Panic Disorder

Palpitations, shortness of breath, sweating, sense of doom, fear of death

Recurrent, unexpected panic attacks followed by persistent concern about future attacks or behavioral changes; attacks are not triggered by specific situations

Generalized Anxiety Disorder

Difficulty sleeping, muscle tension, restlessness

Excessive worry about multiple events/activities for 6+ months; worry is diffuse and not tied to discrete panic episodes

Agoraphobia

Fear of places where escape might be difficult

Can develop secondary to panic disorder; fear is about situations rather than discrete panic episodes; may exist without history of panic

Social Anxiety Disorder

Anticipatory fear, physical symptoms in social situations

Fear specifically of social scrutiny; panic attacks are typically performance-related, not spontaneous

Cardiac Arrhythmias

Palpitations, chest pain, dizziness, shortness of breath

Objective ECG findings; palpitations are typically sustained; no fear of doom characteristic of panic

Hyperthyroidism

Anxiety, palpitations, weight loss, heat intolerance, tremor

Positive thyroid function tests; goiter, exophthalmos; symptoms are persistent, not episodic

Pheochromocytoma

Panic-like episodes with hypertension, headaches, palpitations

Episodes are catecholamine-induced; elevated metanephrines; tumor visible on imaging

Vestibular Dysfunction (Meniere's, PPPD)

Dizziness, disorientation, nausea, sense of unreality

Chronic dizziness patterns; specific vestibular test abnormalities; no discrete panic episodes

Seizure Disorders (Temporal Lobe)

Deja vu, aura, altered consciousness, automatisms

Stereotyped seizure activity; EEG abnormalities; post-ictal confusion

Substance Intoxication/Withdrawal

Anxiety, tremors, sweating, agitation