Panic disorder with agoraphobia

Causes

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.

Symptoms

Panic attacks involve short periods of intense anxiety symptoms, which peak within 10 minutes. Panic attack symptoms can include:

• Chest pain or discomfort
• Choking
• 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
• Sweating
• Trembling

With agoraphobia, you avoid places or situations because you do not feel safe in public places. The fear is worse when the place is crowded.

Symptoms of agoraphobia include:

• Being afraid of spending time alone
• Being afraid of places where escape might be hard
• Being afraid of losing control in a public place
• Depending on others
• Feeling detached or separated from others
• Feeling helpless
• Feeling that the body is not real
• Feeling that the environment is not real
• Having an unusual temper or agitation
• Staying in the house for long periods of time

Exams 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.

Treatment

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
• Relaxing, then imagining the things that cause the anxiety, working from the least fearful to the most fearful (called systematic desensitization and exposure therapy)

You may also be slowly exposed to the real-life situation that causes the fear to help you overcome it.

A healthy lifestyle that includes exercise, enough rest, and good nutrition can also help be helpful.

Outlook (Prognosis)

Most patients can get better with medications or behavioral therapy. However, without early and effective help, the disorder may become more difficult to treat.

Possible Complications

• 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.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of panic attacks or agoraphobia.

Prevention

Early treatment of panic disorder can often prevent agoraphobia.

Alternative Names

Agoraphobia; Anxiety disorder- agoraphobia

References

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.

Update Date: 3/25/2012

Updated by: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.