Pediatric Panic Disorder Differential Diagnoses

Updated: Oct 04, 2018
  • Author: Jeffrey S Forrest, MD, FAPA; Chief Editor: Caroly Pataki, MD  more...
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Diagnostic Considerations

Currently, no consistent physiologic findings have been identified as diagnostic for panic disorder. However, adults with panic disorder have been found to differ from adults without the disorder. For example, panic disorder sometimes is associated with signs of compensated respiratory alkalosis. An increased frequency of panic attack response in reaction to sodium lactate infusion or carbon dioxide inhalation has been reported in research settings. [3]  There have also been studies that suggest differential activation of neural circuitry in fMRI imagery in patients with panic disorder. [4]

Temporal lobe epilepsy may present with panic symptomatology and is another diagnostic consideration in the evaluation of pediatric panic disorder. EEG and relevant brain imaging may be appropriate in atypical presentations with high index of clinical suspicion for possible neurological pathology. [9]

Panic attacks and agoraphobia can occur with several anxiety disorders.

Although panic disorder is more frequent in older adolescents and adults, it does occur in children. It is an important disorder to consider because unrecognized and untreated panic disorder can have a devastating impact on a child's life and can interfere with normal development, schoolwork, and relationships.

Because literature describes the risk of suicide in patients with comorbid depression and because risks are associated with unwarranted diagnostic procedures, consideration of this diagnosis is important when a child presents with the symptoms described earlier.

In the event that further nonpsychiatric medical evaluation is warranted, early mental health professional consultation is important to obtain assistance in excluding this diagnosis.

The initial assessment of symptoms of mental health problems such as panic disorder is commonly performed by a primary care physician. In recent times, mental health screening has been called for as a routine component of pediatric health care. [7]

The family context of a patient presenting with panic disorder symptoms should also be understood, as it may influence the presentation of the patient. [10]

Conditions to consider in the differential diagnosis of panic disorder include the following:

  • Anxiety disorder caused by a general medical condition

  • Substance-induced anxiety disorder

  • Delusional disorder

  • Psychotic disorder

Panic disorder may be and frequently is comorbid with other anxiety disorders, including the listed differential diagnoses. [11] Despite the broad differential diagnosis, panic disorder may be identified in children when a systematic assessment is used. [11]

Go to Pediatric Generalized Anxiety Disorder and Pediatric Obsessive-Compulsive Disorder for complete information on these topics.

Differential Diagnoses