Agoraphobia Panic Attacks Disorder

The emotions of panic, fear, and anxiety are familiar to anyone who has been faced with some threat or danger. However, for some people, rushes of Intense fear (i.e., panic attacks) can occur out of the blue, without any obvious trigger, particularly following periods of stress. Furthermore, in a subset of these people, spontaneous panic attacks occur frequently and independently of stressful life events.

A diagnosis of panic disorder is given to individuals who experience panic attacks frequently (i.e., more than four times per month) or who worry excessively about the occurrence of these attacks. Typical panic symptoms include physical sensations such as breathlessness, dizziness, palpitations, trembling, nausea, and sweating and cognitive symptoms such as fears of dying, going crazy, and doing something uncontrolled.

As a result, many panic attack sufferers develop agoraphobia, a fear of situations in which escape—should a panic attack occur—might be difficult or embarrassing. Agoraphobics tend to avoid crowds, driving, public transportation, large stores, en- closed places, traveling, being home alone, and, in extreme cases, leaving the house. To illustrate the impact of panic attacks on a person’s life, consider the following case history:

Sally experienced her first panic attack out of the blue 3 weeks after completing her senior year in college. She had just finished a job interview and was meeting some friends for dinner. In the restaurant, she began to feel dizzy. Within a few seconds, her heart was pounding, and she was feeling breathless, as though she might pass out. Her friends noticed that she did not look well and offered to drive her home. Sally suggested they stop at the hospital emergency room instead. Although she felt better hy the time they arrived at the hospital, and tests indicated nothing wrong, Sally experienced a similar episode a week later while at a movie.

Sally began to wonder if she had some heart problem not detected by the hospital staff. She found herself scanning her body for unusual sensations. She also felt uneasy about going back to the same restaurant and movie theater where the attacks occurred. Her attacks became more and more frequent. Before long, she was having several attacks per week. In addition, she constantly worried about having attacks. She began to avoid exercise and other activities that produced physical sensations. She also noticed the attacks were worse when she was alone. She began to avoid driving, shopping in large stores, and eating in all restaurants. Some weeks she avoided leaving the house completely. Sally stopped looking tor work, fearing that she would be unable to stay at her job in the event of a panic attack.

Research focused on panic disorder and its treatment has increased dramatically in the past 10 years for several reasons. First, recent epidemiological studies estimate that panic disorder occurs in almost 2 out of 100 people. Second, panic disorder can lead to marked impairment in social and occupational functioning, and suicidal ideation and suicide attempts may be more prevalent than in other psychiatric disorders, including major depression. Finally, agoraphobia is an enormous burden on the health care system. Estimates for the average medical costs (e.g., for tests, medications, hospitalizations) per patient in the first 9 years after panic disorder onset to be over $10,000. With the rapidly increasing costs of health care in the United States, these figures will continue to rise.

Keith Bronson is a former agoraphobia sufferer who supports the mental health community of