PANIC DISORDER AND AGORAPHOBIA

Panic disorder can be an extremely debilitating disorder where people experience frequent and recurrent panic attacks, worry a great deal about panicking and fear that they may experience a heart attack, a stroke, lose control or "go crazy" in response to the panic attack.

Panic attacks may be triggered by certain external triggers later on during the disorder, but they most often "come out of the blue" and may even occur during sleep. The reason for having an initial panic attack and the reason for having subsequent attacks are often very different with panic disorder. The difference between panic disorder and phobias or other anxiety disorders, is that the panic attacks in panic disorder are generally not in response to an external stimulus, but rather come out of the blue or develop in response to a fear of panic. Panic disorder basically results from a fear of panic and changes in physiological state.

Panic attacks are episodes of panic that tend to have a sudden and abrupt onset and tend to peak within several minutes. The following symptoms may occur:

• Heart palpitations, a pounding heart, or an accelerated heart rate
  
• Sweating
  
• Trembling or shaking
  
• Sensations of shortness of breath or smothering
  
• Feeling of choking
  
• Chest pain or discomfort
  
• Nausea or abdominal distress
  
• Feeling dizzy, unsteady, light headed, or faint
  
• Derealization (feelings of unreality) or depresonalization (being detached from oneself)
  
• Fear of losing control or going crazy
  
• Fear of dying
  
• Numbness or tingling sensations
  
• Cold chills or hot flushes

Panic disorder can be successfully treated with a combination of psycho-education, cognitive therapy, interoceptive exposure and in-vivo exposure.

Agoraphobia results from a fear about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristics clusters of situations that include being outside the home alone, being in a crowd or standing in a line, being in the shopping mall, travelling - especially with public transport or being at school. If these situations are not completely avoided then they tend to be endured with marked distress or anxiety about having a panic attack or panic-like symptoms. People will often also only go out if in the presence of a companion. People suffering with severe agoraphobia would tend to battle to leave their homes (which are often seen as "safety zones"). Agoraphobia may be accompanied by panic attacks but may also occur without panic attacks, but with more lower grade anxiety symptoms. Again, as with panic disorder, agoraphobia results from a fear of panic or anxiety, which increases with certain settings.

As with panic disorder, a significant amount of psycho-education is important. Successful treatment tends to entail a combination of cognitive therapy, interoceptive exposure and in vivo exposure.