Private Practice
Jul 9, 2025
F41.0 Panic Disorder: Comprehensive Guide for Mental Health Professionals

Brayden Efseroff, MD

Allia Team
Understanding Panic Disorder (F41.0): A comprehensive guide for mental health professionals covering diagnostic criteria, treatment approaches (CBT, SSRIs), comorbidities, and billing best practices.
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Quick Reference
Code: F41.0
Disorder: Panic Disorder without Agoraphobia
Category: Anxiety Disorders
Billing Status: Active code for reimbursement
DSM-5 Equivalent: 300.01 (Panic Disorder)
Common Comorbidities: Major Depression (60%), GAD (50%), Social Anxiety (30%), Substance Use Disorders (25%)
Note: F41.0 specifically excludes panic disorder with agoraphobia - use F40.01 for panic disorder with agoraphobia
Clinical Description
Panic Disorder is characterized by recurrent unexpected panic attacks followed by at least one month of persistent concern about having additional panic attacks, worry about the implications of the attacks, or significant maladaptive changes in behavior related to the attacks. Panic attacks are sudden surges of intense fear or discomfort that reach a peak within minutes.
Diagnostic Criteria
Panic Attack Criteria (must include 4+ symptoms):
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Paresthesias (numbness or tingling sensations)
Derealization or depersonalization
Fear of losing control or "going crazy"
Fear of dying
Panic Disorder Criteria:
Recurrent unexpected panic attacks (key: not cued by specific situations)
Frequency: At least 2 unexpected panic attacks, though most patients experience many more
At least one month of one or more of the following:
Persistent concern about having additional panic attacks
Worry about implications of attacks or consequences ("Am I having a heart attack?")
Significant maladaptive behavioral changes related to attacks (avoiding exercise, driving, etc.)
Importantly: No agoraphobia present (if agoraphobia is present, use F40.01)
Not attributable to substances or another medical condition
Not better explained by another mental disorder
Cultural Considerations:
Panic attack presentations vary across cultures (e.g., "falling out" in African American communities)
Somatic symptoms may be more prominent in some cultural groups
Religious or spiritual interpretations of panic symptoms should be explored
Differential Diagnosis
Condition | Distinguishing Features | ICD-10 Code |
Panic Disorder with Agoraphobia | Panic attacks PLUS persistent fear of situations where escape might be difficult | F40.01 |
Generalized Anxiety Disorder | Persistent worry rather than discrete panic episodes | F41.1 |
Social Anxiety Disorder | Panic limited to social situations | F40.10 |
Specific Phobia | Panic occurs only in presence of specific feared object | F40.2xx |
Hyperthyroidism | Medical condition causing similar symptoms | E05.x |
Cardiac Arrhythmias | Medical condition with similar physical symptoms | I49.x |
Substance-Induced Anxiety | Clear temporal relationship with substance use | F10-F19 |
PTSD | Panic attacks triggered by trauma-related cues | F43.10 |
Adjustment Disorder | Panic attacks clearly related to identifiable stressor | F43.2x |
Assessment Tools
Validated Screening & Assessment Instruments
Instrument | Description | Scoring |
7-item clinician-rated scale | 0-28 total score; 0-7 mild, 8-14 moderate, 15-21 severe | |
27-item measure of fear and avoidance | Separate subscales for agoraphobia, social phobia, interoceptive fear | |
13-item self-report measure | 0-52 total score; includes panic attack frequency and severity | |
17-item measure of fear of bodily sensations | Higher scores indicate greater fear of physical symptoms |
Treatment Approaches
Evidence-Based Psychotherapy Options
Approach | Level of Evidence | Key Components | Typical Duration |
Cognitive Behavioral Therapy (CBT) | Strong | Cognitive restructuring, interoceptive exposure, in-vivo exposure | 12-16 weeks |
Panic Control Treatment (PCT) | Strong | Breathing retraining, cognitive restructuring, interoceptive exposure | 12 weeks |
Acceptance and Commitment Therapy (ACT) | Moderate | Acceptance of anxiety symptoms, values-based action | 8-12 weeks |
Exposure and Response Prevention | Strong | Systematic exposure to feared sensations and situations | 12-16 weeks |
Mindfulness-Based Interventions | Moderate | Present-moment awareness, acceptance of physical sensations | 8 weeks |
Pharmacotherapy Guidelines
Medication Class | First-Line Options | Starting Dose | Target Dose | Notes |
SSRIs (FIRST-LINE) | Sertraline, Escitalopram, Paroxetine | 12.5-25 mg/day, 5 mg/day, 5-10 mg/day | 50-200 mg/day, 10-20 mg/day, 20-40 mg/day | Start extra low - panic patients are often very sensitive to activation |
SNRIs | Venlafaxine XR | 18.75-37.5 mg/day | 75-225 mg/day | Monitor blood pressure, gradual taper |
Benzodiazepines | Alprazolam, Lorazepam, Clonazepam | 0.125-0.25 mg TID, 0.25-0.5 mg BID, 0.125-0.25 mg BID | Lowest effective dose | AVOID as first-line - high dependence risk and risk of interference with psychotherapy effects, use only short-term if necessary at all |
Tricyclic Antidepressants | Imipramine, Clomipramine | 10 mg/day | 100-300 mg/day | Monitor cardiac function, significant side effects |
Integrative Treatment Considerations
Aerobic exercise (30+ minutes, 3-4 times weekly) reduces panic frequency and intensity
Caffeine elimination often essential for symptom reduction
Sleep hygiene interventions improve treatment outcomes
Breathing retraining techniques as core intervention
Relaxation training including progressive muscle relaxation
Nutritional considerations: Magnesium, B-complex vitamins may provide adjunctive benefit
Practice Management
ICD-10 Coding Tips
F41.0 is specifically for panic disorder WITHOUT agoraphobia
Use F40.01 for panic disorder WITH agoraphobia - this is a critical distinction
F41.0 is a billable/specific code that requires no additional specificity
Can be used as primary or secondary diagnosis
Document frequency and intensity of panic attacks
Must specify "unexpected" nature of panic attacks in documentation
Minimum of 2 unexpected panic attacks required for diagnosis
Note absence of agoraphobic avoidance explicitly
Medical Necessity Documentation Language
Example statements to support medical necessity:
"Patient experiences recurrent unexpected panic attacks occurring [X] times per week/month"
"Panic attacks reach peak intensity within [X] minutes and include [specific symptoms]"
"Patient demonstrates significant functional impairment in [specific domains] due to panic disorder"
"Anticipatory anxiety about future panic attacks has persisted for [X] months"
"PDSS score of [X] indicates [severity level] requiring professional intervention"
Other Documentation Requirements for Reimbursement
Documented evidence of at least 2 recurrent UNEXPECTED panic attacks
Specific panic attack symptoms (minimum of 4) identified with timing (peaks within minutes)
Duration of persistent concern (minimum 1 month) explicitly stated
Functional impairment or behavioral changes specified
Differential diagnosis considered and documented
Medical clearance recommended for cardiac/thyroid/respiratory conditions
Cultural factors and symptom presentation noted when relevant
Insurance Considerations
Payer | Typical Reimbursement | Authorization Requirements | Session Limits |
Medicare | Covered under Part B | No prior auth for outpatient | No specific limit |
Medicaid | Varies by state | Often requires auth after 8-10 sessions | Varies by state |
BCBS | Covered | Often requires auth after 12 sessions | Varies by plan |
Aetna | Covered | Some plans require auth | Often 20 sessions/year |
UnitedHealthcare | Covered | Some plans require auth | Varies by plan |
Client Education Resources
Handouts for Clients
Digital Resources
Recommended Apps:
Panic Relief: Guided breathing and grounding techniques
PTSD Coach: Includes panic attack management tools
Breathe2Relax: Breathing exercises for anxiety
MindShift: CBT-based panic management
Sanvello: Anxiety and panic tracking with coping tools
Online Communities:
Anxiety and Depression Association of America forums
National Alliance on Mental Illness (NAMI) support groups
Psychoeducational Talking Points
Fight-or-flight response and why panic attacks occur: "Your body has a natural alarm system designed to protect you from real danger. During a panic attack, this system fires even when there's no actual threat. Your brain is essentially pulling a fire alarm when there's no fire - it's a false alarm, but your body responds as if the danger is real. This explains why you feel like you need to escape or why your heart races."
"False alarm" concept - panic attacks are not dangerous: "Panic attacks feel terrifying, but they cannot actually harm you. No one has ever died from a panic attack itself. Think of it like a smoke detector that goes off when you burn toast - it's loud, alarming, and unpleasant, but it's not indicating a real fire. Your body is designed to handle these intense sensations. The symptoms peak within 10 minutes and will always come down naturally."
Panic attack cycle and how avoidance maintains the disorder: "Panic creates a vicious cycle. When you avoid places or activities where you've had panic attacks, you're teaching your brain that these situations are actually dangerous. This makes the next panic attack more likely. It's like never getting back on a horse after falling - the fear grows stronger. Each avoidance behavior sends the message to your brain: 'That place/activity is dangerous,' which keeps the panic disorder alive."
Physical symptoms are temporary and will pass: "Every single panic attack symptom has a logical explanation. Racing heart? Your body is preparing to run. Sweating? Your body is cooling itself for action. Shortness of breath? Your breathing changes to get more oxygen. These symptoms are uncomfortable but not dangerous. Most importantly, they're temporary - your body cannot maintain this high-alert state indefinitely. The symptoms will always decrease on their own."
Breathing techniques and why hyperventilation worsens symptoms: "When people panic, they often breathe too quickly and shallowly, which actually makes symptoms worse. Fast breathing lowers carbon dioxide in your blood, causing dizziness, tingling, and more panic. It's like blowing up a balloon too quickly - you get lightheaded. Slow, deep breathing from your diaphragm helps restore the balance and signals to your brain that you're safe."
Catastrophic thinking patterns and cognitive distortions: "Panic attacks are fueled by catastrophic thoughts - 'I'm having a heart attack,' 'I'm going crazy,' 'I'm going to die.' These thoughts are understandable but inaccurate. Your brain is trying to explain the intense sensations, but it's jumping to the worst possible conclusions. Learning to recognize these thought patterns and challenge them with evidence is crucial. Ask yourself: 'What's the evidence for this thought?' 'What would I tell a friend having this thought?' 'What's a more balanced way to think about this?'"
Clinical Pearls
Common Treatment Challenges
Challenge | Strategies |
Fear of panic attacks | Interoceptive exposure, education about benign nature |
Medication non-adherence | Address concerns about side effects, start with low doses |
Agoraphobic avoidance | Gradual exposure hierarchy, accompanied exposures initially |
Hypervigilance to bodily sensations | Mindfulness training, anxiety sensitivity reduction |
Treatment resistance | Consider comorbidities, combination therapy, medication augmentation |
Specialized Interventions
Interoceptive Exposure: Systematic exposure to feared bodily sensations (exercise, spinning, breathing exercises)
Breathing Retraining: Diaphragmatic breathing to prevent hyperventilation (though newer research questions its necessity)
Cognitive Restructuring: Addressing catastrophic interpretations of panic symptoms
Panic Surfing: Riding out panic attacks without resistance or escape behaviors
Symptom Induction: Controlled exposure to panic-like sensations in therapy
Developmental and Cultural Considerations
Pediatric Presentations: Panic disorder rare before puberty; adolescent onset common
Elderly Patients: May present with more somatic complaints, cardiac concerns
Cultural Variations: people of certain cultures may experience related phenotypes as noted below. It is unclear if these are equivalent to panic disorder or just significantly overlapping.
Latin American patients may experience "ataque de nervios"
Southeast Asian patients may report "ghost oppression"
African American patients may experience "falling out" episodes
Gender Differences: 2:1 female predominance, different symptom emphasis
Emerging Research
Digital therapeutics showing efficacy as adjuncts to traditional treatment
Virtual reality exposure therapy for agoraphobic avoidance
Neuroplasticity-based interventions (e.g., TMS) targeting fear learning
Precision medicine approaches based on genetic markers
Intensive outpatient programs for severe, treatment-resistant cases
Transdiagnostic Considerations
Panic Disorder is part of the internalizing disorders spectrum, characterized by inwardly directed negative emotions and distress. It frequently co-occurs with other anxiety disorders, depression, and substance use disorders, requiring integrated treatment approaches.
References and Further Reading
Clinical Practice Guidelines
American Psychiatric Association (2020). Practice guideline for the treatment of patients with panic disorder.
National Institute for Health and Care Excellence (2019). Generalized anxiety disorder and panic disorder in adults: management.
Canadian Psychiatric Association (2014). Clinical practice guidelines for the management of anxiety disorders.
Key Research Articles
Craske, M. G., & Barlow, D. H. (2014). Panic disorder and agoraphobia. In Clinical handbook of psychological disorders (pp. 1-61).
Pompoli, A., et al. (2016). Psychological therapies for panic disorder with or without agoraphobia in adults. Cochrane Database of Systematic Reviews, (4).
Bighelli, I., et al. (2018). Antidepressants versus placebo for panic disorder in adults. Cochrane Database of Systematic Reviews, (4).
Last Updated: July 2025
About This Resource: This comprehensive guide was developed by Brayden Efseroff on behalf of Allia Health to support mental health professionals in providing evidence-based assessment and treatment for clients with Panic Disorder. While efforts have been made to ensure accuracy, clinicians should refer to current DSM-5-TR and ICD-10 manuals for official diagnostic criteria and stay informed about evolving best practices.
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