Panic disorder and agoraphobia: Australian treatment guide for consumers and carers, 2005

What is panic disorder and agoraphobia?

Page last updated: June 2005

Panic disorder

Panic disorder1 is very different to everyday anxiety. Panic disorder is a condition that affects 1 - 2% of the Australian and New Zealand populations each year. It usually begins during the teens or early twenties and women are twice as likely as men to experience it.

The exact causes of panic disorder are still unclear but there is some evidence of a family tendency to nervousness and a link with major life events and stresses. What this means is that if a member of the family has suffered from panic, there is an increased risk of you suffering from it, especially when you are stressed. Often people with panic disorder have always thought of themselves as 'worry worts' or sensitive but this may not always be the case.

Panic disorder involves recurrent, unexpected panic attacks. A panic attack is a sudden period of intense fear or discomfort, in which four or more of the following symptoms reach a peak within 10 minutes2:
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealisation (feeling 'unreal') or depersonalisation (feeling detached from yourself)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations
  • Chills or hot flushes.
At least one of these attacks is followed by one or more of the following, lasting for at least one month:
  • Worry about having more attacks
  • Worry about the what the attacks 'mean' (eg losing control, heart attack, or 'going crazy')
  • A significant change in behaviour related to the attacks.

Agoraphobia

Agoraphobia is often thought to mean that people are afraid of 'open spaces'. This is partly true. Many people with panic disorder avoid a number of situations because of their fears. This avoidance is known as agoraphobia, which is anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having a panic attack.

For this reason people with agoraphobia often avoid places such as trains, crowds and queues or only enter these situations with a trusted friend or relative. Obviously this can be extremely disabling and often limits opportunities in terms of work, social or other activities.

Often there are many less obvious forms of avoidance that people with panic disorder will engage in. For instance, people may avoid exercise, sexual relations, going out in hot weather or experiencing strong emotions such as anger. These forms of avoidance, also known as 'safety behaviours' will also need to be addressed for treatment to be successful.

1 In this guide panic disorder refers to both panic disorder and panic disorder with agoraphobia unless otherwise specified.
2 In Australia and New Zealand most clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to diagnose panic disorder. It is available in most libraries.