Panic Disorder and Agoraphobia?

WHAT ARE PANIC DISORDER AND AGORAPHOBIA? BASIC FACTS • SYMPTOMS • FAMILIES • TREATMENTS RT P SE A Mental Illness Research, Education and Clinical Center E C I D F I A C VA Desert Pacific Healthcare Network V M R E E Long Beach VA Healthcare System N T T N A E L C IL L LN A E IC S IN Education and Dissemination Unit 06/116A S R CL ESE N & ARCH, EDUCATIO 5901 E. 7th street | Long Beach, CA 90822 basic facts Panic disorder and agoraphobia are two separate psychiatric events and environmental stressors. disorders that often occur together. Panic disorder is characterized Although much is unknown about the role of genes in the de- by recurrent and sometimes unexpected panic attacks. A panic at- velopment of panic disorder, genetics research on panic disorder tack, or “fight or flight” response, is a sudden rush of intense anx- indicates that multiple genes are likely involved. Panic and other iety with symptoms such as rapid heart rate, difficulty breathing, anxiety disorders tend to run in families, giving support to genetic numbness or tingling, and/or a fear of dying. Panic attacks usually hypotheses. In addition to genes, other risk factors need to be pres- reach their peak within minutes, but people sometimes continue ent in order for someone to develop panic disorder. For example, to feel anxious or exhausted after one occurs. In some cases, peo- many scientists believe that there is a biological contribution to ple with panic disorder experience nocturnal panic attacks, which the development and maintenance of panic disorder, such as an wake them up from sleep. It is common for individuals with panic imbalance in brain chemicals, specifically GABA, serotonin, and disorder to worry about having another panic attack and to make norepinephrine. Others believe panic disorder is associated with a behavioral changes as a result, such as avoiding people, places, or sensitivity to changes in the body’s carbon dioxide levels. Certain things they associate with the attacks. medical conditions, such as asthma and chronic obstructive pul- The word agoraphobia literally means “fear of wide, open monary disease (COPD), are associated with a higher risk of panic spaces.” However, people with a diagnosis of agoraphobia might disorder, although many people with panic disorder do not have also have extreme fear or anxiety of other types of situations, such significant medical problems. as such as being out of their home alone or being in a crowd. Indi- Personality style and psychological risk factors may also con- viduals with agoraphobia often try to avoid these feared situations tribute to the development of panic disorder. Specifically, two of because of their high levels of anxiety. If avoidance is not possible, the most notable personality risk factors for panic disorder are a they need to be accompanied by another person, and/or they en- tendency towards experiencing negative emotions and high levels dure the situations with extreme anxiety. These situations are often of anxiety sensitivity. Individuals with anxiety sensitivity tend to avoided for fear of having a panic attack. Thus many people with misinterpret symptoms of anxiety as dangerous (e.g., equating a a diagnosis of agoraphobia also have a diagnosis of panic disorder. racing heart with having a heart attack). They also tend to be more aware of bodily sensations than those without high anxiety sensi- It is common for individuals with panic disorder to worry about having tivity. This hyperawareness, combined with the misinterpretation another panic attack and to make behavioral changes as a result, such as of the meaning of the symptoms, makes a person vulnerable to avoiding people, places, or things they associate with the attacks. having panic attacks in the first place and then having ongoing Prevalence attacks and related behavior changes. Stressful life events and environmental factors are often con- Nearly 5% of people in the United States will have panic dis- tributors to the development of panic disorder as well. These fac- order at some point in their lifetimes, and it is about twice as com- tors can include loss, trauma, an extensive illness history during mon in women. It is estimated that approximately one quarter to childhood, or stressful life events as an adult. These could be neg- one third of the population will experience panic-like symptoms at ative events such as a death of loved one, divorce, financial stress, some point in their lifetime, but these subclinical symptoms never or loss of a job. They could also be significant positive life events, progress to the full severity of panic disorder. Nonetheless, sub- such as getting married, having a baby, or getting a work promo- clinical panic symptoms are often associated with high degrees of tion. distress. The prevalence of agoraphobia is similar to that of panic Agoraphobia: The causes for agoraphobia are very similar for disorder, with about 5% of people experiencing it at some point in those described for panic disorder, and it is likely that genetic, bi- their lifetime. ological, personality and environmental stressors all play a role in the development of the disorder. For those who develop agora- Nearly 5% of people in the United States will have panic disorder at phobia after having panic attacks, the stated cause of avoidance of some point in their lifetimes, and it is about twice as common in women. certain situations is usually a fear of panicking in those situations. There are several factors that contribute to the development of panic - MIRECC - FALL 2016 - MIRECC FALL Causes disorder and agoraphobia, including genetic and family history of panic Panic Disorder: There are several factors that contribute to the disorder or other anxiety or mood disorders, biological factors, development of panic disorder, including genetic and family his- personality and psychological factors, and stressful life events and tory of panic disorder or other anxiety or mood disorders, biologi- environmental stressors. cal factors, personality and psychological factors, and stressful life WHAT ARE PANIC DISORDER AND AGORAPHOBIA? ARE PANIC WHAT 2 symptoms Panic disorder and agoraphobia cannot be diagnosed with a anxiety in individuals with agoraphobia, and their fears are out of blood test, CAT-scan, or any other laboratory test. The only way to proportion with the actual danger involved in approaching these diagnose these disorders is with a thorough clinical interview. A situations. The fear or avoidance must cause significant distress medical evaluation is also important to rule out underlying medi- or impairment in major areas of functioning in order to receive a cal causes of the symptoms. diagnosis of agoraphobia. If a person is avoiding these situations because of concerns related to a medical condition, the anxiety and Panic Disorder: avoidance must be clearly excessive. To receive a diagnosis of panic disorder, a person must have Finally, to receive a diagnosis of agoraphobia, the clinician recurrent panic attacks, at least some of which are unexpected (i.e., must determine that the symptoms are not better explained by occur out-of-the-blue). A panic attack is a sudden rush of intense another mental health diagnosis. For example, if the person only anxiety, reaching its peak within minutes and characterized by at avoids social situations, social anxiety disorder might be diag- least 4 of the following symptoms: nosed. If they avoid places that remind them of a traumatic event, 1) Heart palpitations or increased heart rate post-traumatic stress disorder might be diagnosed. Other disor- 2) Sweating ders associated with avoidance, such as major depression, specif- 3) Trembling or shaking ic phobias, and separation anxiety disorder, might be diagnosed 4) Shortness of breath or smothering sensations instead of agoraphobia if symptoms are better accounted for by 5) Feelings of choking those disorders. 6) Chest pain or discomfort 7) Nausea or abdominal distress The only way to diagnose these disorders is with a thorough clinical 8) Feeling dizzy, lightheaded, or faint interview. A medical evaluation is also important to rule out underlying 9) Chills or heat sensations medical causes of the symptoms. 10) Numbness or tingling 11) Feelings of unreality or feeling detached from oneself 12) Fear of losing control or “going crazy” 13) Fear of dying Additionally, a person must experience at least one of the following for one month or longer: 1) Ongoing worry or concern about having more panic attacks or about the consequences of the attacks (such as going crazy, losing control, or having a heart attack). 2) Significant, maladaptive behavior change relating to the attacks, such as avoidance of certain situations or activities (e.g., avoiding crowds or exercising). The clinician would need to check that these attacks were not the result of the effects of a substance or another medical condition, such as hyperthyroidism or asthma. Panic disorder might not be diagnosed if the symptoms are due to an underlying medical condition. In addition, panic attacks can occur in other psychiatric disorders, in which case the other disorder might be diagnosed instead of panic disorder. For example, if someone only has panic attacks in fearful social situations, such as public speaking or talking to unfamiliar people, they might be diagnosed with social anxiety disorder. If a person only has panic attacks when confronted with a very specific type of fear, such as heights, flying, spiders, or blood, 2016 - MIRECC FALL they might

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