The symptoms of panic disorder can be very confusing for many people. It is especially easy to confuse the intense body sensations with physical maladies such as a heart attack. Many of the people that I treat for panic attacks or anxiety attacks (two different ways of describing panic disorder) have been to the emergency room thinking that the overwhelming sensations that they were experiencing must surely be a life threatening physical problem. In fact, it is so hard for some people to accept that what they are feeling are the acute anxiety symptoms of panic disorder that they return to the emergency room again and again only to hear the same explanation. They are usually reassured that their heart is fine and they are sent home. Surprisingly, panic attack sufferers are not always told that they are experiencing panic disorder in the emergency room nor or they always referred for appropriate therapy. I have often been shocked at this. Fortunately, there are still many competent E.R. physicians who will explain about panic disorder to their patients and make an appropriate referral for psychotherapeutic treatment.
Part of the problem that leads to patient confusion is that we are designed to use the same nervous system to articulate both emotional distress and physical distress. Most people tend to think of physical problems first. It is only after they are convinced that they are physically fine that they begin to accept the reality of how intense the symptoms of panic disorder can really be. These sudden overwhelming sensations have confused many panic disorder sufferers. They can include a sudden rush of physical discomfort and fear, chest pain, heart-pounding, trembling or shaking, dizziness, sweating, hot flashes, nausea, breathlessness, a choking sensation, tingling, a fear of dying, losing control, or going crazy.
Another part of the problem is that there has not been a simple way to assess panic disorder symptoms and severity. However, the good news is that there now is. M. Katherine Shear, M.D. has developed a short quiz that tests whether a person may have panic disorder or not. The inventory she developed is the Panic Disorder Severity Scale (PDSS). It is a self-report type of test that is quickly becoming a standard in the field in screening for panic disorder.
Dr. Shear has been kind enough to make her test available for clinicians and researchers to use in assessing panic attack and anxiety attack symptoms and severity. Please note that no single test alone can diagnose whether someone has panic disorder. However, this scale may let you know that you need to seek a complete assessment, diagnosis, and treatment from a licensed mental health professional.
Below, you will find the 7-question test that may begin to bring clarity about some of the intense anxiety symptoms that you have been experiencing. Take the test and add up your score. Hopefully, it can help you decide whether you need to seek professional help.
Panic Disorder Severity Scale (PDSS) – Self-Report Form
Several of the following questions refer to panic attacks and 'limited symptom attacks'. For this questionnaire we define a panic attack as 'a sudden rush of fear or discomfort accompanied by at least 4 of the intense anxiety symptoms listed below'.
In order to qualify as 'a sudden rush', the symptoms must peak within 10 minutes. Episodes like panic attacks but having fewer than 4 of the listed symptoms are called 'limited symptom attacks'. Here are the symptoms to count:
- Rapid or pounding heartbeat
- Chest pain or discomfort
- Chills or hot flushes
- Fear of losing control or going crazy
- Trembling or shaking
- Dizziness or faintness
- Feelings of unreality
- Fear of dying
- Feeling of choking
- Numbness or tingling
- How many panic and limited symptoms attacks did you have during the week?
0 = No panic or limited symptom episodes
1 = Mild: no full panic attacks and no more than 1 limited symptom attack/day
2 = Moderate: 1 or 2 full panic attacks and/or multiple limited symptom attacks/day
3 = Severe: more than 2 full attacks but not more than 1/day on average
4 = Extreme: full panic attacks occurred more than once a day, more days than not
- If you had any panic attacks during the past week, how distressing (uncomfortable, frightening) were they while they were happening? (If you had more than one, give an average rating. If you didn’t have any panic attacks but did have limited symptom attacks, answer for the limited symptom attacks.)
0 = Not at all distressing, or no panic or limited symptom attacks during the past week
1 = Mildly distressing (not too intense)
2 = Moderately distressing (intense, but still manageable)
3 = Severely distressing (very intense)
4 = Extremely distressing (extreme distress during all attacks)
- During the past week, how much have you worried or felt anxious about when your next panic attack would occur or about fears related to the attacks (for example, that they could mean you have physical or mental health problems or could cause you social embarrassment)?
0 = Not at all
1 = Occasionally or only mildly
2 = Frequently or moderately
3 = Very often or to a very disturbing degree
4 = Nearly constantly and to a disabling extent
- During the past week were there any places or situations (e.g., public transportation, movie theaters, crowds, bridges, tunnels, shopping malls, being alone) you avoided, or felt afraid of (uncomfortable in, wanted to avoid or leave), because of fear of having a panic attack? Are there any other situations that you would have avoided or been afraid of if they had come up during the week, for the same reason? If yes to either question, please rate your level of fear and avoidance this past week.
0 = None: no fear or avoidance
1 = Mild: occasional fear and/or avoidance but I could usually confront or endure the situation. There was little or no modification of my lifestyle due to this.
2 = Moderate: noticeable fear and/or avoidance but still manageable. I avoided some situations, but I could confront them with a companion. There was some modification of my lifestyle because of this, but my overall functioning was not impaired.
3 = Severe: extensive avoidance. Substantial modification of my lifestyle was required to accommodate the avoidance making it difficult to manage usual activities.
4 = Extreme: pervasive disabling fear and/or avoidance. Extensive modification in my lifestyle was required such that important tasks were not performed.
- During the past week, were there any activities (e.g., physical exertion, sexual relations, taking a hot shower or bath, drinking coffee, watching an exciting or scary movie) that you avoided, or felt afraid of (uncomfortable doing, wanted to avoid or stop), because they caused physical sensations like those you feel during panic attacks or that you were afraid might trigger a panic attack? Are there any other activities that you would have avoided or been afraid of if they had come up during the week for that reason? If yes to either question, please rate your level of fear and avoidance of those activities this past week.
0 = No fear or avoidance of situations or activities because of distressing physical sensations
1 = Mild: occasional fear and/or avoidance, but usually, I could confront or endure with little distress activities that cause physical sensations. There was little modification of my lifestyle due to this.
2 = Moderate: noticeable avoidance but still manageable. There was definite, but limited, modification of my
lifestyle such that my overall functioning was not impaired.
3 = Severe: extensive avoidance. There was a substantial modification of my lifestyle or interference in my functioning.
4 = Extreme: pervasive and disabling avoidance. There was an extensive modification in my lifestyle due to this such that important tasks or activities were not performed.
- During the past week, how much did the above symptoms altogether (panic and limited symptom attacks, worry about attacks, and fear of situations and activities because of attacks) interfere with your ability to work or carry out your responsibilities at home? (If your work or home responsibilities were less than usual this past week, answer how you think you would have done if the responsibilities had been usual.)
0 = No interference with work or home responsibilities
1 = Slight interference with work or home responsibilities, but I could do nearly everything I could if I didn’t have these problems.
2 = Significant interference with work or home responsibilities, but I still could manage to do the things I needed to do.
3 = Substantial impairment in work or home responsibilities; there were many important things I couldn’t do because of these problems.
4 = Extreme, incapacitating impairment such that I was essentially unable to manage any work or home responsibilities.
- During the past week, how much did panic and limited symptom attacks, worry about attacks, and fear of situations and activities because of attacks interfere with your social life? (If you didn’t have many opportunities to socialize this past week, answer how you think you would have done if you did have opportunities.)
0 = No interference
1 = Slight interference with social activities, but I could do nearly everything I could if I didn’t have these problems.
2 = Significant interference with social activities but I could manage to do most things if I made the effort.
3 = Substantial impairment in social activities; there are many social things I couldn’t do because of these problems.
4 = Extreme, incapacitating impairment, such that there was hardly anything social I could do.
Scoring the Panic Disorder Severity Scale
In scoring the Panic Disorder Severity Scale, items are rated on a scale of 0 to 4. Add the individual item scores to get a total. The maximum score is 28.
Interpreting the Score of the Panic Disorder Severity Scale
Normal (no Panic Disorder) = 0 - 1
Borderline Panic Disorder = 2 - 5
Slightly Severe = 6 - 9
Moderately Severe = 10 - 13
Markedly Severe = 14 - 28
Normal (no Panic Disorder) = 0 - 2
Borderline Panic Disorder = 3 - 7
Slightly Severe = 8 - 10
Moderately Severe = 11 - 15
Markedly Severe = 16 - 28
Scores of 8 or above may be considered clinically significant and represent a level of severity that should be evaluated for therapy by a licensed mental health professional who specialized in the treatment of panic attacks.
Cause and Treatment of Panic Disorder
Panic disorder is primarily caused by the emotional midbrain making a mistake and coding a nonthreatening event or experience as dangerous. Once this type of conditioned-response has been imprinted in the midbrain or limbic system, any future reminder can activate the fight-or-flight reflex.
Secondarily, the thinking brain (cortex) can sometimes imagine a scary outcome so vividly that it tricks the midbrain into setting off the alarm. Once again, the fight-or-flight reflex is engaged. This alarm reflex is what causes the sympathetic nervous system to trigger physical changes in the body that are experienced as the panic symptoms.
Different therapies are available that can address either the midbrain or thinking brain aspects of panic disorder. Sometimes both must be treated to alleviate the problem.
Some of the methods that help the emotional midbrain are behavioral interventions including exposure therapy, EMDR and Quick REMAP. Cognitive therapy is effective for intervening at the thinking brain level.
The good news is that panic disorder is a very treatable condition. People who work with an expert in the field can be helped to overcome the overwhelming effects of panic and anxiety attacks.
To be evaluated by Steve B. Reed, LPC, LMSW, LMFT, a psychotherapist who specializes in the treatment of panic disorder, call 972-997-9955 to request an appointment for evaluation and treatment.
Steve Reed is available for an office appointment for your counseling and psychotherapy needs in the Dallas, Fort Worth, DFW metroplex, including Addison, Allen, Arlington, Bedford, Carrollton, Colleyville, Denton, Euless, Flower Mound, Frisco, Garland, Grand Prairie, Grapevine, Highland Park, Hurst, Irving, Keller, Lake Highlands, Lewisville, McKinney, Mesquite, Murphy, Plano, Richardson, Rockwall, Rowlett, and University Park. He provides therapy at his office in Richardson, TX. Treatment is also available via phone counseling to people worldwide.
Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Gorman JM, Papp LA. Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry 1997;154:1571-1575
Furukawa, T. A., M. Katherine Shear, et al. (2009). 'Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale'. Depression and Anxiety 26 (10): 922-9.
Copyright notice: The Panic Disorder Severity Scale – Self Report Form is copyrighted by M. Katherine Shear, M.D. Permission has been granted to reproduce the scale for clinicians to use in their practice and for researchers to use in non-industry studies. For other uses of the scale, the owner of the copyright should be contacted.