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Panic disorder matters because the defining feature is recurrent panic attacks that strike unexpectedly, without any clear situational trigger, rather than a single frightening episode. It is diagnosed when a person has recurrent, unexpected panic attacks, sudden surges of intense fear with physical symptoms such as palpitations and breathlessness, followed by persistent worry about having another one. For example, imagine a man who has a sudden attack of chest tightness and dread while sitting quietly at home, with no obvious trigger, and then avoids leaving the house for fear of it happening again. In practice, that unpredictability of the attacks is exactly what drives the ongoing anticipatory anxiety.

A panic attack itself involves a rapid surge of intense fear peaking within minutes, with palpitations, sweating, trembling, shortness of breath, chest discomfort, dizziness and a fear of dying or losing control. Panic disorder requires recurrent, unexpected attacks plus at least a month of persistent concern about further attacks or a significant change in behaviour to avoid them. A single isolated panic attack, however frightening, does not meet criteria for panic disorder on its own. Say a patient had one panic attack during a genuinely stressful exam and has not worried about it since: that single episode alone does not justify the diagnosis. In practice, the presence of ongoing anticipatory worry, not the attack itself, is what confirms panic disorder.

• A patient with panic disorder asks for regular diazepam because it stops attacks quickly. Why is this not recommended long term?
• Before confirming panic disorder in a 45-year-old with episodic palpitations, sweating and headache alongside high blood pressure, which condition must be excluded?
• Which time course is required for an episode to count as a panic attack under ICD-11?

• Single panic attack, an isolated episode without recurrence or ongoing worry, unlike panic disorder's recurrent, unexpected pattern.
• Specific phobia, panic symptoms reliably triggered by a defined situation or object, rather than panic disorder's unpredictable, untriggered attacks.
• Agoraphobia, fear of situations where escape is difficult, often developing secondary to panic disorder, unlike panic disorder's core unexpected attacks.
• Generalised anxiety disorder, persistent worry across many domains without discrete attack peaks, whereas panic disorder centres on sudden, time-limited surges of fear.

• A benzodiazepine gives immediate relief; the problem lies in repeated use, not in the first dose.
• Benzodiazepines lower rather than raise sympathetic arousal and are not a hypertensive risk.
• Benzodiazepines and antidepressants can be co-prescribed for a short period during initiation.
• Hypothyroidism causes slowing and cold intolerance; thyrotoxicosis would be the anxiety mimic.
• Coeliac disease causes gastrointestinal and nutritional problems, not episodic hypertensive attacks.

• Extract the defining phenomenology, duration, severity and functional-impact clues.
• Match the pattern to the most specific diagnostic or assessment construct.
• Actively test the closest look-alike against the missing or contradictory clue.
• Choose the precise term rather than a broader category that is merely compatible.