How Are Panic Disorder and Agoraphobia Related?

Panic disorder and agoraphobia are anxiety-related problems that are becoming increasingly common with time, and they often coexist.

The link between panic disorder and agoraphobia is strong, as both conditions share similar symptoms and are classified as anxiety disorders.

Understanding how these conditions intersect, what sets them apart, and how they are treated can help people who are facing increasing isolation and anxiety seek the help they need to lead a better life.

What is a Panic Disorder?

A panic disorder is an anxiety disorder characterized by a stark increase in the frequency and severity of panic attacks, as well as the accompanying feeling of dread or doom surrounding the next panic attack. Panic attacks are different from normal periods of worry or even hyperventilation.

A panic attack is an intense rush of multiple physical and mental symptoms, culminating in a terrifying fight-or-flight state. To qualify as a panic attack, according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5), the experience must begin with feelings of dread or fear and share four or more of the following symptoms:

• Heart palpitations or fast heart rate
• Nausea
• Shortness of breath
• Trembling
• Fear of losing control
• Fear of dying
• Sweating
• Dizziness or lightheadedness
• Hot flashes or chills
• Chest pain
• Choking feeling
• Tingling or numbing sensation
• Depersonalization or dissociation

Furthermore, the panic attack must not have any other reasonable physical or mental explanation, such as substance use or medication side effects. Panic attacks can occur expectedly – for example, a panic attack is expected if you are deathly afraid of spiders and are exposed to multiple of them. However, panic attacks can also occur unexpectedly or for no reason at all.

A panic disorder is usually diagnosed when a person experiences unexpected panic attacks frequently, with no other reasonable potential causes or events that might cause panic.

What sets a panic disorder apart from someone experiencing a panic attack is frequency. If you are experiencing roughly one panic attack a year, you usually are not going to be diagnosed with a panic disorder. But if you are experiencing panic attacks frequently enough that you begin to develop anxiety symptoms in anticipation of another oncoming panic attack, be it in a week, a month, or two months, you may be diagnosed with a panic disorder.

Panic disorders are often diagnosed alongside agoraphobia. In fact, prior to the DSM-5, agoraphobia was solely associated with panic disorder. It is only recently that agoraphobia has been classified as its own condition within the DSM while retaining diagnostic criteria for a panic disorder with agoraphobia.

What is Agoraphobia?

Agoraphobia is a phobia, or intense fear, of embarrassing situations in public. This fear can include having a panic attack in a crowded area, such as a restaurant, school, shopping mall, concert, or anywhere else outside of what you consider your home.

An important distinguishing factor is that the panic is specifically reserved for places from which you cannot easily escape due to large amounts of people, inaccessible or far exits, or the inability to leave (such as a plane or ship).

Common places which people with agoraphobia may avoid include commercial flights, bus rides, ferries, or large crowds. Only about one percent of people struggle with agoraphobia in a given year, and 1.3 percent of adults experience agoraphobia at some point in their lives. Over 40 percent of patients with diagnosed agoraphobia suffer from a serious impairment as a result of their condition.

The word agoraphobia stems from the Greek agora, which is a public square, and phobos, which means fear. This generally encapsulates what the condition is about. Symptoms of agoraphobia must last for at least six months and will include:

• Avoidance symptoms of public spaces or crowded areas
• Fear of leaving home
• Fear of waiting in line
• Fear of enclosed spaces with others
• Fear of large open spaces, such as malls, parking lots, or concert areas
• Fear of public transportation
• Being anxious or worried about being in embarrassing situations
• Experiencing discomfort due to your avoidance of many areas
• Managing to go out and visit public spaces, but only with a companion, and while experiencing distress

How These Conditions Intersect

Agoraphobia and panic disorder are often co-occurring or diagnosed together. In these cases, a doctor will determine eligibility by looking for a history of panic attacks associated with being in situations that trigger a person’s agoraphobia.

The reason panic disorder is its own separate condition, rather than a facet of agoraphobia, is because in many cases, researchers believed that it was the fear of another panic attack that led to the development of agoraphobic symptoms, such as wanting to avoid places that previously caused panic attacks and developing anxious and unwanted thoughts about future embarrassing situations or unavoidable exposure in public, with no way to escape.

While these conditions are treated separately – i.e., patients can experience panic disorders without agoraphobia and agoraphobia without panic attacks – they still often intersect.

What Causes Panic Disorder and Agoraphobia?

As with many other anxiety disorders, genetics and hereditability are common throughlines. In other words, having a family history of anxiety disorders and panic disorder or agoraphobia, in particular, increases a person’s risk of developing panic disorder or agoraphobia symptoms in their lifetime.

While adolescence is usually the age of onset and the age of highest prevalence, these conditions can still develop later in life at any given point.

Stress, therefore, is another important risk factor. Chronic stress, as well as traumatic experiences or intensely stressful periods, can increase the risk of developing recurring panic attacks or a fear of embarrassment in public.

The stress does not necessarily have to be related to social anxiety or social embarrassment. Going through a messy divorce, the death of a loved one, job loss, unemployment, or a personal failure can result in the exacerbation of symptoms that weren’t prominent before.

How Are Panic Disorder and Agoraphobia Treated?

These conditions, whether they overlap or not, are treated similarly to other anxiety disorders through a combination of medication and talk therapy. A doctor may prescribe different medications depending on your symptoms.

Panic attacks are usually treated with anti-anxiety medications like benzodiazepines, as well as anti-convulsant drugs and antidepressants.

Talk therapy methods applied for panic disorder and agoraphobia include cognitive behavioral therapy, mindfulness training, and relaxation training.

If you or a loved one have been experiencing frequent panic attacks and signs of avoidance, especially in public places, you aren’t alone. The recent pandemic has exacerbated these symptoms in many people, potentially making them more common.

If you think you have either Panic Disorder and Agoraphobia, reach out to us and get help today.