A severe form of anxiety that people suffer from is called panic disorder. Panic disorder is diagnosed when a person regularly experiences panic attacks that are not triggered by the influence of drugs or another mental health condition or medical illness. A person who experiences at least one panic attack per month within a six month period is likely appropriate for diagnosis of panic disorder.
Panic disorder can be diagnosed with or without agoraphobia. Agoraphobia is an intense fear of being trapped in a place that is uncomfortable, dangerous, embarrassing or distressing. Any environment that that is stressful or high-energy can be seen as threatening for a person with agoraphobia. Such environments may include, but are not limited to malls, modes of public transportation, or public parks. Some cases of agoraphobia are so severe that leaving the house for any length of time can produce great distress within a person. Agoraphobia is often linked with panic disorder because recurrent panic attacks wreak havoc on the affected person’s nerves. It becomes so intense that a person will avoid places that remind them of situations in which they previously had panic attacks. This is because the affected person will associate the environment with the reason for the attack.
Symptoms Of Panic Disorder With Agoraphobia
There are several symptoms that indicate a person is suffering from panic disorder with agoraphobia. The symptoms will result from both the experience of panic attacks and the agoraphobia diagnosis. Symptoms of panic disorder with agoraphobia include:
- Experiencing a panic attack that reaches its peak of severity within 10 minutes
- Experiencing at least 1 panic attack per month for at least 6 months
- Attributing the experienced panic attacks to the environment in which the panic attack was experienced (this creates a fear or aversion to the given environment)
- Symptoms of a panic attack, including: racing heartbeat, lightheadedness, dizziness, stomachache or nausea, chest pain, ringing in ears, tingling sensation through arms and legs, and hyperventilation
- Fear of being trapped without a space for escape
- Fear of crowds
- Fear of being left alone
- Feelings of helplessness
Those who suffer from panic disorder with agoraphobia will also have behaviors that are performed in effort to prevent a panic attack. Such behaviors include:
- Avoiding people, places and situations that they believe attribute to the onset of a panic attack
- Fleeing or ‘escaping’ places with high energy or that are uncomfortable for the affected person
- Avoiding leaving the home
What Causes Panic Disorder With Agoraphobia?
There are several risk factors that can make a person predisposed to developing panic attacks with agoraphobia. Each risk factor begins with a person’s risk of developing an anxiety disorder. A person is at high risk of developing panic disorder with agoraphobia if he or she has been diagnosed with an anxiety disorder, like generalized anxiety disorder, a phobia, posttraumatic stress disorder, or obsessive-compulsive disorder. The following are also risk factors of panic disorder with agoraphobia:
Genetics play a major role in the likelihood of someone developing panic disorder with agoraphobia. A person with a close family member, like a parent, grandparent, or sibling, who suffers from a severe anxiety disorder diagnosis, especially panic disorder with agoraphobia, is at a high risk of developing panic disorder with agoraphobia as well. Research has found evidence that anxiety-related disorders are genetic and can be passed through generations. If a person is genetically pre-disposed to developing an anxiety disorder and does not address the symptoms with early intervention and treatment, he or she is at high risk for developing panic disorder with agoraphobia.
A person’s upbringing plays a critical role in the development of self-esteem, social skills, and self-soothing coping strategies for stress, anxiety, and unpleasant situations. If a child grows up in an insecure or chaotic environment, or is deprived of proper guidance, nurturing, and supervision, he or she will not be able to develop life skills and coping strategies to handle difficult situations. Children who were brought up in such environments are more likely to develop panic disorder with agoraphobia than those who grew up in secure environments.
Stress Management Skills
People have panic attacks as a result of stress. Stress comes from almost every area of a person’s life, including:
- Physical health
- Mental health
- Uncertainty about the future
It is important for a person to understand how to cope with stress. If he or she does not then he or she will develop ‘maladaptive coping strategies’, which are habits that worsen an anxiety-related condition. Having maladaptive coping strategies for stress is a major contributing factor for the onset of panic attacks. If left unaddressed for long enough, the stress-related panic attacks will progress to a panic disorder.
Experiencing A Traumatic Event
Sometimes people who do not have a history of anxiety, panic attacks, or stress-related issues can develop panic disorder with agoraphobia. This is often due to the affected person experiencing or witnessing a traumatic event with which he or she was not able to properly cope. Common cases of trauma include:
- Physical, mental, or verbal assault or abuse
- Domestic violence or abuse
- Sexual assault or abuse
- Experiencing, witnessing, or surviving a natural disaster
- Experiencing, witnessing, or surviving an act of terror
- Being involved in an accident
- Grief and loss
- Adjustment issues regarding a stage of life change or a change in environment
It is difficult to cope with the feelings, emotions and thoughts that traumatic or abusive situations create. People who go through situations like the ones listed above often feel:
Sometimes these thoughts, emotions, and feelings can be so overwhelming that it results in panic attacks and an intense fear of certain places and situations. Eventually, these fears and attacks will graduate into panic disorder with agoraphobia.
Treatment For Panic Disorder With Agoraphobia
If you feel you may be suffering from panic disorder with agoraphobia it is important to seek professional help as soon as possible. Panic disorder with agoraphobia is a progressive disorder; so the sooner it is treated the more likely it is that you will be able to overcome the symptoms of the disorder. If you suffer from panic attacks, severe anxiety, or a fear of leaving your house and being in certain environments, then it is important to seek a mental health professional, who will be able to determine if you are appropriate for a ‘panic disorder with agoraphobia’ diagnosis.
If you are diagnosed with panic disorder with agoraphobia, there are treatment options available to you. With patience and commitment there is a high chance that you will be able to learn how to control the symptoms. Panic disorder with agoraphobia is often treated with cognitive and behavioral interventions. Such therapeutic interventions include:
Eye Movement Desensitization And Reprocessing
Eye movement desensitization and reprocessing is a therapeutic technique that utilizes eye movements to make the stress reaction of a triggered stimulus less intense. The process of eye movement desensitization and reprocessing is as follows:
The patient will be asked to trace the movement of a pointer with his or her eyes while recalling a distressing or traumatic incident. As you move your eyes with the cursor your mind will associate the traumatic event with different parts of the brain. This reduces the intensity of the stress response, which reduces the prevalence of panic attacks and agoraphobia.
Eye movement desensitization and reprocessing is especially effective for panic disorder with agoraphobia because it breaks the association between the occurring panic attacks and the feared situation that triggers the panic attack. This shows the patient that it is not the trigger itself that causes the panic attack, but rather the conditioned response to that panic attack.
Exposure therapy comes from the theory that with repeated or prolonged exposure to the feared stimulus, the stress reaction that causes the panic attack will become less intense. A patient who is participating in this form of therapy will be gradually exposed to elements that remind him or her of the feared situation to desensitize the stress response. This will reduce overall prevalence of panic attacks and agoraphobia.
Exposure therapy utilizes a hierarchy of fears to gradually expose the patient to the feared trigger. With time and repeated exposure, the stress response caused by fear becomes less intense and eventually the association between the trigger and the panic attacks is broken.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is a form of therapy that focuses on how thoughts affect emotions and behavior. Treating panic disorder with agoraphobia with cognitive behavioral therapy aims to teach a patient the difference between conditioned triggers and realistic situations. A person with panic disorder with agoraphobia will often associate certain places and situations with panic attacks, causing them to believe that the environment is causing the attack. Cognitive behavioral therapy helps break down this thought process to illustrate the conditioned reaction. This teaches the patient that the environment itself is not causing the panic attack; it is the fear of having the panic attack in that environment that triggers the attack. From this realization, the patient can work to unlearn the conditioned response.