In differential diagnosis, with Panic Disorder, somatic symptoms and health anxiety tend to occur in which type of episodes?

• A. Panic Disorder: Acute episodes; SSD: Persistent
• B. Panic Disorder: Chronic; SSD: Persistent
• C. Panic Disorder: Acute; SSD: Acute
• D. Panic Disorder: Intermittent; SSD: Persistent

Answer: (A)

The key idea is how the symptoms unfold over time. Panic attacks are discrete, abrupt episodes of intense fear that peak within minutes, bringing prominent somatic sensations like palpitations, sweating, dizziness, and shortness of breath. These somatic symptoms are tied to the acute panic episode and tend to come and go with each attack, with little or no symptoms between episodes. Health anxiety in this context is often linked to fear of having another attack, rather than a constant preoccupation with bodily symptoms.

In contrast, somatic symptom disorder involves persistent somatic symptoms that are present for a long period, typically months, and are accompanied by excessive thoughts, feelings, or behaviors about those symptoms. The focus is ongoing distress and preoccupation with bodily symptoms, not limited to discrete panic episodes.

So the pattern that fits differential diagnosis is panic disorder with acute episodes for the somatic symptoms and health anxiety, versus somatic symptom disorder with persistent symptoms.