A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
	Note: The abrupt surge can occur from a calm state or an anxious state.
	1. Palpitations, pounding heart, or accelerated heart rate.
	2. Sweating.
	3. Trembling or shaking.
	4. Sensations of shortness of breath or smothering.
	5. Feelings of choking.
	6. Chest pain or discomfort.
	7. Nausea or abdominal distress.
	8. Feeling dizzy, unsteady, light-headed, or faint.
	9. Chills or heat sensations.
	10. Paresthesias (numbness or tingling sensations).
	11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
	12. Fear of losing control or “going crazy.”
	13. Fear of dying.
	Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
	1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
	2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).