What is Panic Disorder and Agoraphobia?

Panic disorder is a common condition in which a person has episodes of intense fear or anxiety that occur suddenly (often without warning). These episodes — called panic attacks — can last from minutes to hours. They may occur only once in a while, or they may occur quite frequently. The cause, or "trigger," for these attacks may not be obvious.

What is a Panic Attack?

A Panic Attack is defined as the abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms:

• a feeling of imminent danger or doom;
• the need to escape;
• palpitations;
• sweating;
• trembling;
• shortness of breath or a smothering feeling;
• a feeling of choking;
• chest pain or discomfort;
• nausea or abdominal discomfort;
• dizziness or lightheadedness;
• a sense of things being unreal, depersonalization;
• a fear of losing control or "going crazy";
• a fear of dying;
• tingling sensations;
• chills or hot flushes.

There are three types of Panic Attacks:

1. Unexpected - the attack "comes out of the blue" without warning and for no discernable reason.
2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel.
3. Situationally Predisoposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

Panic Disorder

Panic Disorder is diagnosed when an individual suffers at least two unexpected Panic Attacks, followed by at least 1 month of concern over having another attack. Sufferers are also prone to situationally predisposed attacks. The frequency and severity of the attacks varies from person to person, an individual might suffer from repeated attacks for weeks, while another will have short bursts of very severe attacks.

Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lungs, intestines or nervous system. The similarities between panic disorder and other diseases may add to the person's fear and anxiety during and after a panic attack. As a result, the sufferer often worries about the physical and emotional consequences of the Panic Attacks. Many become convinced that the attacks indicate an undiagnosed illness and will submit to frequent medical tests. Even after tests come back negative, a person with Panic Disorder will remain worried that they have a physical illness. Some individuals will change their behavioral patterns, avoiding the scene of a previous attack for example, in the hopes of preventing having another attack.

Agoraphobia

Just the fear of having a panic attack is often enough to trigger the symptoms. This is the basis for a condition called agoraphobia. Agoraphobia is characterized by a fear of having a panic attack in a place from which escape is difficult. A person who has agoraphobia finds it difficult to leave home (or another safe area) because he or she is afraid of having a panic attack in public or not having an easy way to escape if the symptoms start. Agoraphobia often, but not always, coincides with Panic Disorder. Many sufferers refuse to leave their homes, often for years at a time. Others develop a fixed route, or territory, from which they cannot deviate, for example the route between home and work. It becomes impossible for these people to travel beyond what they consider to be their safety zones without suffering severe anxiety. Typically, people with agoraphobia fear being in crowds, standing in line, entering shopping malls, and riding in cars or public transportation.

Who has Panic Disorder?

In the United States, 1.6 percent of the adult population, or more than 3 million people, will have panic disorder at some time in their lives. The disorder typically begins in young adulthood, but older people and children can be affected. Women are affected twice as frequently as men. While people of all races and social classes can have panic disorder, there appear to be cultural differences in how individual symptoms are expressed.

For more information about Panic Disorder and agoraphobia, contact the following national organizations:

Anxiety Disorders Association of America
8730 Georgia Avenue, Suite 600
Silver Spring, MD 20910
Telephone: 240-485-1001
http://www.adaa.org

National Institute of Mental Health
NIMH Public Inquiries
6001 Executive Blvd.
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Telephone: 800-647-2642
www.nimh.nih.gov 

References

Barlow, D.H., and Craske, M.G. Mastery of Your Anxiety and Panic. Albany, NY: Graywind Publications, 1988.

Gold, M.S. The Good News About Panic, Anxiety, and Phobias. New York: Bantam, 1989.

Greist, J.H., and Jefferson, J.W. Panic Disorder and Agoraphobia: A Guide. Madison, WI: Anxiety Disorders Center and Information Centers, University of Wisconsin, 1992.

Hecker, J.E., and Thorpe, G.L. Agoraphobia and Panic: A Guide to Psychological Treatment. Needham Heights, MA: Allyn and Bacon, 1992.

Katon, W. Panic Disorder in the Medical Setting. NIH Pub. No. 93-3482. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1993.

Klerman, G.L., et al., eds. Panic Anxiety and Its Treatments. Washington, DC: American Psychiatric Press, 1993.

Mathews, A.M.; Gelder, M.G.; and Johnston, D.W. Agoraphobia: Nature and Treatment. New York and London: Guilford Press, 1981.

National Institutes of Health. NIH Consensus Development Conference Statement, Vol. 9, No. 2. Treatment of Panic Disorder. Bethesda, MD: NIH, September 1991.

Rachman, S., and Maser, J.D. Panic: Psychological Perspectives. Hillsdale, NJ: Erlbaum Associates, 1988.

Wilson, R.R. Don't Panic: Taking Control of Anxiety Attacks. New York: Harper and Row, 1986.