PANIC DISORDER: WITH OR WITHOUT AGORAPHOBIA

In Panic Disorders there is a sudden and often unexplainable attack of acute panic characterised by a high number of symptoms including dyspnea (breathlessness and feeling anxious), palpitations, nausea, chest pains, a sensation of suffocation and asphyxia, dizziness, sweating and trembling, intense apprehension, terror and the sensation of an imminent disaster. The individual may be assailed and overwhelmed by a sense of depersonalization (an alteration in the perception or experience of the self) and derealisation (a sense of unreality of the outside world). Depersonalization consists in perceiving oneself as detached from oneself and from one’s body. Derealization on the other hand is characterised by the sensation that the world has acquired an unreal quality. Other frequent symptoms are the fear of losing control, going crazy or even of dying.

Panic attacks can occur frequently: for example, once a week or even more often. They normally last just a few minutes and would rarely go on for a number of hours. They are occasionally associated with specific situations, such as driving an automobile for example. When they are strongly associated with triggering factors of a situational type, they are defined as panic attacks caused by a situation (o generated by a situation). When there is a relationship between exposure to the stimulus and the attack itself but this link is not as strong as in the previous case, the event is referred to as a panic attack dependant on the situation. Very often between one panic attack and another there is a high degree of anticipatory anxiety (see glossary). Finally, the attacks may occur also in the presence of apparently benign mental states such as a period or moment of relaxation or sleep itself, or also in situations in which they would appear to be entirely unjustified. In such cases one would speak in terms of unexpected panic attacks (not caused by a particular stimulus).

The lifetime prevalence of panic disorders is approximately 2% in men and over 5% in women (Kessler et al., 1984). The disorder typically first occurs during adolescence and its onset is associated with particularly stressful life experiences (Pollard, Pollard and Corn, 1989).

According to the categorization established in the DSM-IV this anxiety disorder presents with or without agoraphobia. Agoraphobia (from the Greek agorà, meaning <<central city square or village marketplace>>) refers to a group of various fears mainly related to open or busy, public areas and spaces, from which it might be difficult to withdraw or separate oneself or where no help may be available in the case an individual were suddenly overcome by a panic attack. In very simple terms, we might say that agoraphobia is the actual fear of having a panic attack. The disorder includes the fear of going shopping, the fear of being in the middle of a crowd and the fear of travelling. People who suffer from agoraphobia often experience great psychological malaise and discomfort when leaving their house and may completely avoid doing so. Such cases are referred to as Panic Disorder with Agoraphobia.

Panic Disorder is also very frequent amongst those who already suffer from a different type of anxiety disorder. Examples can be found in individuals suffering from Generalized Anxiety Disorder or one of the Phobias (Sanderson et al., 1990). The co-existence of Panic Disorder and Major Depression is also a frequent occurrence (Breier et al., 1986).

>>> (Generalized Anxiety Disorder)

 

Bibliographical references:

Breier, A., Charney, D.S., & Heninger, G.R. (1986). Agoraphobia with panic attacks. Archives of General Psichiatry, 43, 1029-1036.

Kessler, R.C., McGonagle, K.A., Shayang, Z., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.U., & Kendler, K. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8-19.

Pollard, C.A., Pollard, H.J., & Corn, K.J. (1989). Panic onset and major events in lives of agoraphobics: A test of contiguity. Journal of Abnormal Psychology, 98, 318-321.

Sanderson, W.C., DiNardo, P.A., Rapee, R.M., & Barlow, D.H. (1990). Syndrome comorbidity in patients diagnosed with a DSM-IIIR anxiety disorders. Journal of Abnormal Psychology, 99, 308-312.

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