What is panic disorder and agoraphobia ?
Most of us have felt anxious at times. A panic attack however involves such a high level of anxiety that it can feel as if you are having a heart attack, going insane or losing control of yourself. During a panic attack you may have physical symptoms such as shortness of breath, tingling sensations, ringing in your ears, a sense of impending doom, trembling, and a feeling of choking, chest pain, sweating and heart pounding. Panic attacks can produce the same physical symptoms as some medical conditions. Once your GP has ruled out the medical conditions, you can have treatment for the panic disorder.
Many patients who have panic disorder also experience agoraphobia. Agoraphobia is a fear of places or situations where a panic attack may occur or from which escape might be difficult. People with agoraphobia avoid being out alone, going to supermarkets, travelling in trains and planes, being at heights, in elevators or tunnels or crossing open fields, Many patients even experience panic when they are asleep.
What are the causes of panic disorder and agoraphobia ?
In early human evolution, many situations that can trigger a panic attack were truly dangerous. For example, public places might have brought our ancestors in contact with hostile strangers. In any given year, 30% to 40% of the general population will have a panic attack. Some of these people will not interpret their panic as a signal of danger or illness, and thus will not go on to develop panic disorder and agoraphobia.
Panic attacks are usually activated by stressful situations such as leaving home, relationship conflicts, surgery, new responsibilities or physical illness. The sensations of physical arousal (pounding heart etc) may be misinterpreted as signals of being in the throws of a heart attack. The person therefore starts developing "hyper vigilance" (they focus excessively on physical sensations), which can result in an increase in the sensations and worry. This, in turn, may result in a full blown panic attack. The person may then develop anticipatory anxiety (fear that panic attacks will continue to occur) and begins to avoid situations that give rise to such anxiety. Once avoidance becomes wide spread the person has developed agoraphobia. The person's world may become smaller and smaller as they increase their avoidance behaviours and although they may not be experiencing a panic attack, they often live in constant fear of the next occasion when they have such an attack.