What are the criteria for diagnosing panic disorder in the DSM-5? Many people start asking when their heart is pounding in a packed conference room or a crowded subway car, and a quieter question follows: is this a panic attack, or is something wrong with my body? If you later typed that question into a search bar, you probably want a plain answer, not a wall of jargon. This guide explains the criteria in everyday language and shows how a single panic attack differs from panic disorder. It also walks through how Refresh Psychotherapy in New York, NY approaches diagnosis and treatment planning, including how insurance fits in (Refresh accepts Aetna, Cigna, and UnitedHealthcare), so you know what the next step involves before you take it.
What are the criteria for diagnosing panic disorder in the DSM-5?
The DSM-5 diagnoses panic disorder when a person has repeated, unexpected panic attacks and at least one attack is followed by a month or more of persistent worry about more attacks or a significant change in behavior to avoid them. A substance or a medical condition cannot be the cause of the attacks, and another mental health condition cannot explain them better.
The DSM-5 (2013) labels these four parts A through D, and they carry over into the 2022 text revision, the DSM-5-TR. Here is what each one means, as summarized in this clinical overview of anxiety disorder diagnosis_508.pdf):
- A: You have had recurrent panic attacks that came out of the blue, with no obvious trigger.
- B: After at least one attack, for a month or longer, you kept worrying about the next one or what it might mean, such as a heart attack, losing control, or “going crazy.” Or you changed how you live to avoid attacks.
- C: A drug, a medication, caffeine, alcohol withdrawal, or a medical condition such as a thyroid or heart problem does not account for the attacks.
- D: Another condition, such as social anxiety or PTSD, does not explain the attacks better.
Matching yourself to these points is not the same as receiving a diagnosis. A qualified clinician confirms each criterion by talking with you, hearing how your attacks unfold, and looking at your history. The criteria can help you put words to what is happening, but they cannot rule anything in or out on their own.
What counts as a panic attack? The 13 symptoms explained
Before the criteria make full sense, it helps to know what the DSM-5 means by a panic attack. A panic attack is an abrupt surge of intense fear or discomfort that peaks within minutes and includes at least 4 of 13 symptoms. In plain words, those symptoms are:
- A pounding, racing, or fluttering heart
- Sweating
- Trembling or shaking
- Feeling short of breath or smothered
- A choking feeling
- Chest pain or discomfort
- Nausea or stomach distress
- Dizziness, lightheadedness, or feeling faint
- Chills or waves of heat
- Numbness or tingling
- Feeling detached from reality or from yourself
- Fear of losing control or “going crazy”
- Fear of dying
An “unexpected” attack has no clear cue in the moment. It can even start when you feel calm, such as while you read on the couch or wake from sleep. An expected attack shows up in a situation you already fear, like a crowded elevator when elevators frighten you.
The DSM-5 also notes that some people experience culture-specific symptoms, such as ringing in the ears, neck soreness, headaches, or uncontrollable screaming or crying. These symptoms are real parts of the experience, but they do not count toward the four. That detail matters at a culturally diverse practice like Refresh, where clinicians explore how your background shapes the way distress shows up and how you describe it, instead of forcing your experience into one framework.
In the DSM-5, a panic attack is not a disorder on its own. It is a “specifier,” a label a clinician can add to almost any diagnosis, including depression or PTSD, to show that panic attacks are part of the picture.
What is the difference between a panic attack and panic disorder?
A panic attack is an event, and panic disorder is a pattern. One frightening attack, or a few spread across years, does not mean someone has the disorder. The diagnosis requires repeated unexpected attacks plus at least a month of ongoing fear about them or real changes in how a person lives.
In New York, those changes often look practical. A person might take a cab instead of the express train, sit near the door in every meeting, or climb twelve flights of stairs to avoid the elevator. They might stop going to the gym because a racing heart from exercise feels too much like the start of an attack. Each choice makes sense in the moment, but together they can quietly shrink a life.
Agoraphobia is related but separate, and since the DSM-5 it has had its own diagnosis. Agoraphobia means intense fear or avoidance of places where escape might be hard or help might not be available, such as public transit, crowds, enclosed spaces, open spaces, or being outside the home alone. Many people live with both conditions, and a clinician can diagnose them together when both fit.
If this sounds familiar, you are not overreacting and you are not weak. A person living with panic disorder has a body alarm system that has learned to treat certain sensations as danger, and many people find that this learning can shift with support. Reaching out for help is a common, reasonable step.
Why do clinicians rule out medical causes and other conditions?
Clinicians rule out medical causes and other conditions because panic symptoms overlap with physical health problems and with other anxiety disorders. The right treatment depends on an accurate diagnosis, and criteria C and D are meant to guard against a mistaken one.
Criterion C covers the body. Heart rhythm problems, thyroid conditions, asthma, low blood sugar, stimulant medications, high caffeine intake, and withdrawal from alcohol or sedatives can all feel like panic. Clinical reviews of panic disorder describe a medical workup as part of the evaluation for this reason. If you have chest pain, fainting, or symptoms that are new to you, see a primary care doctor or get urgent medical care first, because a therapist does not replace that check.
Criterion D covers conditions that look similar, a sorting process clinicians call differential diagnosis:
- Attacks that only happen in social situations may point to social anxiety disorder.
- Attacks set off by one feared object or situation suggest a specific phobia.
- Attacks tied to obsessions suggest OCD.
- Attacks tied to trauma reminders suggest PTSD.
- Attacks around separation from loved ones suggest separation anxiety disorder.
Panic disorder also often occurs alongside depression or another anxiety condition, so Refresh clinicians consider co-occurring conditions throughout the intake period. For example, they separate generalized anxiety disorder from OCD by asking whether distress comes from broad worry or from intrusive thoughts and the rituals that follow. The same careful questioning helps clarify whether panic is the main concern or a feature of something else.
How does Refresh Psychotherapy approach a panic disorder diagnosis in New York, NY?
Knowing the answer to “what are the criteria for diagnosing panic disorder in the DSM-5?” is only half the picture; the other half is how a clinician actually applies them. Refresh Psychotherapy approaches diagnosis through a clinical interview that unfolds over the first 3 to 4 sessions, not through a single screening. The same therapist who does your intake provides your ongoing treatment, so you do not have to retell a painful history to a second person.
Diagnosis rests on the clinical interview, observation over time, your developmental and psychosocial history, behavioral observations, and the DSM-5 criteria. Refresh does not rely on a questionnaire or a cutoff score to decide whether someone has panic disorder.
This approach matters for panic in particular. Many people downplay their symptoms in a first meeting, and others do not realize that skipping the subway or always carrying a water bottle counts as avoidance. As trust builds over several sessions, these details often come out and can make the diagnostic picture clearer.
What happens in the 60-minute first session and sessions 3 to 4
Your first appointment is a 60-minute diagnostic intake. Your therapist asks why you are seeking help now and also covers:
- Your current symptoms
- Your psychiatric and medical history
- Previous treatment and medications
- Immediate stressors
- How symptoms affect your work and daily life
- Any safety concerns
- Your strengths and goals
Therapy itself does not happen in this session, because the intake is an assessment period. If you are using insurance, your therapist assigns a working diagnosis.
Around the second session, you and your therapist build the treatment plan together. The plan reflects how you see the problem and what you are and are not willing to try. Over sessions 3 to 4, your therapist gathers developmental, family, educational, occupational, relationship, and social history, and by that point confirms or refines the diagnosis.
What treatments are used for panic disorder?
Cognitive behavioral therapy (CBT) with interoceptive exposure is considered a first-line psychotherapy for panic disorder, and SSRI and SNRI medications are a first-line medication option. Some people combine therapy and medication.
In panic treatment, CBT usually follows steps like these, adjusted to each person:
- Learning how panic works. You map the cycle: a normal body sensation, a frightening interpretation, a rush of adrenaline, and then more sensations that seem to confirm the fear.
- Tracking attacks between sessions. Homework often includes noting when attacks happen, what you felt, and what you told yourself.
- Cognitive restructuring. You and your therapist examine thoughts like “my heart is racing, so I am having a heart attack” and compare them with the evidence.
- Interoceptive exposure. You bring on mild versions of feared sensations on purpose, for example by spinning in a chair or breathing quickly. The aim is to give your body a chance to learn that these sensations are uncomfortable but not dangerous. If you have heart or lung concerns, get a medical check before starting this step.
- Facing avoided situations. You gradually return to trains, elevators, or meetings while dropping safety behaviors such as gripping a rail or checking your pulse.
Refresh does not use a fixed exposure ladder. You and your therapist build each exposure together around your symptoms and goals. Depending on your clinician’s training and your goals, treatment may also draw on Acceptance and Commitment Therapy (ACT) strategies, which help you make room for uncomfortable sensations while you keep doing what matters to you.
Medications commonly prescribed for panic disorder include:
- SSRIs, such as sertraline, paroxetine, or fluoxetine, which are often a first choice
- SNRIs, such as venlafaxine, which are also a first-line option
- Benzodiazepines, such as clonazepam or alprazolam, which are usually limited to short-term or bridging use
- Beta-blockers, which are sometimes prescribed for the physical symptoms of situational anxiety but are not a standard treatment for panic disorder
| Medication type | How fast it works | Main risks | Intended use |
|---|---|---|---|
| SSRIs and SNRIs | Several weeks to reach full effect | Nausea, sleep changes, sexual side effects, and early jitteriness. Stopping suddenly can cause discontinuation symptoms. | Longer-term, first-line treatment |
| Benzodiazepines | Often within an hour | Drowsiness, tolerance (needing more for the same effect), physical dependence, and withdrawal if stopped suddenly. Combining them with alcohol or opioids is dangerous. | Short-term relief or a bridge while other treatment starts working |
| Beta-blockers | Usually within an hour or two | Fatigue, dizziness, and low blood pressure. They are not suitable for some people with asthma. | Calming a racing heart in specific situations, not first-line for panic disorder |
Refresh provides therapy, not medication. Questions about whether medication fits you belong with a psychiatrist, a psychiatric nurse practitioner, or your primary care doctor, and telling your prescriber about the therapy work you are doing can help them make an informed choice.
How long treatment takes depends on the person, and Refresh does not use a standard timeline. Instead, your clinician watches whether the symptoms and daily limits that brought you in are changing. Some people notice things like fewer attacks, less dread between them, or riding the express train again with less bracing, though experiences differ. If you also take medication, SSRIs and SNRIs usually need several weeks to reach full effect. Refresh provides long-term therapy, and most clients stay more than a year, which leaves room to work on related concerns the practice often treats, such as perfectionism, chronic stress, or work stress.
What can you do in the moment when your heart races or you feel dizzy?
Treatment takes time, so it helps to have a plan for the moments in between. In the moment, you can try slowing your exhale, naming the sensation as a panic surge, and staying where you are instead of escaping. These steps may not stop an attack, but they are aimed at the cycle that keeps panic going.
Start with your breath. Breathe in normally, then make each exhale longer than the inhale, for example in for four counts and out for six, since a long exhale can signal your body to settle. Next, name what is happening: “This is a panic surge. It peaks and passes.” That statement fits the DSM-5 definition, which describes a surge that peaks within minutes.
Then stay put if it is safe, whether you are on a subway platform, in an elevator, or at your desk in an open-plan office. Leaving brings quick relief, but it can also teach your brain that the place was dangerous. Try letting go of safety behaviors such as checking your pulse, searching your symptoms online, or texting someone for reassurance. Afterward, jot down what happened so you can bring it to your next session. If your symptoms are new or include chest pain, get medical help first.
When should you seek help for panic attacks?
Seek a clinical evaluation when attacks keep coming back, when worry about the next one follows you through your day, or when you start rearranging your life to avoid them. Watch for these signs:
- You have had more than one unexpected attack.
- You have spent a month or more worrying about the next attack.
- You avoid trains, meetings, elevators, exercise, or being alone.
- You use alcohol or other substances to get through certain situations.
- Attacks are affecting your work, sleep, or relationships.
- You have chest pain, fainting, or new symptoms, in which case you should see a doctor first.
Refresh is an outpatient practice. If you need more support than outpatient therapy can offer, such as inpatient care, partial hospitalization (PHP), or intensive outpatient treatment (IOP), Refresh refers you to providers better equipped to help. For medication questions, talk with a prescriber or your primary care doctor. If you have thoughts of harming yourself, get emergency care right away.
What does getting started at Refresh Psychotherapy look like?
You might be worried that you will finally open up and the therapist will not get it, or that therapy did not help before, so why would this time be different. Those are fair fears, and Refresh’s process is built around them. Getting started begins with you choosing your own therapist after reviewing each clinician’s bio, areas of specialization, therapeutic approach, and availability. Refresh does not assign clients, and if the fit feels wrong after treatment starts, the practice talks it through openly and supports a transfer to another clinician when appropriate.
The team is culturally diverse, with two clinicians who speak fluent Russian, three who speak fluent Spanish, and one who speaks fluent Italian. The practice values experienced clinicians and does not typically hire new graduates. Refresh serves adults ages 21 and older, many of them high-achieving professionals who look composed at work while panic shapes their private hours.
You can meet with a clinician in New York, NY, convenient for clients in Manhattan and Brooklyn, or use teletherapy from anywhere in New York State. Refresh accepts Aetna, Cigna, and UnitedHealthcare, and cash pay is also available. Federal parity rules generally prevent health plans from limiting mental health benefits more strictly than medical benefits, but details vary by plan, so check your benefits before your first visit. You can browse clinician profiles at Refresh Psychotherapy’s New York practice.
Care at Refresh is tailored to the person, and the practice’s aim is to support steady work over time rather than a quick fix.
Questions people ask before booking a panic evaluation
How many panic attacks do you need for a panic disorder diagnosis?
The DSM-5 requires recurrent unexpected attacks, which means more than one, plus at least a month of ongoing worry or avoidance after an attack.
Can you have panic attacks without having panic disorder?
Yes. Panic attacks can happen with other conditions or on their own. The disorder requires repeated unexpected attacks plus persistent fear or a change in behavior.
Is agoraphobia part of panic disorder in the DSM-5?
No. The DSM-5 diagnoses agoraphobia separately, although the two often occur together.
Do I need a questionnaire or test to be diagnosed with panic disorder?
Not at Refresh. If you have wondered what are the criteria for diagnosing panic disorder in the DSM-5 and how anyone checks them, the answer here is a clinical interview, observation over several sessions, and the DSM-5 criteria, not a routine questionnaire or cutoff score.
Should I see a doctor before a therapist for panic symptoms?
A medical check is wise if you have chest pain or new symptoms, because the criteria require ruling out medical causes.
Can I get panic disorder treatment through telehealth in New York?
Yes. Refresh offers teletherapy to adults across New York State.
Your next step can be a single conversation
Book a 60-minute first session with a Refresh Psychotherapy clinician in New York, NY, or by teletherapy, to talk through your symptoms and check whether your Aetna, Cigna, or UnitedHealthcare benefits apply. Before that first session, write down the places you have started avoiding, even small ones like a certain train car or the elevator at work. That list can give your therapist useful information about how panic shows up for you.
Questions About Panic Symptoms? Talk With Someone
Reading through the DSM-5 criteria can bring up a quiet worry: that what you feel is “not bad enough” to count, or that it might be something you just have to live with. Only a trained clinician can sort out whether your experiences point to panic disorder, and you do not have to match every line on a checklist to deserve support. If you are in New York, NY and want to talk through what you have been noticing, call the office at Refresh Psychotherapy to ask about individual psychotherapy.
Experiences with panic disorder and its treatment vary from person to person, and this article is general education, not medical advice or a diagnosis.
