background There is uncertainty about the clinical relevance of panic disorder and subsyndromal panic disorder.
aim To assess the clinical relevance of panic disorder and subsyndromal panic disorder.
method We searched Medline and Psycinfo for population studies performed as from 1980. We used as search terms: 'general population', 'psychiatr*', 'prevalence' and 'panic'. On the basis of the studies found we compiled a review of the epidemiology of panic which enabled us to assess the clinical relevance.
results The life time prevalence of panic disorder is 2.1%; subsyndromal panic disorder is more prevalent (limited symptom attacks 7.5%, infrequent panic attacks 5.1%). Lifetime psychiatric comorbidity is high. The risk and symptom profile for panic disorder and subsyndromal panic disorder is the same. The course of both disorders is unfavourable. There is an increased risk that someone with panic disorder will develop a depression; subsyndromal panic disorder is a nonspecific precursor of psychopathology. Both panic disorder and subsyndromal panic disorder are associated with attempted suicide, deficiencies and the use of the health care services, even after comorbidity has been corrected for.
conclusion It is incorrect only to label panic symptoms 'pathological' if they satisfy the dsm criteria for panic disorder; both panic disorder and subsyndromal panic disorder are clinically relevant.