Panic disorder and agoraphobia

Panic disorder is not the same as anxiety or a single panic attack. Most people experience anxiety and up to 40 per cent of us have a panic attack at some stage during our lives. People who have recurring panic attacks are more likely to have panic disorder, and this affects one to two per cent of people.

Agoraphobia may be classified separately from panic disorder, because some people have the symptoms of agoraphobia without experiencing a panic attack. However, some people will have panic attacks along with their other symptoms of agoraphobia.

Symptoms of panic disorder and agoraphobia

Not everyone who has a panic attack has a panic disorder, but having recurring panic attacks is a symptom of panic disorder. Some people with agoraphobia have panic attacks, but you can have agoraphobia without having panic attacks.

Symptoms of panic attacks

Panic attacks occur suddenly. Symptoms can vary for different people, but they tend to hit their peak within 10 minutes.

A panic attack typically has four or more of:

• chest pain
• chills or hot flushes
• dizziness or feeling faint
• fear of dying
• fear of losing control or ‘going crazy’
• feeling like you are choking
• feeling short of breath
• nausea
• pounding heart and rapid heart rate
• sweating
• tingling or numbness
• trembling or shaking.

Symptoms of panic disorder

Rather than having just a single panic attack, if you have panic disorder you will experience several recurring panic attacks.

Symptoms of panic disorder include:

• frequent and unexpected panic attacks
• ongoing worry about having another panic attack for more than one month after the panic attack
• ongoing worry about the consequences of having an attack – such as losing control, ‘going crazy’ or having a heart attack.

Symptoms of agoraphobia

Agoraphobia is often thought of as fear of open spaces, but it is more than this. Agoraphobia is fear or anxiety of being in situations where you feel you cannot escape.

These include being:

• in an enclosed space – theatre, meeting room or small shop
• in an open space – bridge, car park or large shopping mall
• on public transport – bus, train or plane
• out of your home alone.

Causes of panic disorder and agoraphobia

The exact causes of panic disorder or agoraphobia are not known, but there are several risk factors, including:

• family history of anxiety disorders or depressive illness – some studies suggest a possible genetic component
• negative life experiences – extremely stressful experiences, such as childhood abuse, being made redundant or a death of a family member or friend, have been associated with recurring panic attacks
• physical medical conditions – some medical conditions, such as cardiac arrhythmias, asthma, chronic obstructive pulmonary disease and irritable bowel syndrome, are associated with panic disorder.

Diagnosis of panic disorder and agoraphobia

Healthcare professionals who can diagnose a mental health condition include your GP, a psychiatrist and some psychologists. Each of these professionals offers different types of services, so the first step is to visit your GP to speak about your concerns. They can then refer you to other healthcare professionals, if required.

Your doctor will do a physical examination and may take blood samples for testing. A diagnosis of panic disorder or agoraphobia will also involve your healthcare professional asking you questions about your symptoms and feelings, so they can understand your problem. If you experience panic attacks, they will want to know when, where and how often you have them.

They will also ask about your medical history. Some healthcare professionals may ask you to fill in some forms, which will also ask you a range of questions about your symptoms, moods and panic attacks. This will help the healthcare professional to understand and diagnose your problem, so that you can get the best treatment possible.

Diagnosis of panic disorder

To fit the criteria for a diagnosis of panic disorder, you will need to have experienced the symptoms of panic disorder. Your doctor will also need to confirm that medication, substances or other physical or mental health conditions are not causing your symptoms.

Diagnosis of agoraphobia

To fit the criteria for a diagnosis of agoraphobia, you will need to have experienced the symptoms of agoraphobia and some additional signs. These include:

• your fear or anxiety is almost always experienced when you are in the same situation
• you avoid the situation that causes your symptoms
• your fear and anxiety is out of proportion to the actual situation.

Treatment for panic disorder and agoraphobia

Having early treatment is important for recovery from panic disorder or agoraphobia. Treatment can be very effective in reducing the number of panic attacks for most people. The first step is to visit your doctor and get professional help.

The treatment for panic disorder or agoraphobia is medication or psychological therapies. You can also make a number of changes in your life to support your treatment.

Psychological therapies for panic disorder and agoraphobia

Psychological therapies, which involve talking with a therapist, can be an effective form of treatment. The most common form used for panic disorder and agoraphobia is cognitive behaviour therapy (CBT).

CBT can be short-term and helps you to learn:

• what triggers your symptoms
• how to cope with your symptoms
• how to change unwanted behaviours.

When choosing a healthcare professional to treat your panic disorder or agoraphobia, do your research and check the therapist’s qualifications and experience. The booklet, Panic disorder and agoraphobia. Australian treatment guide for consumers and carers, from the Royal Australian and New Zealand College of Psychiatrists provides information about the types of qualifications to look for.

Medication for panic disorder and agoraphobia

Treatment for panic disorder or agoraphobia can include either antidepressant or anti-anxiety medication. Some antidepressant medication can also be used to treat anxiety.

Self-help for panic disorder and agoraphobia

Other ways you can support your own mental wellbeing include:

• eating a healthy diet
• exercising
• searching online to find information or courses – check out This way up.
• seeking out support groups or online forums
• staying connected with family and friends
• training in relaxation practices.

Where to get help

• In an emergency, always call triple zero (000)
• Your GP (doctor)
• Emergency department of your nearest hospital
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Anxiety Recovery Centre Victoria - Helpline Tel. (03) 9830 0533 or 1300 269 438
• Beyondblue Support Service Tel. 1300 22 4636
• Lifeline Tel. 13 11 14
• SuicideLine Tel. 1300 651 251
• SANE Australia Helpline Tel. 1800 187 263