Panic Disorder and Agoraphobia
Panic disorder (PD) is characterized by recurrent panic attacks. Panic attacks are defined as discrete periods of intense fear that at least initially occur “from out of the blue” or “for no apparent reason”. These attacks are characterized by many physical symptoms or sensations such as an increase in heart rate, pounding of the heart or heart palpitations (i.e., skipping), breathlessness or difficulty breathing, chest pain, tightness or discomfort, sweating, hot flushes or cold chills, dizziness, tingling or numbness in the extremities (e.g., hands, scalp), shaking or trembling, throat tightness, stomach upset or nausea, and the feelings of unreality (e.g., derealization, depersonalization). Individuals experiencing panic attacks also commonly misinterpret these bodily sensations as a sign of impending doom (e.g., believe they are having a heart attack, going insane, fainting or about to lose control), and fear having additional attacks. These attacks occur very suddenly and build to their peak rapidly. Because of the nature of these attacks many PD sufferers are seen initially in medical settings (e.g., emergency rooms, primary care offices).
PD is also commonly associated with agoraphobia. Agoraphobia refers to the fear of certain situations due to the belief that one may have a panic attack and escape would be difficult or embarrassing. Situations commonly feared and typically avoided by people with agoraphobia include driving or riding as a passenger in an automobile, riding public transportation, being home alone, crowds, restaurants, movie theaters or church, stores or malls, bridges, escalators, open spaces, and closed spaces. Agoraphobia generally develops within the first year of the onset of recurrent panic attacks.
PD affects more women than men. Seventy-five percent of individuals with PD are women. The average age of onset appears to be roughly 22.5, however it can develop in children as well. PD tends to be a chronic condition with a fluctuating course if left untreated. PD with agoraphobia (PDA) affects roughly 5% of the U.S. population.
The cause of PDA is unknown. There are biological and psychological theories that have been supported by research. It appears that the best explanation for this condition maybe a “psychobiological” model combining both schools of thought. It may also be that different people with PDA may panic for different reasons, pointing to multiple causes for this phenomenon and not just one.
PDA is also a very treatable condition in the vast majority of cases. Medications (e.g., certain antidepressants, certain antianxiety drugs) have been found to be helpful. These medications appear to be more successful in blocking the panic attacks than helping with the associated feature of agoraphobic fear and avoidance.
Cognitive-Behavioral Therapy (CBT) has also been found to be effective and many feel is the treatment of choice for PDA. CBT not only has been found to help block panic attacks but also to help reduce the agoraphobic fear and avoidance. Success rates as high as 85% have been found using CBT. CBT for PDA consists of monitoring panic attacks and avoidance behavior, respiratory control (i.e., slow, controlled breathing), cognitive restructuring (i.e., identify and correct errors in thought), interoceptive exposure (i.e., exposure to bodily sensations), and in vivo exposure (i.e., exposure to feared situations). For some, the most effective and efficient way to be treated may be a combination of medication and CBT.