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Panic Disorder and Agoraphobia

What is Panic Disorder? 

Panic Disorder is an illness in which episodes of intense fear and physical symptoms occur repeatedly at times when there is no real threat. These panic attacks are unexpected and may occur more than once a day. The fear and physical symptoms may be so intense that the person believes he or she is about to lose control or die. DSM IV defines Panic Disorder as four panic attacks within a four-week period or one or more attacks followed by a persistent fear of having another attack. Some people have panic attacks less often and do not develop anxiety about having another attack. 
Agoraphobia is a type of panic disorder in which a person becomes unable to leave a place they feel is safe, often one's home, for fear of a panic attack.

What are the symptoms of Panic Disorder?

The symptoms of a panic attack may include racing or pounding heartbeat; chest pains; dizziness; feeling lightheaded; nausea; trouble breathing; tingling or numbness in the hands; flushing or chills; dreamlike feelings or sensory distortions; terror; fear of losing control and doing something embarrassing; fear of dying; or feeling disconnected from yourself or from the world. A panic attack lasts for several minutes to an hour and is one of the most distressing conditions a person can have. 

What causes Panic Disorder? 

The exact cause of Panic Disorder is not known. There is a debate between those who think Panic Disorder is caused by a chemical problem in the brain and those who favor a cognitive-behavioral theory. The cognitive-behavioral theory is that the misinterpretation of the physical symptoms of anxiety triggers more intense anxiety, which in turn creates more disturbing bodily sensations in a vicious cycle until panic results. 

What happens to people who have Panic Disorder? 

When a person has repeated panic attacks, he or she may start to avoid situations where panic has struck. For instance, a person who has had a panic attack in a car may avoid driving. In time, the person may avoid more and more situations, and his or her life may become quite limited. These limitations imposed by Panic Disorder may cost the individual his or her job and interfere with social relationships. The avoidance of situations where a person has had or fears having a panic attack is called Agoraphobia. Agoraphobia can be mild or severe, and develops in most people who suffer from Panic Disorder. Panic Disorder usually begins in young adulthood, but children and older adults can also be affected. All ethnic groups are vulnerable to the disorder. Women are affected twice as often as men. 

What is the treatment for Panic Disorder? 

The main treatments are medications and/or psychotherapy. The medications most often used fall into two categories: antidepressant and antianxiety medicines. The antidepressant medicines most often used are Prozac, Paxil, Zoloft and Tofranil. The antianxiety medicines most often used are Xanax, Klonopin and Ativan. Cognitive and/or behavioral psychotherapy are also effective treatments for Panic Disorder and/or Agoraphobia. 

What can I do to help get my illness under control? 

To make the fullest possible recovery, a person with Panic Disorder can:

  • Avoid caffeine and other stimulants and alcohol or cut down on using them.
  • Get enough sleep every night (7 to 8 hours for most people).
  • Exercise for 20 minutes every day or every other day.
  • Learn deep breathing and other relaxation techniques and do them for 10 minutes at least once a day. 
  • Identify what triggers panic attacks and learn to expect and accept them at times. 
  • Improve coping skills for dealing with your panic symptoms. The less you fear the symptoms, the less they will occur. 

What happens if the symptoms return after I get them under control? 

There may be times after recovery when symptoms return. This is called relapse. If relapse occurs, it is important to identify the returning symptoms as early as possible and intervene by seeing your therapist, temporarily reducing stress and considering a return to or increase in medications and/or behavior therapy. 

How can I learn more about Panic Disorder and Agoraphobia? 

There are several good books about Panic Disorder and Agoraphobia:

Jack Gorman.  The Essential Guide to Psychiatric Drugs.  St. Martin's Press, 1998.

Wilson Reid. Don't Panic: Taking Control of Anxiety Attacks.  Harper Collins, 1996.

Jerilyn Ross.  Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks and Phobias.  Bantam Doubleday Dell,  1995.

David Sheehan.  The Anxiety Disease.  Bantam, 1986.

Claire Weeks. Agoraphobia.  NAL Dutton, 1977.
 

The following organization can provide help, information and support:

Anxiety Disorders Association of America (ADAA).  Call
301-231-9350 or reach them online at www.adaa.org

 
 
 
 
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Weill Cornell Physicians NewYork-Presbyterian