Agoraphobia and Panic Disorders

Agoraphobia - Agoraphobias & Panic Disorders



Many people who suffer from panic attacks go on to develop agoraphobia, a severely handicapping disorder that often prevents its victims from leaving their homes unless accompanied by a friend or relative - a "safe" person. The first panic attack may follow some stressful event, such as a serious illness or the death of a loved one. (The agoraphobic often doesn't make this connection, though.) Fearing more attacks, the person develops a more-or-less continual state of anxiety, anticipating the next attack, avoiding situations where he would be helpless if a panic attack occurred. It is this avoidance behavior that distinguishes agoraphobia from panic disorder. Two different types of anxiety appear to afflict the person with agoraphobia - panic and the "anticipatory anxiety" engendered by expectations of future panic attacks.

If you have agoraphobia, chances are it developed something like this: One ordinary day, while tending to some chore, taking a walk, driving to work - in other words, just going about your usual business - you were suddenly struck by a wave of awful terror. Your heart started pounding, you trembled, you perspired profusely, and you had difficulty catching your breath. You became convinced that something terrible was happening to you, maybe you were going crazy, maybe you were having a heart attack, maybe you were about to die. You desperately sought safety, reassurance from your family, treatment at a clinic or emergency room. Your doctor could find nothing wrong with you, so you went about your business, until a panic attack struck you again. As the attacks became more frequent, you spent more and more time thinking about them. You worried, watched for danger, and waited with fear for the next one to hit.

You began to avoid situations where you had experienced an attack, then others where you would find it particularly difficult to cope with one - to escape and get help. You started by making minor adjustments in your habits - going to a supermarket at midnight, for example, rather than on the way home from work when the store tends to be crowded.

Gradually, you got to the point where you couldn't venture outside your immediate neighborhood, couldn't leave the house without your spouse, or maybe couldn't leave at all. What started out as an inconvenience turned into a nightmare. Like a creature in a horror movie, fear expanded until it covered the entire screen of your life.

To the outside observer, a person with agoraphobia may look no different from one with a social phobia. Both may stay home from a party. But their reasons for doing so are different. While the social phobic is afraid of the scrutiny of other people, many investigators believe that the agoraphobic is afraid of his or her own internal cues. The agoraphobic is afraid of feeling the dreadful anxiety of a panic attack, afraid of losing control in a crowd. Minor physical sensations may be interpreted as the prelude to some catastrophic threat to life.

Agoraphobics may abuse alcohol in an effort to keep the anticipatory anxiety in check. Their pattern of abuse appears to be different from the binging characteristics of alcoholism, however. The agoraphobic usually takes small amounts of alcohol, avoiding loss of control. Other drugs may also be abused.

Agoraphobia typically begins during the late teens or twenties. The best surveys done to date show that between 2.7 percent and 5.8 percent of the U.S. adult population suffer from agoraphobia. Women are affected two to four times more often than men. The condition tends to run in families.

Recent surveys have found that many people are afraid to leave their homes. Most likely, they are not all suffering from agoraphobia. Some people may stay confined because of depression, fear of street crime, or other reasons. These surveys also show, however, that many agoraphobics may have never suffered a panic attack. This finding suggests that their agoraphobia may have developed in ways different from that outlined above.

Panic and agoraphobia have received a great deal of attention from clinical investigators in recent years. Some believe that panic attacks are a severe expression of general anxiety, while others think that they constitute a biologically distinct disorder, possibly related to depression, possibly indistinguishable from agoraphobia. This controversy will probably be resolved through more research in the coming years.


THE MASQUERADE: PHOBIAS AND OTHER CONDITIONS
Given the dramatic symptoms of phobic and panic disorder, it is surprising that they are sometimes difficult to recognize, even for medical professionals. Some patients, especially those with simple phobias, are able to conceal the severity of their handicap. Agoraphobia is often not detected because its physical symptoms become the center of concern for both patient and doctor. Health problems, such as peptic ulcer, high blood pressure, skin rashes, tics, tooth grinding, hemorrhoids, headaches, muscle aches, and heart disease, often occur together with anxiety disorders.

Phobias may cover up other problems. School phobia, a complex condition in which a youngster refuses to attend school, is one example; often the underlying problem is the child's anxiety over separating from his parents. (A mental health professional can easily distinguish between school phobia and other causes of missing school.)

Just as panic and phobias can masquerade as other illness, some physical diseases may be mistaken for anxiety disorders. For example, people can become anxious as the result of such medical conditions as head injury, withdrawal from alcohol and drugs, and even pneumonia. In these cases, the panicky feelings usually disappear when the condition clears up. Phobic behavior also occurs in conditions that are not diagnosed as phobias, such as the phobic-like avoidance of sexual contact in a person whose principal problem is sexual.

Reactive hypoglycemia - a rapid decline in blood Sugar followed by compensatory changes in adrenalin and other hormones - can produce many symptoms of panic, such as sweating, heart palpitations, and tremor. Most likely, this medical condition mimics panic disorder.

More puzzling is the relationship between panic attacks and agoraphobia, on the one hand, and depression, on the other. About half of people subject to phobias and panic are demoralized or depressed more often than the average person. Many agoraphobic patients develop their symptoms shortly after suffering a loss (which can trigger depression), and some either have histories of depressive episodes themselves or have relatives who do.

Whether phobias cause Depression or Depression causes phobias is unknown. Panic and anxiety can wear down a person until he or she feels demoralized. Alternatively, phobia and panic might result from Depression and its symptoms - difficulties with sleep, appetite, and concentration, fatigue, lack of pleasure, and feelings of worthlessness.

Yet another possibility is the simple coexistence of anxiety and depression, neither causing the other. Some underlying biological process - an inherited vulnerability, perhaps - may be common to both anxiety and depression
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