THE DSM-IV PANIC DISORDER FIELD TRIAL - PANIC ATTACK FREQUENCY AND FUNCTIONAL DISABILITY

The goal of the DSM-IV panic disorder field trial was to provide an em pirical basis for choosing between alternate proposals (DSM-III-R and proposed DSM-IV) for the diagnostic threshold for panic disorder, in p articular the number and frequency of panic attacks required for diagn osis, The two criteria sets were compared with respect to their abilit y to identify, individuals whose panic attacks were associated with di stress, impairment or help-seeking, Subjects were a convenience sample screened in three geographically diverse primary care clinics for pre sence (past 6 months) or absence (lifetime) ofpanic attacks. Each unde rwent a clinician-administered semistructured interview which included assessment of panic frequency, panic-related impairment psychiatric d iagnosis, health services utilization, and medical illness. Self-perce ived health-related quality of life was assessed using the Medical Out come Study SF-36 Health Survey Questionnaire, Although both proposals diagnosed the same proportion of panic-impaired individuals, they were not completely overlapping Twenty percent of subjects diagnosed by ea ch criteria set were excluded by the other, Subjects who had been excl uded by the DSM-III-R but included by the DSM-IV proposal were those w ith fewer than 4 attacks in 4 weeks who also denied worry about the '' next'' attack. Broadening the worry criterion to include concerns abou t the health implications of attacks enabled diagnosis of this group, Subjects who met DSM-III-R, but not the proposed DSM-IV criteria, had 4 attacks in 4 weeks bat denied any panic related worry Modification o f the DSM-IV proposal to include a month of worry or ''a significant c hange in behavior related to the attacks'' allowed inclusion of this g roup in the diagnostic category. These data suggest that the finalized DSM-IV panic disorder criteria will diagnose a greater proportion of individuals whose panic attacks are associated with impairment without inflating the diagnostic category or significantly reducing specifici ty. (C) 1996 Wiley-Liss, Inc.