Panic Disorder & Agoraphobia

Updated: Oct 10, 2020

When a person has a panic attack it may have nothing to do with their environment, and is brought on by a faulty panic switch which is brought on by faulty thinking. It normally starts with late adolescence or early adulthood. Panic attacks are created when one has systematically trained their body and brain to become hyper-vigilant and prepared in anticipation of the next stressful experience. We send the body into the fight or flight reaction, triggering many of the symptoms below, through our thoughts only.

When we continue to think in a certain way, be it positive or negative we build more and more synaptic connections within the brain. The neural pathways become stronger. If you are always having panic attacks then these pathways become thicker and richer, whilst positive calming pathways are pruned away because they are not being used. This means that it becomes easier to think in panicked anxious ways and harder to think realistically and positively, so in reality you nurture a habit of panic and anxiety.

So, what is going on from a bio-chemical standpoint. Panic is a chain reaction which starts in the brain. It starts with a stressful stimulus, be it real in the environment or produced through thought alone. Our sympathetic nervous system is turned on. Adrenaline and Cortisol are released into the blood stream, blood pressure, heart rate and respiration are increased and blood is sent to the limbs for action.

A panic attack happens when the body is mobilised to fight or flee but there is no real physical threat. The excess energy produced is detrimental to the situation instead of helpful. Many folks try to fight the attack. For example, they become aware that the breath has quickened, which causes the person to focus more on it. This could bring about feeling faint or dizzy due to the depletion of CO2. The best reaction to a panic attack is no reaction. Just allowing the feelings to come and then let them go. Eventually the Parasympathetic Nervous System is turned on and the body and brain calms.

According to the Diagnostic and Statistical Manual (DSM), a panic attack is a discreet period of intense fear or discomfort in which 4 or more of the following symptoms are developed abruptly and reach a peak within 10 minutes.

- Palpitations, pounding heart or accelerated heart rate.

- Sweating

- Trembling or shaking

- Sensations of shortness of breath or smothering.

- Feeling of chocking.

- Chest pain or discomfort.

- Nausea or abdominal distress.

- Feeling dizzy, unsteady, light-hearted, or faint.

- Derealisation or Depersonalisation

- Fear of losing control or going crazy.

- Fear of dying.

- Tingling or pins and needles.

- Chills or hot flushes.

All of which are created by the switching on of the Sympathetic Nervous System.

There are 3 types of panic attacks:

1. Unexpected – starts for no apparent reason.

2. Situational – Starts in certain situations always.

3. Situational predisposed – Starts in certain situations sometimes.

Many people experiencing frequent panic attacks go to the doctor or the hospital emergency ward often. While an average person goes to a doctor 4 times a year, a person prone to panic attacks visit the emergency ward 30 times a year. Many times, the person is hooked up to all types of diagnostic equipment, then to find out that they are not having a heart attack or dying or going crazy but having a panic attack. The sympathetic nervous system turns on even though it is not required. This is due to faulty thinking. Emotionally charged thoughts are stored in the Hippocampus, and when released they cause reactions in various glands and organs throughout the body excreting fight flight chemicals.

There are two major factors to be met before somebody is diagnosed with a Panic Disorder:

- Reoccurring unexpected panic attacks.

- At least one of the attacks followed by a month or more of at least one of the following:

1. Persistent concern about additional attacks.

2. Worry about the consequences of the attacks.

3. Significant change of behaviour to the attacks.

The first things to rule out is if these attacks have been brought on by the use of substances or medication. It could also be the symptoms of another mental disorder. Panic disorder can co-exist with other disorders like depression. Research tells us that 20% of people with a panic disorder will attempt suicide. A therapist is required to address this issue together with the attacks.

If people believe that their panic attack happens in certain situations, even though this may not be true, then they may start to avoid these situations. Taken to an extreme, people withdraw more and more from doing normal things like going out in public and tend to stay at home just in case an attack may occur. This is called Agoraphobia. The official definition of Agoraphobia is:

Anxiety about being in places or situations which escape might be difficult or embarrassing or in which help may not be available in the event of having an unexpected or situational predisposed panic attack or panic-like symptoms.

There are two types of Agoraphobia:

1. Agoraphobia with panic disorder.

2. Agoraphobia without history of panic disorder.

Techniques used by a health care workers, psychologist, psychiatrist and counsellors for treating a Panic Disorder and Agoraphobia may be:

1. Medical Assessment – Send client for a medical check up to make sure that the sensations experienced aren’t real medical concerns.

2. Thought Tracking – Look at the thoughts just before the panic attack starts.

3. Thought Stopping – The client saying to themselves or out loud STOP when thoughts of panic comes into the mind. Then replacing it with a positive thought.

4. Journaling – The client is to write down all the thoughts leading up to the panic attack for a week. Bring journal to next session with therapist to analysis these thoughts.

5. Relaxation techniques – These include slow diaphragmic breathing and moving through the body relaxing each body part. Many times, people hyperventilate when panic sets in. The therapist or teacher may get the person to hyperventilate first then teach the client to slow the breath in relaxation.

6. Meditate – The client should practice sensations meditation which will make the client more self-aware. Find a good meditation teacher and practice this daily.

7. Exposure Therapy – The client ventures out little by little into the situations and places where they have had panic attacks in the past. Best done with someone at the client’s side. This brings about systematic desensitisation.

8. Pairing Therapy – The therapist puts the person in the environment where the client believes the panic attack starts, and when and if it does start then uses relaxation techniques to reduce the effects of the attack. This reprograms the brain to relax to the signals which trigger the attacks.

9. Medication – Medication might be prescribed depending on the severity of the disorder. This can kick start the recovery. This must be diagnosed and prescribed by Mental Health Nurse, Doctor or Psychiatrist.

Early treatment of panic attacks may lead to decreased possibility of developing Panic Disorder which could manifest into Agoraphobia. Panic attacks are real. Even though the attacks start with faulty thinking, the physical symptoms are very real and very frightening. It is important that people who suffer panic attacks get professional help.

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