Panic disorder with agoraphobia
Panic disorder with agoraphobia is an anxiety disorder in which there are repeated attacks of intense fear and anxiety, and a fear of being in places where escape might be difficult, or where help might not be available.
Agoraphobia usually involves fear of crowds, bridges, or of being outside alone.
This article discusses panic disorder with agoraphobia. For information on panic disorder itself, see also: Panic disorder
Agoraphobia; Anxiety disorder- agoraphobia
Causes, incidence, and risk factors
The exact causes of panic disorder and agoraphobia are unknown. Because panic attacks often occur in areas or situations where they have happened in the past, panic may be a learned behavior. Agoraphobia sometimes occurs when a person has had a panic attack and begins to fear situations that might lead to another panic attack.
Anyone can develop a panic disorder, but it usually starts around age 25. Panic disorder is more common in women than men.
Panic attacks involve short periods of intense anxiety symptoms, which peak within 10 minutes. Panic attack symptoms can include:
- Chest pain or discomfort
- Dizziness or faintness
- Fear of being out of control
- Fear of dying
- Fear of "going crazy"
- Hot flashes or chills
- Nausea or other stomach distress
- Numbness or tingling
- Racing heart
- Shortness of breath
Agoraphobia is considered to be present when places or situations are being avoided. People with agoraphobia generally do not feel safe in public places. Their fear is worse when the place is crowded. Symptoms of agoraphobia include:
- Becoming housebound for prolonged periods of time
- Dependence on others
- Fear of being alone
- Fear of being in places where escape might be difficult
- Fear of losing control in a public place
- Feelings of detachment or estrangement from others
- Feelings of helplessness
- Feeling that the body is unreal
- Feeling that the environment is unreal
- Unusual temper or agitation
Signs and tests
People who first experience panic sometimes fear they have a serious illness, or are even dying. Often, people will go to an emergency room or other urgent care center because they think they are having a heart attack.
A physical examination and psychological evaluation can help diagnose panic disorder. It is important to rule out any medical disorders, such as problems involving the heart, hormones, breathing, nervous system, and substance abuse. Which tests are done to rule out these conditions depends on the symptoms.
The goal of treatment is to help you feel and function better. The success of treatment usually depends in part on how severe the agoraphobia is.
The standard treatment approach combines cognitive-behavioral therapy (CBT) with an antidepressant medication.
- Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice of antidepressant.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice. Other antidepressants and some anti-seizure drugs may be used for more severe cases.
- Other anti-anxiety medications may also be prescribed. For example, your health care provider may recommend benzodiazepines when antidepressants don't help or before they take effect.
CBT involves 10 to 20 visits with a mental health professional over a number of weeks. CBT helps you change the thoughts that cause your condition. It may involve:
- Gaining understanding and control of distorted feelings or views of stressful events or situations
- Learning to recognize and replace panic-causing thoughts
- Learning stress management and relaxation techniques
- Systematic desensitization and exposure therapy, in which you are asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful.
Gradually exposing the patient to the real-life situation that causes the fear has also helped some people overcome their fears.
A healthy lifestyle that includes exercise, enough rest, and good nutrition can also help be helpful.
Most patients can get better with medications or behavioral therapy. However, without early and effective help, the disorder may become more difficult to treat.
- Some people may abuse alcohol or other drugs while trying to self-medicate.
- Some people may be unable to function at work or in social situations.
- Some people may feel isolated, lonely, depressed, or suicidal.
Calling your health care provider
Call for an appointment with your health care provider if you have symptoms of panic attacks or agoraphobia.
Early treatment of panic disorder can often prevent agoraphobia.
Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders: panic, social anxiety, and generalized anxiety. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 32.
Reviewed By: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.