Posts tagged: agorophobia

Panic

Dr. Holzmacher's Business Logo for Orlandopsych.comPanic is not a disorder unto itself, and neither is a panic attack.  The modern conceptualization is that panic is a form of anxiety that may or may not include agoraphobia.  This last term is taken from the Greek, and literary means “fear of the marketplace”.  It is a fear of being unable to escape in a crowded situation, fear of bridges, and fear of travel in any kind of conveyance.   Much of the fear is anticipation of having a panic attack in these sort of situations.  The fear is heightened if the person believes the situation is such that no one will come to their assistance.  The agoraphobia is rarely initiated by a specific trauma, as is a post-traumatic stress disorder.  It is also not secondary to a fear of being socially embarrassed, as is a social phobia.  All these anxiety disorders impel one to flee the situation, but for different reasons.  Situations that involve travel or crowds  are feared and consequently avoided.  Many agoraphobics do not experience panic, but most suffer with the disorder.

Many agoraphobics develop anticipatory anxiety of being in public places, then avoid these situations for fear of having an attack.  Phobic avoidance develops over time, which reinforces the avoidant behavior.  The combined disorder of agoraphobia with panic tends to be more functionally debilitating than either disorder in isolation.  Anticipation of a fearful situation reaches the point of panic, and the panic is so startling that a person would do anything to avoid another panic attack.

Many patients complain of panic, but rarely do they meet the criteria.  Most people experience acute unpleasant anxiety and label that as panic.  Several symptoms overlap with generalized anxiety, but a few are better indicators of true panic than the rest.  The onset of panic and anxiety may be sudden, but panic tends to peak within ten minutes and then subside.  Generalized anxiety has less intensity at the onset, and tends to take a long time to resolve-if ever.  There are intense fears of dying or going insane while enduring a panic attack.  It almost seems like a medical problem when the heart beats so strongly.  A miasma of nausea, dizziness, palpitations, chest pains and shortness of breath overwhelm one to the point they fear dying.  Sweat pours forth in buckets.  Generalized anxiety often is accompanied by sweat, but typically not as intense or circumscribed.

The good news is that most people who believe they are experiencing panic are actually experiencing acute anxiety.  The onset of panic is so strong and unforgettable, that it creates a cycle of fear and avoidance.  Generalized anxiety does not have specific fears that could be avoided.  Many people have agoraphobic symptoms, but fortunately, few will fall prey to the disorder.  It is commonplace for people to fear bridges, especially if they can see through a metal roadbed.  It is also normal to have fear of being trapped while waiting in line, or have a fear of being immobilized in a crowded elevator.  It is rare these mild anxieties develop into a Panic Disorder with Agoraphobia.

Treatment of all phobias is cognitive-behavioral in nature.  The main thrust of the therapy is to gradually expose the patient to the feared object.  The hope is to decouple the feared situation from the biological and psychological reaction. A psychologist will have the person imagine driving over a bridge, and discuss their emotional and cognitive apprehensions.  As the therapy progresses, the psychologist will attempt increased contact with the feared situation until the person masters their reaction.  Another method is to directly expose the patient to the feared situation in an aggressive fashion, which often alleviates the anticipatory anxiety of the next exposure.  There is a greater risk of being overwhelmed or even traumatized by this second sort of treatment, such that it should only be attempted with professional assistance.  Medication is not advised for long-term control of panic, but temporary usage can assist the therapy by lowering the overall level of anticipatory anxiety.  Please leave your comments regarding this article in the space provided below.

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