Panic Disorder vs Post-Traumatic Stress Disorder
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.
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Side-by-side comparison
| Feature | Panic Disorder | Post-Traumatic Stress Disorder |
|---|---|---|
| At a glance | Recurrent 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 presentation | Panic 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 labs | DSM-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… |
| Imaging | Not routinely required; CT/CTA only if PE, dissection, or other organic cause suspected | Not routinely indicated |
| First-line treatment | Cognitive behavioral therapy with interoceptive and in vivo exposure — strongest evidence base; SSRI — sertraline, escitalopram, paroxetine, fluoxetine (start at low dose to avoid initial activation); SNRI — venlafaxine XR; Patient education: panic attacks are time-limited, not dangerous; reduce safety behaviors | Trauma-focused psychotherapy — prolonged exposure (PE), cognitive processing therapy (CPT), or eye movement desensitization and reprocessing (EMDR); SSRI — sertraline and paroxetine (FDA-approved), fluoxetine, escitalopram; SNRI — venlafaxine XR; Combine medication with trauma-focused therapy in moderate-to-severe symptoms |
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