prominent **autonomic and somatic symptoms**. ### Core Diagnostic Criteria (DSM-5) | Feature | Panic Attack | Generalized Anxiety | |---------|--------------|--------------------| | **Onset** | Abrupt, often without warning | Gradual, insidious | | **Peak Intensity** | 5–10 minutes | Persistent, fluctuating | | **Autonomic Symptoms** | Prominent (palpitations, sweating, tremor, dyspnea) | Present but less dramatic | | **Sense of Impending Doom** | Intense, often catastrophic | Worry-based, less acute | | **Duration** | Brief (10–20 minutes typically) | Hours to days | ### Autonomic Manifestations in Panic 1. Cardiovascular: palpitations, chest pain, tachycardia 2. Respiratory: dyspnea, hyperventilation, sensation of choking 3. Neurological: dizziness, paresthesias, depersonalization/derealization 4. Gastrointestinal: nausea, abdominal distress **High-Yield:** The **sudden onset + rapid peak + autonomic storm** triad is pathognomonic for panic attacks and distinguishes them from other anxiety disorders. **Mnemonic:** **PANIC** = **P**eak in minutes, **A**utonomic surge, **N**o gradual buildup, **I**ntense fear, **C**atastrophic thoughts **Clinical Pearl:** Patients often present to emergency departments with panic attacks, fearing a cardiac or respiratory emergency. Reassurance and breathing techniques are first-line acute management.