Panic disorder and/or agoraphobia

Panic disorder and/or agoraphobia

Panic disorder and/or agoraphobia


Panic Disorders

People who have a panic disorder, also known as anxiety attacks, experience sudden attacks of intense and overwhelming fear that something awful is about to happen. Their bodies react as if they’re in a life-threatening situation. These attacks come without warning and often strike when the person is in a non-threatening situation.

About 6 million adults have a panic disorder. Anyone can develop the disorder. However, it is more common in women than in men. Symptoms typically first appear at about age 25.


Agoraphobia usually involves a fear of being caught in a place where “escape” would not be easy, or would be embarrassing. This includes:

  • malls
  • airplanes
  • trains
  • theaters

You may begin to avoid the places and situations where you had a panic attack before, for fear it might happen again. This fear can keep you from traveling freely or even leaving your home.

Causes of Panic Disorder and Agoraphobia

Biological Factors

Brain Activity: brain imaging studies using a technique called positron emission tomography (PET) have shown that people with panic disorder have different amounts of activity in particular areas of the brain (especially an area known as the hippocampus), compared to people without panic disorder. The precise nature of these differences is not completely understood, and studies tend to have inconsistent results.

Neurotransmitters: A number of neurotransmitters (i.e., chemical messengers that pass information from one nerve cell in the brain to the next) are thought to play a role in the development and maintenance of panic attacks and panic disorder. The neurotransmitter for which the evidence is strongest is norepinephrine. For example, substances that increase norepinephrine in the brain (e.g., inhaling carbon dioxide enriched air) have been shown to trigger panic attacks in people with panic disorder. Also, medications that act on the norepinephrine system have been found to block panic attacks. In addition to norepinephrine, other neurotransmitters that may contribute to panic disorder include serotonin and cholecystokinin.

Genetics: Evidence is quite strong that panic disorder runs in families. In fact, if an individual has panic disorder, his or her immediate relatives are about three times as likely to develop panic disorder than relatives of an individual who doesn’t have panic disorder. In addition, studies on identical and fraternal twins suggest that part of the reason that panic disorder is transmitted from generation to generation has to do with our genetic make up. Environmental factors, such as learning, may also contribute to the tendency for panic disorder to occur across multiple family members.

Psychological Factors

Misinterpreting Panic Symptoms: People with panic disorder tend to misinterpret their physical symptoms as a sign of danger. For example, a racing heart may be misinterpreted as a signal that one is having a heart attack; dizziness may be misinterpreted as a sign that one is about to faint; feelings of unreality may be misinterpreted as a sign that one is going to lose control or go “crazy.” Anxiety-provoking beliefs about one’s panic-related symptoms can trigger a full blown panic attack in response to symptoms that might otherwise be ignored.

Attention and Memory:  People with panic disorder tend to pay special attention to the physical symptoms that frighten them. For example, they may scan their bodies for unusual symptoms (e.g., dizziness, racing heart), and in so doing, they are more likely to notice these feelings than other people. Individuals with panic disorder are also more likely to remember information that is consistent with their panic-related beliefs than are people without panic disorder. For example, they may recall stories about young athletes who experienced a heart attack while exercising and use this information as evidence that exercise is dangerous.

Life Experiences: Life stress puts people at risk for developing panic attacks and panic disorder. During stressful periods (e.g., work stress, marital problems, health problems, exams at school), people with panic disorder often report more frequent and intense panic attacks. In addition, many people with panic disorder report that their panic attacks began following a period of life stress (e.g., divorce, unemployment, graduation, etc.).


The Symptoms of Panic Attacks and Agoraphobia

Panic Attacks

The symptoms of a panic attack often feel the strongest in the first 10 to 20 minutes. However, some symptoms can linger for an hour or more. Your body reacts as if you were truly in danger when you experience a panic attack. Your heart races, and you can feel it pounding in your chest. You sweat and may feel faint, dizzy, and sick to your stomach.

You may become short of breath and may feel as if you’re choking. You may have a sense of unreality and a strong desire to run away.You may fear you’re having a heart attack, or that you’re going to lose control of your body, or even die.

You will have at least four of the following symptoms when experiencing a panic attack:

  • feelings of danger
  • need to flee
  • heart palpitations
  • sweating or chills
  • trembling or tingling
  • shortness of breath
  • a choking or tightening sensation in the throat
  • chest pain
  • nausea or stomach discomfort
  • dizziness
  • a feeling of unreality
  • fear that you are losing your mind
  • fear of losing control or dying


Agoraphobia usually involves fear of places that would be difficult to leave or find help if a panic attack occurs. This includes crowds, bridges, or places like planes, trains, or malls.

Other symptoms of agoraphobia include:

  • fear of being alone
  • fear of losing control in public
  • a feeling of detachment from others
  • feeling helpless
  • feeling that your body or the environment is not real
  • rarely leaving home


Diagnosing Panic Disorder with Agoraphobia

People experiencing panic attacks frequently seek emergency medical attention, either to have their panic attack treated or because they are afraid that their physical symptoms might be due to a life-threatening medical problem. The physical symptoms of panic attacks are typical of a heart attack, which makes panic attacks difficult to diagnose and treat. All physical causes must be ruled out prior to diagnosing the panic attack.

After general medical conditions and substance use have been ruled out (a requirement prior to diagnosing virtually any mental health disorder), a diagnosis is made according to the DSM-5 criteria for panic disorder with agoraphobia. The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) is the standard diagnostic manual for all mental health disorders.

Since there is no diagnostic test to confirm anxiety disorders, individuals are diagnosed when interviews or questionnaires confirm that they meet the panic disorder with agoraphobia criteria outlined in the DSM-5.

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