Confusable diagnoses · PANCE / PANRE

Panic Disorder vs Post-Traumatic Stress Disorder

Written & clinically reviewed by Ryan Busch, PA-C · Updated August 2026 · Report an error

Panic Disorder and Post-Traumatic Stress Disorder are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Panic Disorder vs Post-Traumatic Stress Disorder at a glance

  • Panic Disorder: Recurrent unexpected panic attacks plus >=1 month of worry about future attacks or maladaptive behavior change.
  • Post-Traumatic Stress Disorder: Trauma exposure plus intrusion, avoidance, negative cognition/mood, and arousal symptoms >1 month.

Try two board-style questions on Panic Disorder vs Post-Traumatic Stress Disorder

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Question 1PsychiatryMedium
A 40-year-old man reports recurrent panic attacks and avoids driving because he fears being unable to escape if symptoms occur. Which of the following is the most appropriate first-line long-term pharmacotherapy?
  • AAlprazolam
  • BPropranolol
  • CSertraline
  • DHydroxyzine
Reveal answer & full explanation
Correct answer: C — Sertraline
  • AAlprazolam
  • BPropranolol
  • CSertraline✓
  • DHydroxyzine

Why Sertraline is correct

  • Panic disorder with situational avoidance is treated long-term with an SSRI plus cognitive behavioral therapy.
  • Sertraline lowers attack frequency and anticipatory anxiety without dependence, making it the preferred maintenance agent.
  • It addresses the underlying disorder rather than only aborting acute attacks.

Why the others are wrong

  • Alprazolam — fast relief but tolerance, dependence, and rebound anxiety make benzodiazepines poor long-term monotherapy (rapid-relief trap).
  • Propranolol — blunts peripheral autonomic symptoms such as tremor and palpitations but does not prevent panic attacks or reduce the anticipatory avoidance described here.
  • Hydroxyzine — a nonaddictive as-needed anxiolytic without evidence for maintenance control of panic disorder (PRN-versus-maintenance trap).
Question 2PsychiatryMedium
A 55-year-old male with post-traumatic stress disorder (PTSD) from combat has hypervigilance, flashbacks, avoidance of crowds, and nightmares for 8 years. He has tried sertraline for 2 years with only partial response. Which of the following psychotherapies has the strongest evidence for PTSD?
  • ATrauma-focused cognitive behavioral therapy
  • BSupportive expressive group psychotherapy
  • CDialectical behavior skills therapy
  • DInterpersonal social rhythm therapy
Reveal answer & full explanation
Correct answer: A — Trauma-focused cognitive behavioral therapy
  • ATrauma-focused cognitive behavioral therapy✓
  • BSupportive expressive group psychotherapy
  • CDialectical behavior skills therapy
  • DInterpersonal social rhythm therapy

Why Trauma-focused cognitive behavioral therapy is correct

  • Trauma-focused psychotherapies have the strongest evidence for post-traumatic stress disorder (PTSD).
  • Prolonged Exposure (PE): imaginal exposure (recounting the trauma repeatedly) plus in vivo exposure (real-world avoided situations) — reduces PTSD symptoms in 60-80% of patients.
  • Cognitive Processing Therapy (CPT): addresses trauma-related cognitions.
  • Eye Movement Desensitization and Reprocessing (EMDR): bilateral stimulation during trauma memory processing.

Why the others are wrong

  • Supportive expressive group psychotherapy — lacks the trauma-focused exposure component that drives PTSD symptom reduction; not first-line (right-concept-wrong-modality).
  • Dialectical behavior skills therapy — first-line for borderline personality disorder and emotion dysregulation, not PTSD (premature closure).
  • Interpersonal social rhythm therapy — used in bipolar disorder to stabilize circadian rhythms; not indicated for PTSD (confused-with mood-disorder therapy).

Additional high-yield points

  • Pharmacotherapy: selective serotonin reuptake inhibitors (SSRIs) — sertraline and paroxetine are FDA-approved; serotonin-norepinephrine reuptake inhibitors (SNRIs) — venlafaxine.
  • Prazosin (alpha-1 blocker): reduces PTSD nightmares and sleep disturbance; evidence from multiple randomized controlled trials (RCTs); doses 1-15 mg at bedtime.
  • Benzodiazepines: AVOID in PTSD — worsen long-term outcomes, increase avoidance, and potentially worsen trauma processing.
  • Cannabis: growing interest but insufficient evidence; not recommended.
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Side-by-side comparison

FeaturePanic DisorderPost-Traumatic Stress Disorder
At a glanceRecurrent unexpected panic attacks plus >=1 month of worry about future attacks or maladaptive behavior change.Trauma exposure plus intrusion, avoidance, negative cognition/mood, and arousal symptoms >1 month.
Classic presentationPanic attack: >=4 of 13 symptoms peaking within minutes — palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea, dizziness, chills/heat, paresthesias, derealization/depersonalization, fear of losing control, fear of dying; Attacks last 10-30 minutes; afterwards, patients feel exhausted; Anticipatory anxiety…Intrusion: recurrent intrusive memories, distressing dreams, flashbacks, intense distress or physiological reactivity to cues; Avoidance: of trauma-related thoughts/feelings or external reminders; Negative cognition/mood: inability to recall key aspects, persistent negative beliefs, distorted blame, persistent negative emotional state,…
Workup / key labsDSM-5-TR: Recurrent unexpected panic attacks AND >=1 month of one or both: (a) persistent concern about additional attacks or their consequences, (b) significant maladaptive change in behavior related to attacks. Not attributable to substance/medical condition and not better explained by another disorder. Agoraphobia is a separate,…DSM-5-TR: (A) Trauma exposure as defined; (B) >=1 intrusion symptom; (C) >=1 avoidance symptom; (D) >=2 negative cognition/mood symptoms; (E) >=2 arousal symptoms; (F) Duration >1 month; (G) Significant distress/impairment; (H) Not attributable to substance/medical condition. Specify dissociative subtype or delayed expression (>=6…
ImagingNot routinely required; CT/CTA only if PE, dissection, or other organic cause suspectedNot routinely indicated
First-line treatmentCognitive behavioral therapy — interoceptive exposure targets fear of bodily sensations; graded in vivo exposure to avoided situations is added for agoraphobia — strongest evidence base; SSRI — sertraline, escitalopram, paroxetine, fluoxetine (start at low dose to avoid initial activation); SNRI — venlafaxine XR; Patient education:…Trauma-focused psychotherapy — prolonged exposure (PE), cognitive processing therapy (CPT), or eye movement desensitization and reprocessing (EMDR); SSRI — sertraline or paroxetine (the only FDA-approved agents; recommended by VA/DoD 2023); fluoxetine has weaker guideline support; SNRI — venlafaxine XR; Trauma-focused psychotherapy is…

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Full outlines

Panic Disorder Post-Traumatic Stress Disorder (PTSD) All 514 diagnoses

Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.