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Panic Attacks and Panic Disorder with and without Agoraphobia

 

A panic attack is a discrete period of intense fear or discomfort that is associated with numerous physical and cognitive (thoughts and images) symptoms. These symptoms include palpitations, sweating, trembling, shortness of breath, sensations of choking or smothering, chest pain, nausea or gastrointestinal distress, dizziness or lightheadedness, tingling sensations, and chills or blushing and “hot flashes.” The attack typically has an abrupt (sudden) onset, building to maximum intensity within 10 to 15 minutes. Most people report a fear of dying, “going crazy,” or losing control of emotions or behavior. The experience of a panic attacks generally provokes a strong urge to escape or flee the place where the attack begins and, when associated with chest pain or shortness of breath, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance. Yet an attack rarely lasts longer than 30 minutes. The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature.

Panic attacks are not always indicative of a mental disorder, and up to 10 percent of otherwise healthy people experience an isolated panic attack per year. Also, panic attacks also are not limited to panic disorder. For example, they commonly occur in the course of social phobia, generalized anxiety disorder, and major depressive disorder. Panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and develops persistent concern or worry about having further attacks or changes his or her behavior to avoid or minimize such attacks. Whereas the number and severity of the attacks varies widely, the concern and avoidance behavior are essential features. The diagnosis is not given when the attacks are presumed to be caused by a drug or medication or are due to a general medical disorder, such as hyperthyroidism.

Panic disorder is frequently complicated by major depressive disorder and alcoholism and substance abuse disorders. Panic disorder is also co-occurs with other specific anxiety disorders, including social phobia, generalized anxiety disorder, specific phobia, and obsessive-compulsive disorder. Approximately one-half of people with panic disorder at some point develop such severe avoidance as to warrant a separate diagnosis (i.e., panic disorder with agoraphobia). Panic disorder is about twice as common among women as men. Age of onset is most common between late adolescence and mid-adult life, with onset relatively uncommon past age 50. Typically, an early age of onset of panic disorder carries greater risks of having additional disorders, having a longer problem with panic, and having a greater degree of impairment.

Panic disorder with agoraphobia is diagnosed when in addition to panic attacks, an individual has severe and pervasive anxiety about being in situations from which escape might be difficult or avoidance of situations such as being alone outside of the home, traveling in a car, bus, or airplane, or being in a crowded area. Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and the subsequent worry, preoccupation, and avoidance. Thus, the formal diagnosis of panic disorder with agoraphobia was established. However, for those people in communities or clinical settings who do not meet full criteria for panic disorder, the formal diagnosis of agoraphobia without history of panic disorder is used.

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder. The 1-year prevalence of agoraphobia is about 5 percent. Agoraphobia occurs about two times more commonly among women than men. This gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women, although other explanations are possible.

 

An excerpt from Mental Health: A Report of the Surgeon General, U.S. Department of Health & Human Services.


 

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