People who have a panic disorder, also known as anxiety attacks, experience sudden attacks of intense and overwhelming fear that something awful is about to happen. Their bodies react as if they’re in a life-threatening situation. These attacks come without warning and often strike when the person is in a non-threatening situation.
About 6 million adults have a panic disorder. Anyone can develop the disorder. However, it is more common in women than in men.
Symptoms typically first appear at about age 25.
Agoraphobia usually involves a fear of being caught in a place where “escape” would not be easy, or would be embarrassing. This includes:
You may begin to avoid the places and situations where you had a panic attack before, for fear it might happen again. This fear can keep you from traveling freely or even leaving your home.
The symptoms of a panic attack often feel the strongest in the first 10 to 20 minutes. However, some symptoms can linger for an hour or more. Your body reacts as if you were truly in danger when you experience a panic attack. Your heart races, and you can feel it pounding in your chest. You sweat and may feel faint, dizzy, and sick to your stomach.
You may become short of breath and may feel as if you’re choking. You may have a sense of unreality and a strong desire to run away. You may fear you’re having a heart attack, or that you’re going to lose control of your body, or even die.
You will have at least four of the following symptoms when experiencing a panic attack:
- feelings of danger
- need to flee
- heart palpitations
- sweating or chills
- trembling or tingling
- shortness of breath
- a choking or tightening sensation in the throat
- chest pain
- nausea or stomach discomfort
- a feeling of unreality
- fear that you are losing your mind
- fear of losing control or dying
Agoraphobia usually involves fear of places that would be difficult to leave or find help if a panic attack occurs. This includes crowds, bridges, or places like planes, trains, or malls.
Other symptoms of agoraphobia include:
- fear of being alone
- fear of losing control in public
- a feeling of detachment from others
- feeling helpless
- feeling that your body or the environment is not real
- rarely leaving home
The specific cause of panic attacks is unknown. However, some evidence suggests that there may be a genetic aspect involved. Some people diagnosed with the disorder do not have other family members with the disorder, but many do.
Stress may also play a role in bringing on the disorder. Many people first experience attacks while going through intensely stressful periods. This could include:
- the death of a loved one
- job loss
- another circumstance that causes your normal life to be disrupted
Development of Attacks
Panic attacks tend to come on with no warning. As more attacks occur, the person tends to avoid situations they view as potential triggers. A person with a panic disorder will feel anxious if they think they are in a situation that could cause a panic attack.
The symptoms of panic disorder with agoraphobia can be similar to those of other conditions. Therefore, correctly diagnosing a panic disorder can take time. The first step is to visit your doctor. They will perform a thorough physical and psychological evaluation to rule out other conditions that have some of the same symptoms as panic disorders. These conditions could include:
- a heart problem
- hormone imbalance
- substance abuse
The Mayo Clinic makes the point that not everyone who has panic attacks has a panic disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), you must meet three criteria for a diagnosis of panic disorder:
- you frequently have unexpected panic attacks
- you have spent at least a month worrying about having another panic attack
- your panic attacks are not caused by alcohol or drugs, another illness, or another psychological disorder
The DSM has two criteria for the diagnosis of agoraphobia:
- fear of being in places that would be difficult or embarrassing to get out of if you had a panic attack
- avoidance of places or situations where you fear you might have a panic attack, or experiencing great distress in such places
Be completely honest with your doctor about your symptoms to obtain an accurate diagnosis.
Panic disorder is a real disease that requires treatment. Most treatment plans are a combination of antidepressant medications and psychotherapy like cognitive-behavior therapy (CBT). However, your doctor may treat you with medication or CBT alone. Most people are able to successfully manage their panic attacks with treatment.
Two types of psychotherapy are common for the treatment of panic disorder with agoraphobia.
Cognitive behavioral therapy(CBT)
You will learn about agoraphobia and panic attacks in cognitive behavioral therapy (CBT). This therapy focuses on identifying and understanding your panic attacks, then learning how to change your patterns of thought and behavior.
In CBT, you’ll typically:
- be asked to do some reading on your condition
- keep records between appointments
- complete some assignments
Exposure therapy is a form of CBT that helps you reduce your responses to fear and anxiety. As the name implies, you’re gradually exposed to situations that cause fear. You’ll learn to become less sensitive to these situations over time, with the help and support of your therapist.
Eye movement desensitization and reprocessing (EMDR)
EMDR also has been reported to be useful in treating panic attacks and phobias. EMDR simulates the rapid eye movements (REM) that happen normally when you are dreaming. These movements affect the way the brain processes information and can help you see things in a way that is less frightening.
Four types of medication are commonly used to treat panic disorder with agoraphobia.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are a type of antidepressant. They are usually the first choice of medication for treating panic disorder. Common SSRIs include:
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are another class of antidepressant and are considered as effective as SSRIs in treating anxiety disorders. These tend to have more side effects than SSRIs. Side effects include:
- upset stomach
- sexual dysfunction
- increased blood pressure
Benzodiazepines are drugs that promote relaxation and reduce the physical symptoms of anxiety. They are often used in the emergency room to stop a panic attack. These drugs can become habit-forming if taken for a long time or at a high dose.
These are effective in treating anxiety but can cause significant side effects, such as:
- blurred vision
- urinary retention
- a sudden drop in blood pressure upon standing
Take these medications exactly as prescribed. Do not change your dosage or stop taking any of these without first consulting your doctor.
It may take a few tries to get the medication that is exactly right for you. Your doctor will help you do this.
Be sure to tell your doctor about any side effects you are experiencing so they can make the necessary adjustments. Do not stop taking your medication without talking to your doctor. This can cause other health risks.
It can be difficult to live with a chronic condition. Talk to your doctor about support groups in your area. Many people find support groups helpful because it allows them to connect with people that have the same condition as them.
It may take some time for you to find a therapist, support group, or medication dosage that helps you manage your symptoms. Be patient and work with your doctor to make a treatment plan that works best for you.