The essential characteristic is recurrent severe anxiety attacks (panic) that are not limited to a specific situation or particular circumstances and are therefore unpredictable. As with other anxiety disorders, the main symptoms include sudden heart palpitations, chest pain, feelings of suffocation, dizziness, and feelings of alienation (depersonalization or derealization). Fear of dying, loss of control, or fear of going insane often develops secondarily. Panic disorder should not be used as the primary diagnosis if the individual is suffering from a depressive disorder at the onset of the panic attacks. In these circumstances, the panic attacks are likely to be secondary to the depression.
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