Self-Help Information: Panic & Agoraphobia
What is Panic Disorder?
In Panic Disorder, brief episodes of intense fear are accompanied
by multiple physical symptoms (such as heart palpitations and
dizziness) that occur repeatedly and unexpectedly in the absence of
any external threat.
These "panic attacks" are believed to occur when the brain’s normal
mechanism for reacting to a threat – the so called "flight or fight" response –
becomes inappropriately aroused. Most people with Panic Disorder also feel
anxious about the possibility of having another panic attack and avoid
situations in which they believe these attacks are likely to occur. Anxiety
about another attack, and the avoidance it causes, can lead to disability in
Panic Disorder.
Symptoms of Panic Attacks
During a panic attack, some or all of the following symptoms
occur:
Terror – a sense that something unimaginably horrible is about
to happen and one is powerless to prevent it
Racing or pounding heartbeat
Chest pain
Dizziness, lightheadedness, nausea
Difficulty breathing
Tingling or numbness in the hands
Flushes or chills
Sense of unreality
Fear of losing control, going "crazy", or doing something
embarrassing
Fear of dying
Initial Panic Attack
Typically, a first panic attack comes "out of the blue",
occurring while a person is engaged in some ordinary activity like
driving a car or walking to work. Suddenly, a barrage of frightening
and uncomfortable symptoms strikes the person. These symptoms often
include terror, a sense of unreality, or a fear of losing control.
These symptoms usually last several seconds, but may continue for
several minutes and gradually fade over the course of about an hour.
People who have experienced a panic attack can attest to the extreme
discomfort they felt and to their fear that they had been stricken
with some terrible, life-threatening disease or were "going crazy".
Initial panic attacks may occur when people are under considerable
stress, such as overwork or from the loss of a family member or
close friend. The attacks may follow surgery, a serious accident,
illness, or childbirth. Excessive consumption of caffeine or use of
cocaine or other stimulants or medicines, can also trigger panic
attacks. Some people who have one panic attack, or an occasional
attack, never develop a problem serious enough to affect their
lives. For others, however, the attacks continue and cause much
suffering.
Panic Disorder
In Panic Disorder, panic attacks recur and the person develops
an intense apprehension of having another attack. This fear – called
anticipatory anxiety or fear of fear – can be present most of the
time and interfere with the person’s life even when a panic attack
is not in progress. In addition, the person may develop irrational
fears, called phobias, about situations where a panic attack has
occurred. For example, someone who has had a panic attack while
driving may be afraid to get behind the wheel again, even to drive
to the grocery store. People who develop panic-induced phobias will
tend to avoid situations that they fear will trigger a panic attack,
and their lives may be increasingly limited as a result.
Agoraphobia
Panic Disorder may progress to where the person becomes afraid
of being in any place or situation where escape might be difficult
or help unavailable in the event of a panic attack. This condition
is called Agoraphobia and affects about a third of people with panic
disorder. Typically, people with Agoraphobia fear being in crowds,
standing in line, entering shopping malls, or riding in cars. Often,
they restrict themselves to a ‘zone of safety" that may include only
the home or neighborhood. Any movement beyond this zone creates
mounting anxiety. Sometimes a person with Agoraphobia is unable to
leave home alone, but can travel if accompanied by a particular
family member or friend. Even when they restrict themselves to
"safe" situations, most people with Agoraphobia have occasional
panic attacks.
Treatment for Panic Disorder
Treatment can bring significant relief to 70 to 90 percent of
people with Panic Disorder, and early treatment can help keep the
disorder from progressing to the later stages where Agoraphobia may
develop. Before undergoing treatment for Panic Disorder, a person
should undergo a medical examination to rule out other possible
causes of the symptoms. Several effective treatments have been
developed for Panic Disorder and Agoraphobia. A treatment should be
selected according to the individual needs and preferences of the
person. Cognitive-Behavioral Therapy is a combination of cognitive
therapy which can modify or eliminate thought patterns contributing
to the patient’s symptoms, and behavioral therapy which aims to help
the patient to change his or her behavior. When indicated, a
prescription medication is used both to prevent panic attacks or
reduce their frequency and severity, and to decrease the associated
anticipatory anxiety. Many believe that a combination of medication
and Cognitive-Behavioral Therapy represents the best treatment of
Panic Disorder.
Causes of Panic Disorder
Though we do not know for sure what causes Panic Disorder, it is
probable that there are multiple causes. Both genetics and brain
biochemistry have been implicated as factors.
(The above information was condensed from a public domain
brochure produced by the National Institute of Mental Health. For
the full text of the brochure, visit the NIMH website at
www.nimh.nih.gov).
Recommended Books to Read
An End to Panic: Breakthrough Techniques for Overcoming Panic
Disorder, 2nd Edition. Elke Zuercher-White, Oakland, CA:
New Harbinger, 1998. This workbook begins with a discussion of
recognizing and understanding panic attacks and when to consider
medication for panic. Following a discussion of the physiology
of fear and panic, the author focuses on ways to cope with panic
through breathing retraining, changing thoughts and beliefs, and
coping with phobias secondary to panic. Worksheets and exercises
are presented.
Coping with Panic: A Drug-Free Approach to Dealing with
Anxiety Attacks. George A. Clum, Belmont, CA:
Brooks/Cole, 1990. This book begins with an examination of panic
and its causes and symptoms. The author then discusses coping
strategies people naturally acquire for dealing with panic and
discusses how to develop better coping techniques. The primary
focus is cognitive, focusing on changing catastrophic ways of
thinking. Avoiding the feared situation and its relationship to
Agoraphobia are discussed, followed by an elaboration of ways to
eliminate these avoidance strategies.
Panic Disorder and Agoraphobia: A Guide. Obsessive
Compulsive Information Center, Madison Institute of Medicine,
1998. This pamphlet describes the symptoms and causes of panic
and agoraphobia. It then describes the treatment options, with
an emphasis on medication.
Need Additional Help?
Washington State University College of Veterinary Medicine
Counseling and Wellness Services offer free individual counseling for these and
related issues for veterinary students (WSU Veterinary Students ONLY). For more
information or to schedule an appointment call or e-mail:
Donna J. Scott, PhD
ADBF 1035
509-335-4607
djscott@vetmed.wsu.edu
NOTE: The information contained in these self help
documents is not to be used as a substitute for professional care. Neither the
authors, Washington State University nor the College of Veterinary Medicine
assume liability for injury incurred by following the information presented in
these self-help documents
