Assessment of Panic Disorder
Uploaded by Jim.Dude.2 on Apr 14, 2007
On average, 18% of the population will develop an anxiety disorder at some time in their lives (NIMH, 2007), and for around 1.5% to 4% of those individuals, that will be panic disorder (Katerndahl & Realini, 1993; Kessler et al., 1994). Panic disorder is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness or dizziness (Galassi, Quercioli, Charismas, Niccolai, & Bariciulli, 2007). During an attack, an individual may feel flushed or chilled, experience tingling or numbness and may experience nausea, chest pain or smothering sensations. Attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control (Barlow, Brown, & Craske, 1995).
Unsurprisingly, panic disorder is correlated with significant suffering and disability in social and occupational domains (Leon, Portera, & Weissman, 1995), as well as a highly impaired lifestyle (Leon, Shear, Portera, & Klerman, 1993). Research also suggests a strong positive correlation between onset of panic disorder and severity of the condition (Keller & Hanks, 1993; Noyes et al., 1993), due to the persistent nature of the disorder. Furthermore, onset of panic disorder before 25 years is correlated with severe clinical psychopathology, such as increased likelihood of depression or social phobia (Goodwin & Hamilton, 2002).
Nonetheless, panic disorder is highly treatable with specific medication and cognitive therapy. However, due to the physiological nature of the symptoms individuals with panic disorder can be easily misdiagnosed or may not be diagnosed at all, meaning that accurate identification and assessment of individuals with panic disorder is essential.
There are three broad approaches to assessment in panic disorder: diagnostic interviews, clinician rated scales and self report measures. Each approach has a different application and brings with it a different set of assumptions, limitations and applications. The purpose of this review is to present valid and reliable examples of each approach so as to demonstrate that no individual measure is indefinitely more useful than any other, rather, that the usefulness and application of any one scale or interview is curtailed or facilitated by the situation to which it is applied.
There are numerous structured and semi-structured interview formats that can assess panic disorder, such as the Structured Clinical Interview for DSM-IV (First, Spizter, Gibbon, & Williams, 1996). However, when dealing with anxiety disorders the Anxiety Disorders Inventory Schedule for DSM-IV (ADIS-IV; Di Nardo, Brown, & Barlow, 1994) is preferred because of its specificity, although it...