Study Notes on Panic Disorder and Agoraphobia

Panic Disorder Overview

  • Definition: Panic disorder is characterized by recurrent unexpected panic attacks.
  • Diagnosis: This disorder is defined based on the DSM-5 criteria as outlined in Table 5.2 (APA, 2013).
  • Essential Features:
    • At least one panic attack must be followed by a month or more of:
    • Concern regarding potential additional panic attacks
    • Worry about the implications of the panic attack
    • Change in behavior due to the panic attacks
    • Symptoms must not stem from substance use or a medical condition.
    • Differentiation: Panic disorder is not to be confused with other anxiety disorders where panic attacks are predictable and linked to specific situations (e.g., public speaking).

Definition of Panic Attack

  • A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. During this time, four (or more) of the following symptoms must occur:
    • Palpitations, pounding heart, or accelerated heart rate.
    • Sweating.
    • Trembling or shaking.
    • Shortness of breath or sensations of smothering.
    • Feelings of choking.
    • Chest pain or discomfort.
    • Nausea or abdominal distress.
    • Dizziness, unsteadiness, light-headedness, or faintness.
    • Chills or heat sensations.
    • Paresthesias (numbness or tingling sensations).
    • Derealization (feelings of unreality) or depersonalization (feeling detached from oneself).
    • Fear of losing control or “going crazy.”
    • Fear of dying.
  • Note: Culture-specific symptoms should not be counted towards the four required symptoms.

Diagnostic Criteria for Panic Disorder (DSM-5)

  • Criterion A:
    • Recurrence of unexpected panic attacks.
  • Criterion B:
    • At least one of the attacks must be followed by 1 month (or more) of:
    • Persistent concern or worry about further panic attacks.
    • A significant maladaptive change in behavior related to the attacks.
  • Criterion C:
    • The disturbance must not be attributable to the physiological effects of a substance or another medical condition.
  • Criterion D:
    • The disturbance cannot be better explained by the symptoms of another mental disorder.

Impact and Implications of Panic Disorder

  • General Fear:
    • Panic disorder can be frightening because individuals often face unpredictability regarding when an attack may occur.
    • Common experiences include frequent attacks throughout the day or attacks occurring over several days, leading to anxiety about potential situations of panic.
  • Internal Sensation Fear:
    • Although panic attacks are not physically harmful, many individuals fear their own internal sensations (e.g., dizziness, heart palpitations) and may misinterpret them as signs of serious medical conditions.
  • Avoidance Behavior:
    • Individuals often avoid situations where they previously experienced attacks or where they believe attacks may occur, leading to diagnosis of related issues such as agoraphobia.

Agoraphobia Related to Panic Disorder

  • Definition: Agoraphobia is characterized by anxiety regarding situations where panic symptoms might occur, particularly those where escape may be difficult or assistance may not be readily available.

  • Key Features of Agoraphobia Include:

    • Criterion A: Marked fear/anxiety about two or more of the following situations:
    1. Using public transportation.
    2. Being in open spaces.
    3. Being in enclosed spaces.
    4. Standing in line or being in a crowd.
    5. Being outside the home alone.

  • Criterion B:

    • Fear or avoidance is due to thoughts that escape might be difficult if panic-like symptoms arise.

  • Criterion C:

    • Agoraphobic situations almost always provoke fear or anxiety.

  • Criterion D:

    • Avoidance of these situations occurs or is endured with intense fear or anxiety.

  • Criterion E:

    • The fear/anxiety/avoidance is disproportionate to the actual danger involved.

  • Criterion F:

    • Symptoms persist for 6 months or more.

  • Criterion G:

    • Causes clinically significant distress or impairment in areas of functioning (social, occupational).

  • Criterion H:

    • Excessive fear/anxiety/avoidance not better explained by symptoms of another mental disorder.

Connection to Behavioral Avoidance

  • Key Concept: Behavioral avoidance is a significant aspect in anxiety disorders.
    • For example, Angelina avoided restaurants due to fears of having panic attacks and feeling embarrassed.
    • Such avoidance can escalate, potentially to the point where individuals cannot leave their homes, leading to severe impacts on marital, occupational, academic, and other areas of life.