Panic Disorder and agoraphobia

what is a panic attack

an abrupt surge of intense fear that reaches a peak within minutes and four or more of the following symptoms occur

• heart pounding

• sweating

• trembling

• shortness of breath

• choking sensations

• chest pains

• nausea

• dizzy/feeling faint

• chills/heat flashes

• numbness/tingling

• derealization (you feel like you’re in a dream)

• depersonalization — feeling like you’re out of your body

• losing control/going crazy

• fear of dying

Panic Disorder DSM 5 Criteria

• recurrent , unexpected panic attacks

• at least a month of

  • persistant consern about having more panic attacks or the symptoms that accompany it

  • a significant change in behavior due to the attacks (avoiding exercise because it increases HR like a PA)

a person with panic disorder also often has _____

agoraphobia

Agoraphobia DSM 5 Criteria

marked fear or anxiety for two or more of the following situations

• using public transportation

• being in open spaces

• being in enclosed spaces

• standing in line or being in a crowd

• being outside the house alone

this anxiety avoidance must last for over 6 months

why are these places typically avoided

because people with agoraphobia believes that these spaces are difficult to escape from if they experience a panic attack

what do agoraphobic spaces provoke

fear and anxiety

is the fear out of proportion or in proportion to the actual danger

out of proportion

stats for PA and A (prevalence, ratio, onset)

prevalence

• 2.7 % year

• 4.7% lifetime

ratio

• 2:1 female to male

onset

• acute (sudden and quick) because it often develops after 1 panic attack

• ages 20-24

why are females more likely to develop PA and A over males

because males are more likely to push through these difficult emotions because their gender roles require them to

what are the Biological causes of Panic disorder

Increased NE.

• NE is released from the locus coeruleus. because theres higher NE, our sympathetic nervous system is activated more often, F or F is constantly activated

what are the physiological causes of Panic Disorder

behavioral:

• conditioning: if you had a PA in a movie theatre, you will associate the movie theatre with getting PAs

Cognitive

• misperceptions and inaccurate assumptions

• increased sensitivity of bodily sensations

  • high introspective awareness: you are VERY aware of your bodily sensations, so when something feels “off” you panic or see it as a negative

is the cause agoraphobia more tied to biological, psychological, or social/cultural factors

social and cultural factors

what are the biological treatments to PA and A

SSRIs — prozac and Paxil

• currently the best

• downside is that they have HIGH relapse rates when discontinued

what are the Psychological treatments to PA and A

cognitive restructuring and exposure —- panic control therapy

what is cognitive restructuring

teaching that body sensations are not meaningful and that they're normal

what is exposure — panic control therapy

exposure is where people are exposed to the fearful stimulus to see that nothing happens

panic control therapy is where you are letting the body sensations run their course to train the patient how to calm themselves down

what is the best approach though?

a combined approach. bio breaks the cycle, but psychological ensures it stays broken