Generalized anxiety disorder with panic attacks
Pro Research Analysisby 
Searched over 200M research papers
Generalized Anxiety Disorder with Panic Attacks: An Overview
Prevalence and Characteristics of Panic Attacks in GAD
Prevalence of Panic Attacks in GAD Patients
Panic attacks are a significant concern for individuals with Generalized Anxiety Disorder (GAD). Research indicates that approximately 21% of patients with GAD experience panic attacks specifically related to their generalized anxiety1. These panic attacks can be categorized into different types: situationally predisposed, situationally bound, and unexpected, with unexpected panic attacks being the most common at 39.4%1.
Symptom Severity and Anxiety Sensitivity
Patients with GAD who experience panic attacks tend to have higher scores on the Anxiety Sensitivity Index, indicating a heightened sensitivity to anxiety symptoms compared to those who experience other types of panic attacks1. This suggests that anxiety sensitivity plays a crucial role in the manifestation of panic attacks within the context of GAD.
Prodrome of Generalized Anxiety in Panic Disorder
Prodromal Symptoms
A significant subset of patients with panic disorder (PD) report experiencing generalized anxiety symptoms as a prodrome before the onset of their first panic attack. Specifically, 28% of patients with PD had a prodrome of generalized anxiety lasting a median of five years2. This prodromal phase can complicate the diagnosis, as these patients may initially be misdiagnosed with GAD, contributing to the heterogeneity of GAD presentations2.
Risk Factors and Predictive Models
Emotion Regulation and Anxiety Sensitivity
Both non-clinical panic attacks and PD are associated with GAD, primarily due to shared factors such as anxiety sensitivity and difficulties in emotion regulation3. Emotion regulation difficulties, in particular, have been found to reliably predict GAD beyond the presence of non-clinical panic attacks and PD, highlighting the importance of addressing these underlying issues in treatment3.
Diagnostic and Treatment Considerations
Screening and Diagnosis
GAD and PD are common in primary care settings, and while universal screening is not currently recommended, evaluation should be considered for patients presenting with pervasive worry or unexplained somatic symptoms4. Validated screening tools such as the GAD-7 and the Panic Disorder Severity Scale (PDSS) can aid in the diagnosis and assessment of these conditions4 8.
Treatment Approaches
Effective treatments for both GAD and PD include cognitive-behavioral therapy (CBT) and antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)4 5. Benzodiazepines are generally not recommended for long-term use due to risks of dependence and adverse reactions4.
Distinguishing GAD from PD
Symptom Profiles and Comorbidity Patterns
GAD and PD have distinct symptom profiles and patterns of comorbidity. GAD is characterized by central nervous system hyperarousal and a gradual onset, whereas PD is marked by autonomic hyperactivity and more acute episodes6 7. GAD patients often have comorbid simple phobias, while PD patients are more likely to experience depersonalization, agoraphobia, and social phobia6.
Historical Context and Diagnostic Evolution
Historically, GAD and PD were not always distinct diagnostic categories. The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 formally separated anxiety neurosis into GAD and PD, based on differences in symptomatology and response to treatment9 10. This distinction has been maintained in subsequent editions, although the boundaries between these disorders and other anxiety-spectrum conditions remain a topic of ongoing research and debate9.
Conclusion
Understanding the interplay between GAD and panic attacks is crucial for accurate diagnosis and effective treatment. The prevalence of panic attacks in GAD patients, the role of anxiety sensitivity, and the importance of emotion regulation are key factors that clinicians must consider. Distinguishing between GAD and PD, while recognizing their comorbidities and historical context, can guide more targeted and effective therapeutic interventions.
Sources and full results
Most relevant research papers on this topic
Panic Attacks in Generalized Anxiety Disorder
One in five patients with generalized anxiety disorder (GAD) reported experiencing panic attacks, with higher anxiety sensitivity scores.
Observational StudyThe occurrence of a prodrome of generalized anxiety in panic disorder.
A prodrome of generalized anxiety symptoms can occur in panic disorder patients, contributing to the heterogeneity of generalized anxiety disorder.
Observational StudyAn examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample.
Emotion regulation difficulties are a reliable predictor of generalized anxiety disorder, with shared relationships between panic disorder and GAD partially explaining their association.
Observational Study
Highly CitedGeneralized Anxiety Disorder and Panic Disorder in Adults.
Generalized anxiety disorder and panic disorder are common mental health conditions in adults, and effective therapies include cognitive behavior therapy and antidepressants.
Panic and generalized anxiety disorders: Nature and treatment
EMG biofeedback and relaxation treatments effectively improve anxiety levels in both panic and generalized anxiety disorder patients, with both disorders responding equally well to treatment.
RCTHighly CitedGeneralized Anxiety Disorder vs. Panic Disorder: Distinguishing Characteristics and Patterns of Comorbidity
The distinction between generalized anxiety disorder (GAD) and panic disorder (PD) is valid, with GAD having a more central nervous system hyperarousal symptom pattern and a more gradual onset of illness, and unique patterns of comorbidity within each disorder.
Observational StudyHighly CitedA comparison of panic disorder and generalized anxiety disorder.
Generalized anxiety disorder has fewer autonomic symptoms, a more gradual onset, and a more chronic course and more favorable outcome compared to panic disorder.
Observational StudyHighly CitedMood and Anxiety Disorders: Generalized Anxiety and Panic Disorders.
Generalized anxiety disorder (GAD) and panic disorder (PD) are common anxiety disorders in the United States, and effective treatment involves serotonin reuptake inhibitors and psychotherapy.
The history of generalized anxiety disorder as a diagnostic category
Generalized anxiety disorder (GAD) has been a diagnostic category since the third edition of the DSM-III in 1980, with worry about various life circumstances being the core symptom.
Highly Cited