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Panic Disorder with Agoraphobia
or Agoraphobia

Panic Disorder with Agoraphobia is one of two widely recognized subtypes of Panic Disorder. The Panic Disorder with Agoraphobia subtype varies from the standard Panic Disorder subtype by the severity and extent of the patient’s phobic avoidance. Patients with Panic Disorder with Agoraphobia avoid locations and situations where escape may be difficult or cause embarrassment, or where help might not be available if a panic attack occurs. The symptoms of avoidance can vary from mild to extreme, and can negatively influence normal home, work and social activity. In extreme cases, patients can become totally housebound and completely dysfunctional.

Many patients develop a fixed route, or an area within close proximity to their home and they will not vary from that route or go outside that territory. The patient is often incapable of leaving that safety zone without suffering extreme anxiety. Agoraphobia nearly always occurs with Panic Disorder, and hence, is identified as a subtype, but it can occasionally occur on its own without the symptoms of Panic Disorder, or it may occur with symptoms of other Anxiety Disorders. While some people consider agoraphobia to be a fear of open spaces, it often includes a fear of crowded places, as well. The patient’s fear can include ‘clusters’ of public situations like going outside alone, being in a very crowded room, standing in a line, driving through a tunnel, elevators, bridges, travel on public transportation systems, and many other situations. The onset of Panic Disorder is typically from late adolescence to the mid-thirties. However, there are a few reports of this disorder in children.

What are the symptoms?

There are a number of symptoms of Agoraphobia, and the severity and occurrence of these symptoms will vary from patient to patient.

• Confused or disoriented
• Numbness, tingling sensation
• Difficulty in breathing
• Sweating or feeling flushed
• Anxiety or Panic Attack
• Feeling ‘unreal’ or disconnected
• Feeling isolated, or detached
• Fear of loss of control in public
• Tendency to choose ‘safe’ places to go (home, friend or family residence, etc)
• Fear of being alone
• Fear of ‘going crazy’ or of dying
• Nausea or vomiting, stomach pain
• Chest pain or rapid heart rate
• Feeling dizzy or faint
• Agitation, trembling, shaking
• Feeling that surroundings are unreal
• Being housebound for long periods of time
• Helplessness, dependent on other people
• Fear of specific places like elevators, bridges, crowded rooms, etc.
• Fear of places where there is no easy exit

How is it diagnosed and treated?

As with most suspected mental disorders, doctors will typically perform a physical examination and blood tests to rule out other physical problems and other associated mental disorders. When diagnosing Agoraphobia with or without Panic Disorder, doctors will look for the following signs:

• Patient is anxious about being in places where escape is difficult or embarrassing.
• Avoidance is practiced so ensure that the patient does not have a panic attack and when exposed to things they fear the patient will show marked distress and anxiety
• Patient is anxious about being outside the home and possibly about being in crowds, being in elevators, on buses or bridges, etc.

Treatments vary depending on whether the patient has other associated anxiety or panic disorders, and on the severity and type of symptoms the patient exhibits: Treatment(s) can include:

• Psychotherapy
• Stress Management and Meditation Techniques
• Medications: Antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) tricyclics, Monoamine-Oxidase Inhibitors (MAOIs), anti-anxiety medication (bezodiazepines, buspirone)
• Cognitive Behavioral Therapy
• Group Therapy

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