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Panic Disorder and Agoraphobia

Last updated Thursday, 16 July 2009
By Tomi Redman, Psychologist

Sometimes Peter experiences episodes of overwhelming anxiety, in which his heart races, he feels like he can’t breathe, he can’t swallow, he feels dizzy and faint, he needs to go to the toilet and he pours with sweat. When he’s having one of these ‘panic attacks’, he often feels like he’s going crazy or is going to die, and sometimes he feels disconnected from everyone or everything around him.

Peter finds these attacks terrifying, and becomes so anxious about having another one that this anxiety can actually trigger another panic attack. When he is in his own home or his known area, he feels safe and secure and is less likely to experience one of these horrible attacks. As a result, often he avoids going out, just in case he has a panic attack. He has become much more limited in what he feels able to do – things he used to do easily have become difficult, such as going out, seeing friends, eating a meal out. Some days he even struggles to walk to the mailbox.



What does it look like? (Symptoms)

Panic Disorder
Recurrent and unexpected panic attacks:

Body
  • Racing or pounding heart
  • Sweating, chills or hot flushes
  • Trembling/Shaking
  • Numbness or tingling
  • Difficulty breathing
  • Feeling of choking
  • Chest pain
  • Nausea, stomach cramps or diarrhoea

Mind
  • Dizzy, lightheaded, feeling you’re going to faint
  • Loss of a sense of connection to reality or to yourself
  • Fear of having another panic attack
  • Worry about going crazy, losing control or dying
 
Agoraphobia
  • Anxiety about being in places or situations where it’s hard to escape if you have a panic attack (eg, a shopping centre, a train)
  • These situations are avoided, or only done with a companion who can assist you if you do have a panic attack

How can it cause a problem in my life?

People with panic disorder often find that their life is ruled by their efforts to avoid experiencing panic attacks. When they do experience a panic attack, they often believe they are dying, or that they will faint, or some other unbearable outcome will occur. As you can imagine, many people experiencing panic disorder and/or agoraphobia suffer from depression, as they find their lives are more and more limited by their fear of the overwhelming symptoms of anxiety.

Some people with panic disorder are so terrified of the next attack that they resist ever being alone, under the mistaken belief that a panic attack may kill them or make them lose control. Some people with agoraphobia rarely leave their house, so ‘normal’ life is severely limited. There can be significant financial and emotional costs for those experiencing panic disorder or agoraphobia. They may be unable to attend work, or miss many days at work. They may feel ashamed of their condition, and avoid social interaction as a result, and their relationships may suffer.


Who else experiences it?


Anxiety disorders are about twice as common in females, and are more common in people aged 18-54 years. Most anxiety disorders begin in young adulthood, although many people with anxiety disorders say that they’ve felt anxious for their whole lives.  About 2% of females and 0.6% of males suffer from panic disorder, and about 1.5% of females and 0.7% of males suffer with agoraphobia in any year.

About 40-50% of people with anxiety disorders have another mental health problem, such as depression. It is important to remember, however, that most people do recover from panic disorder and agoraphobia, and with good treatment almost everyone will be able to return to a fully functioning life.

What can I do about it? How can I manage it?


  • Research suggests the most effective treatment is a psychological approach, Cognitive Behavioural Therapy (CBT). This involves identifying the thoughts that lead to the anxiety (e.g. I’m going to die, I’ll lose control and do something crazy) and changing them to more realistic, evidence-based thoughts. At the same time, CBT assists people to manage the symptoms of their anxiety, by helping them to learn to control breathing, relax their muscles, and slow down the panic response. CBT also helps people work towards doing the things they’ve been avoiding (such as go shopping), until those situations become comfortable.
  • Many people with panic attacks take medications to try to help. Benzodiazepines, such as Xanax, are commonly prescribed by Doctors. This group of drugs can be helpful in the short term, but if they are used for longer than the recommended 2-4 weeks, they may actually begin to cause anxiety and panic attacks. Some antidepressants are also sometimes prescribed for anxiety, and are helpful for some people, but do not work for everyone. As mentioned about above, research consistently finds that psychological treatments are most effective.
  • Breathing techniques, relaxation and meditation classes are all really useful for panic disorder, and can be accessed in most communities. Yoga is a fantastic way to learn breathing techniques and meditation.
  • Many things may cause a panic attack, and then the ‘fear of the fear’  (i.e. the terror of experiencing another panic attack) can lead to the develop of an ongoing panic disorder. Such causes may include: hyperventilation (over-breathing), inner ear problems, unstable blood sugar levels, low blood pressure, reactions to drugs (especially  speed, cocaine, LSD and benzodiazepines such as Valium, Xanax), drug/alcohol/nicotine withdrawal, heat/exercise, caffeine (too much coffee or tea or energy drinks such as ‘V’), and stressful events.
  • Learning that panic attacks are not dangerous or harmful, and to reduce the fear around panic symptoms.

 
What can I expect? What’s the outlook?


You CAN recover from panic disorder and agoraphobia. You will always have some anxiety – all of us do, it serves a useful purpose in motivating us and warning us of danger. But, it won’t always rule your life. You may find that you still have panic attacks, but because you won’t be scared of them they’ll only last moments and won’t feel overwhelming. With good treatment, most people recover from panic and agoraphobia quickly – the biggest barrier is believing that a panic attack is dangerous.

What resources are available for help?

Books
Bev Aisbett (1993). Living With IT.
Bronwyn Fox (2001). Power Over Panic.
John Franklin (1997). Overcoming Panic.
Ruth Greenberger & Aaron Beck (1995). Panic attacks: How to cope, how to recover.
Andrew Page (2002). Don't Panic: Anxiety, phobias and tension.

Websites
Reconnexion           www.reconnexion.org.au
ClimateTv                www.climate.tv
Anxiety Panic Hub   www.panicattacks.com.au



This information was provided by Tomi Redman, Psychologist.info.gif

She can be contacted at Reconnexion, on:

Phone:  1300 273 266
Website:  www.reconnexion.org.au
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