Question 1

What is the difference between panic disorder and GAD?

Accepted Answer

Panic disorder features recurrent, unexpected panic attacks — discrete surges of intense fear that typically peak within minutes. GAD features persistent, diffuse worry about multiple life domains, present more days than not for at least 6 months. The temporal pattern (episodic surges vs chronic worry) is the key anchor.

Question 2

Does buspirone work for panic disorder?

Accepted Answer

[Buspirone](/medications/buspirone) has evidence for efficacy in GAD but is not an evidence-based treatment for panic disorder. This is one of the most commonly tested pharmacologic distinctions on PMHNP boards.

Question 3

Can you have panic disorder and GAD at the same time?

Accepted Answer

Yes. The two conditions frequently co-occur. If a patient has both discrete panic attacks and chronic multi-domain worry meeting full criteria for each, both diagnoses can be assigned.

Question 4

How do you distinguish anticipatory anxiety in panic disorder from GAD?

Accepted Answer

In panic disorder, anticipatory anxiety is focused specifically on having another panic attack and avoiding situations where an attack would be hard to escape or manage. In GAD, the worry is diffuse and spans multiple life domains (work, finances, family, health) most days for at least 6 months.

Question 5

What is interoceptive exposure and why is it used in panic disorder?

Accepted Answer

Interoceptive exposure is a CBT technique for panic disorder that deliberately induces feared bodily sensations (e.g., dizziness, breathlessness, tachycardia) in a controlled setting to reduce catastrophic misinterpretation of normal physiological sensations and weaken the panic cycle.

Question 6

A 28-year-old woman presents to the emergency department for the third time in two months with acute-onset chest tightness, palpitations, diaphoresis, and a feeling that she is about to die. Each episode begins suddenly, peaks within minutes, and typically subsides within about 20-30 minutes. Between episodes, she is constantly worried about when the next episode will strike and has stopped taking the subway because she worries she could not get help or escape if an attack started. Cardiac workup is negative. Which of the following is the most likely diagnosis?

Accepted Answer

This presentation is consistent with panic disorder: recurrent, unexpected panic attacks that peak within minutes, with prominent autonomic symptoms (palpitations, diaphoresis, chest tightness) and catastrophic cognitions (fear of dying). The one-month criterion is met by her persistent concern about future attacks and behavioral change (avoidance of the subway). Her avoidance pattern — avoiding a setting where escape or help would be difficult — suggests comorbid agoraphobia, which is commonly associated with panic disorder and is diagnosed separately when criteria are met. The worry between episodes is anticipatory anxiety about panic attacks specifically — not the diffuse multi-domain worry of GAD. Somatic symptom disorder (C) involves excessive thoughts, feelings, or behaviors related to somatic symptoms that are disproportionate and persistent — it does not typically present with discrete paroxysmal surges. Illness anxiety disorder (D) involves preoccupation with having a serious illness with minimal somatic symptoms, which does not fit this episodic, symptomatic presentation.

Question 7

A 45-year-old man reports that for the past 8 months he has been unable to stop worrying about his job security, his children's academic performance, his mortgage payments, and his own health. He states that the worry is present most days and he finds it very difficult to control. He endorses chronic muscle tension, poor sleep, fatigue, and irritability. He denies discrete episodes of acute fear or autonomic surge. He has never had an episode where he felt he was dying or losing control. Which medication is most appropriate as first-line monotherapy?

Accepted Answer

This patient meets criteria for GAD: excessive worry about multiple domains, more days than not, for at least 6 months, with difficulty controlling the worry and associated symptoms (muscle tension, sleep disturbance, fatigue, irritability). Buspirone is an evidence-based pharmacotherapy for GAD with a favorable side-effect profile and no abuse potential. Buspirone is not an evidence-based treatment for panic disorder, making it a commonly tested pharmacologic distinguisher between these two conditions. Alprazolam (A), while effective for anxiety, carries dependence risk and is not considered first-line maintenance therapy. Propranolol (C) is used for performance anxiety and some somatic anxiety symptoms but is not a first-line GAD treatment. Hydroxyzine (D) may be used adjunctively but is not typically considered first-line monotherapy for GAD.

Question 8

A 34-year-old woman with panic disorder is being treated with an SSRI and referred for cognitive-behavioral therapy. Which of the following CBT techniques is most specific to the treatment of panic disorder as opposed to generalized anxiety disorder?

Accepted Answer

Interoceptive exposure is the CBT technique most specific to panic disorder. It involves deliberately inducing feared bodily sensations (spinning in a chair to produce dizziness, breathing through a straw to produce breathlessness, running in place to produce tachycardia) in a controlled therapeutic setting. The goal is to weaken the catastrophic misinterpretation of normal physiological sensations that drives the panic cycle. Cognitive restructuring (A) is a general CBT technique used across many anxiety and mood disorders. Progressive muscle relaxation (B) is more commonly associated with GAD treatment. Stimulus control techniques for worry (D) — such as scheduling a designated worry period — are specific to GAD, not panic disorder.

Panic Disorder vs GAD

Frequently Asked Questions

What is the difference between panic disorder and GAD?

Does buspirone work for panic disorder?

Can you have panic disorder and GAD at the same time?

How do you distinguish anticipatory anxiety in panic disorder from GAD?

What is interoceptive exposure and why is it used in panic disorder?

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