Panic Disorder and Agoraphobia

For most people, panic disorder¬†is extraordinarily stressful–it can seriously disrupt our lives and sometimes disable us. Panic attacks, by definition, occur without warning, and can even happen when we’re sleeping.¬†Panic attacks usually peak within 10 minutes, and resolve within thirty minutes–although it’s possible to be very anxious for a much longer period, panic attacks themselves are acute, intense feelings of fear or discomfort, and usually involve the following symptoms:

  • heart palpitations, racing heart, or accelerated heart rate
  • sweating
  • shortness of breath, sensations of smothering, or choking
  • trembling and shaking
  • chest pain or constriction, discomfort
  • nausea or stomach distress
  • feeling dizzy, lightheaded, or faint
  • fear of losing control, going crazy, or passing out,fear of dying
  • chills or hot flushesfeeling detached from reality or from oneself
While the symptoms of a panic attack itself are extremely unpleasant, we become most bothered by trying to predict and avoid when and whether it will happen again. We develop an entire relationship to panic, and dedicate ourselves to avoiding these physical sensations. In other words, we are afraid of being afraid. We have many ways of avoiding, and may develop elaborate systems or methods.

We also avoid situations that might trigger another attack. This is agoraphobia: fear of being in places or situations from which we may not be able to escape easily if we have a panic attack. We may be scared of having a panic attack and “losing control,” “going crazy,” having a heart attack, or passing out. We may fear embarrassing ourselves in public and damaging our relationships or reputations. We may avoid being alone, standing in line, being in a crowd, taking public transportation, exercising, having uncomfortable conversations, flying… you name it. We can always find ways of avoiding–and therefore accommodating–our anxiety. Panic disorder, and the system of avoidance we develop, becomes a full-time job that demands more and more of us. We are no longer free to live our lives without restriction or deference to the disorder; we are no longer free.

Quite understandably, we’re driven to avoid panic symptoms and sensations. The most important thing to remember is that, although panic is a miserable experience, it is very responsive to treatment–typically in 8-12 sessions.