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Panic Disorder with Agoraphobia (PDA)

What is Panic Disorder?

Panic disorder is a diagnosis that is often made when people have recurrent, unexpected panic attacks.  In order for symptoms to fit with a diagnosis of Panic Disorder, the person must not only have panic attacks but the attacks must be followed by at least a month of persistent concerns about having another panic attack, worry about if there will be some consequences to the panic attacks, or a significant change in behavior due to the panic attacks. 

Sooo, what does a panic attack feel like?  Usually it is a discrete period of intense fear that feels like it comes out of nowhere and builds to its peak in ten minutes or less.  It may include symptoms such as heart palpitations, sweating, shaking hands, feeling like you’re choking, chest pain, nausea, lightheadedness, fear of going crazy or dying, numbness or tingling in extremities, or hot flashes or chills. 

One point that is important is that there are a number of other psychological and medical diagnoses that can easily be mistaken for panic disorder.  For example, posttraumatic stress disorder may include periods that feel like panic attacks, but these periods are related to strong reactions to reminders of a traumatic event.  Other types of anxiety may include chronic symptoms of stress but do not have the same sharp, discrete patterns present in panic. 

Also, just because someone has a panic attack it doesn’t mean that they have or will get panic disorder.  Some studies have found that over the course of a year about 10-12% of the general population will have a panic attack, but in contrast 2-6% will actually meet the diagnostic criteria for panic disorder.

With regard to physical and medical issues, the effect of some substances such as caffeine and other stimulants can result in events that feel like panic.  Also, medical disorders such as mitral valve prolapse can easily be mistaken for panic disorder.  Therefore, it is important to provide information on substance use to your psychologist and check in with your doctor to make sure you get an accurate diagnosis.

What is Agoraphobia?

If you read much about panic disorder, you will find that agoraphobia is sometimes mentioned in the same breath as panic attacks.  Agoraphobia often goes along with panic disorder, but can occur in the absence of panic.  Agoraphobia is simply fear of anxiety about being in a situation where escape might be difficult or embarrassing, or where it might be difficult to get help if something bad (like a panic attack) happened.  Often, people will avoid crowded places where they might have to be around strangers.  If a person does have to spend time in a place they wish to avoid, it is usually very stressful and difficult to endure.

Like panic disorder, there are other diagnoses that can easily be confused with agoraphobia.  For instance, social anxiety disorder (also known as social phobia) is associated with avoidance of social situations because of fear of embarrassment, feeling uncomfortable with one’s self, or fearing that others will pass negative judgments.  With specific phobias, people may have specific fears of situations such as being in airplanes or flying on planes.

A General Idea on How All of This Fits Together

The reason that panic and agoraphobia often go together may fit with some of the theory about how panic with agoraphobia happens in people.  Specifically, the first panic attack a person has is often very frightening.  For about 72% of people, their first panic attack is associated with a specific stressful situation.  This situation might be one’s body doing something strange (for example, one’s heart beating irregularly), a bad experience with a medication, stress for a relationship, or illness.

Once a person has a panic attack, they may worry about if it means that there is something wrong with their body or mind.  They may feel more anxious, and may monitor their body closely for signs of anxiety that went along with the panic attack.  Unfortunately, this vigilance and monitoring actually makes having another panic attack more likely.  Which may mean that the person is more likely to have another panic attack . . . which makes them more vigilant and anxious . . . which makes the person more vigilant and anxious . . . which makes them more like to have another panic attack . . . (you get the picture).

There have been some fascinating studies that have shown that people with panic disorder are more likely to be very, very good at monitoring their heart rate, and may have panic attacks that are triggered by otherwise imperceptible changes in physiology, such as breathing slightly higher carbon dioxide levels than usual.

How all of this relates to agoraphobia is that people fear that they will have a panic attack in public, or fear that if someone they trust is not with them that they will panic and something awful will happen.  Therefore, they start avoiding being in public (or whatever the feared situation is) more and more, and may start to avoid a variety of situations where they start to feel anxious.

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References:

American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Washington D.C.: American Psychiatric Association.

Barlow, D.H. (1988). Anxiety and Its Disorders: The nature and treatment of anxiety and panic. New York: The Guilford Press.

Brown, T.A. & Barlow, D.H. (1995). Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment.  Journal of Consulting and Clinical Psychology, 63,  754-765.

Craske, M.G. & Barlow, D.H. (1993). Panic disorder and agoraphobia. In Clinical Handbook of Psychological Disorders (Ed. D. Barlow).  New York: The Guilford Press.

Ehlers, A. (1995). A 1-year prospective study of panic attacks: Clinical course and factors associated with maintenance.  Journal of Abnormal Psychology, 104, 164-172.

Falls, W.A. & Davis, M (1995). Behavioral and physiological analysis of fear inhibition: Extinction and conditioned inhibition.  In Neurobiological and Clinical Consequences of Stress: From normal adaptation to PTSD. Eds Friedman, M.J., Charney, D.S., & Deutch, A.Y.  Philadelphia: Lippencott-Raven Publishers.

Weissman, M. & Marikangas, K.R. (1986). The epidemiology of anxiety and panic disorder: An update.  Journal of Clinical Psychiatry, 47, 11-17.  

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The information posted on this site reflects our understanding of peer-reviewed research and generally accepted principles in psychology.  It is not intended to be used for self-treatment or as a substitute for individualized assessment and treatment by a licensed professional, and should not be construed as professional advice.

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