Panic Disorder With Agoraphobia

By Dr. Stephen Antony, MD (Psychiatry)

People suffering from panic disorder with agoraphobia experience spontaneous and sudden panic attacks and are preoccupied with the fear of a recurring attack. Panic attacks can occur at any given time, it may even occur in the middle of sleep.

Some people avoid going to situations or places where they’ve previously had panic attacks due to the fear that a panic attack may happen again in such a place and they get no help and may be embarrassed in public.

These people tend to develop agoraphobia, the characteristic feature being that they avoid public places where they feel immediate escape might be difficult, such as public places, markets, shopping malls, public transportation, or large sports gatherings.

They tend to limit the number of places they go to and stay constantly on guard, waiting for the next panic attack. Some people maintain a fixed route or territory, and it is very difficult for them to move beyond their safety zones without experiencing severe anxiety.

There are over four million people who suffer panic disorders in America and it estimated that about one in three people with panic disorder develop agoraphobia.

Panic and anxiety disorders are known to develop during the early years of adulthood and is seen more commonly in women.

But not all people suffering from panic symptoms seek help; many are afraid or embarrassed to tell anyone, including their doctors and loved ones. Instead of seeking immediate help and treatment to get rid of their problems they remain passive and suffer in silence which makes the condition worse.

The exact causes of panic disorder and agoraphobia are unknown but it has many contributing factors such as family history of psychiatric disorders, stressful environment and maladaptive behavior. Since panic attacks often occur in areas or situations where they have happened in the past, panic may be a learned behavior.

Symptoms of panic attacks:

Panic attacks happen over short periods of intense anxiety and the symptoms usually peak within 10 minutes. Panic attack symptoms include:

Difficulty in breathing
Rapid and racing heartbeat
Feelings of nervousness
Trembling/ feeling extremely nervous
Heart palpitation,
Terror that is almost paralyzing
Dizziness, lightheadedness, or feeling of nausea
Choking sensation
Chest pain/ distress
Hot flashes or sudden chills
Tingling in fingers or toes
Fear, fright, or anxiety
Fear that you may die

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Symptoms of agoraphobia include:

Staying housebound for prolonged periods of time
Dependence on others for social tasks
Fear of being alone
Fear of going to places where escape might be difficult
Fear of losing control in a public place
Feeling of detachment from the body
Feeling that the environment is unreal
Increased anger problems, short temper or agitation
Feelings of detachment or estrangement from others
Feelings of helplessness

Diagnosis:

As soon as you suspect that you are having a panic attack it is best to get yourself evaluated by a physician and rule out any underlying medical conditions that may mimic panic disorders. These conditions include heart disease, imbalance of hormones, breathing difficulty, nervous system, and substance abuse. Appropriate tests will be carried out to according to the symptoms to rule out medical conditions causing panic symptoms. Once the diagnosis is done, appropriate treatment needs to be taken so as to prevent panic attack.

Treatment:

Pharmacological therapy is used when panic disorder is significantly affecting the person’s functioning and quality of life. The success of treatment usually depends in part on how severe the panic disorder and agoraphobia is.

Panic disorder symptoms The regular treatment approach is to combine cognitive-behavioral therapy (CBT) with an antidepressant medication.

Benzodiazepines are used in the short term treatment of panic disorders & agoraphobia.
Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine and sertraline are usually the first choice of treatment.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) can also be used.
Some anti-seizure drugs such as oxcarbamezepine may be used when the person suffers from anger outbursts.
Other anti-anxiety medications may include TCAs such as Amitryptiline.

Cognitive behavior therapy involves sessions with a therapist who helps you to look at your stressful thinking patterns and you helps you take control over them. CBT usually involves 10 to 20 visits with the therapist over a number of weeks.

The goals of CBT are to help you:

Gain understanding and develop control over negative distorted feelings of stressful events or situations
To identify and replace panic-causing thoughts
To identify stress and tension points in your body and use relaxation techniques

The therapy may also involve Systematic desensitization and exposure therapy, in which you are guided into a relaxed state, then asked to imagine the things that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation that causes the fear has helped many people overcome their fears.