A 43-year-old woman presents to the emergency department complaining of dizziness, tremor, diaphoresis, and shortness of breath. She indicates to the physician that she has come into the hospital with similar complaints twice in the past several weeks. On those occasions, as well as currently, her physical examination, routine laboratory studies, ECG, and cardiac enzymes have all been unremarkable. The patient states that these episodes are starting to concern her greatly and she is worried about going out of her house alone now. Which of the following is the most likely diagnosis?
A. Factitious disorder
B. Generalized anxiety disorder
C. Panic disorder
E. Social phobia
Explanation: The correct answer is C. This patient’s symptoms are all suggestive of panic attacks. Her symptoms do not appear to be related to substance use or a general medical condition. The frequency of her symptoms and her agoraphobia (fear of social situations) are also indicative of a diagnosis of panic disorder. Factitious disorder (choice A) is a disorder in which physical symptoms are intentionally produced or feigned. The motivation for the behavior in the patient is
to assume the sick role. Generalized anxiety disorder (choice B) is characterized by excessive anxiety and worry occurring more days than not for at least 6 months, and concerning activities such as work or school performance, with accompanying muscle tension, irritability, and sleep disturbance. Schizophrenia (choice D) is a thought disorder characterized by auditory hallucinations of at least 6 months’ duration. Social phobia (choice E) is characterized by fear and avoidance of social situations, even though it is often accompanied by a desire for social contact and interaction with others. It is often accompanied by low self-esteem.