PDA – Panic Disorder and Agoraphobia – A Study Essay

Until recently, not much was known about Agoraphobia, a disorder that in many cases can be almost crippling. Panic disorder is a milder form of Agoraphobia and in its own way can be almost as disabling. Together, these two disorders are referred to as PDA, or Panic Disorder Agoraphobia. Those who suffer from either of these are forced to modify their lives in many ways. With the milder form – panic disorder – these modifications may not be quite so severe, but those who have Agoraphobia may often have to drastically alter their lives in order to even function.

While medications such as Olanzapine (Mokhber, & Savadkoohi, 2011) and Imipramine (Marchand, 2008) have been shown to be effective in many cases, they don’t always work for everyone and the side effects can be almost as devastating as the disorder itself. Agoraphobia is a severe form of anxiety disorder defined by RightHealth. com as a fear of having severe panic-like symptoms in a situation that the sufferer deems difficult, if not impossible to escape; situations such as wide-open spaces, crowds, or uncontrolled social conditions.

Claustrophobia, which is the fear of being trapped in an enclosed space is basically the opposite of Agoraphobia, as Agoraphobia is a fear of being out in the open (Mayo, 2011). The open space itself is not as much of a problem as it is if that space contains a crowd. It is then that the situation turns into a fear because the situation may seem insurmountable and inescapable. Those who suffer from Agoraphobia are often fearful that they will be injured or even killed if they leave the safety of their homes.

Agoraphobia is often brought on by a traumatic event in the life of the one who suffers from it. A loss such as the death of a loved one, divorce or even hearing on the news of a traumatic event can trigger the disorder in some people. As someone who suffers from this disorder, I can say with certainty that the trigger can be just about anything. Mine was triggered by a news report in October 1991 of a gunman who walked into a restaurant in Killeen, Texas and began randomly firing at everyone (Rugeley, 2001).

For some reason that report scared me immensely and the next time someone asked me to go out to eat with them I suffered from my first panic attack. Many medications have been developed for the treatment of both Panic Disorders and Agoraphobia – the side effects however, can be life altering as well. Imipramine is one of the popular medications for Panic Disorders and Agoraphobia and while it does work for some who have these disorders, for others it can cause intensely frightening nightmares.

Olanzapine, while initially prescribed for treatment of schizophrenia and acute manic episodes associated with bipolar I disorder (Omudhome, 2011); in recent years it has also been shown to assist in the treatment of Panic Disorder as well as Agoraphobia. Olanzapine is most commonly used in conjunction with other drugs such as Geodon, Zoloft, Lorazepam and Sertraline hcl, all of which have their own side effects (“Olanzapine side effect:,” 2011). As with most mental disorders, there is no hard and fast rule or way to diagnose Agoraphobia (Butcher, Mineka and Hooley, 2010).

Other mental disorders must be ruled out and it needs to be distinguished from social anxiety disorder and other phobias. It is also crucial to make certain that medication or a side effect from a medication is not causing the disorder. A psychiatrist or someone who specializes in the disorder may be essential in the diagnosis and treatment of Agoraphobia. The following are some of the signs and symptoms of Agoraphobia that may present: • strong feelings of horror, terror, dread or panic sufferer knows that they are making too much of the anxiety, yet is unable to talk themselves out of it • shortness of breath, visible bodily trembling and rapid heartbeat; may also be accompanied with an overwhelming urge to flee the situation. These are all physical reactions often associated with extreme fear • Many Agoraphobics may find themselves going out of their way to avoid known situation(s) that causes the fear Agoraphobia has been known to disappear on its own without treatment, but in most cases professional help is needed.

Some therapies that seem to help many with the disorder are exposure therapy, which is exposure to what causes the attack initially, and diaphragmatic breathing which consists of deep breathing exercises which can help calm someone who is suffering from Anxiety Disorder or Agoraphobia by calming the fear response felt when in the throes of a panic attack. Cognitive behavioral therapy is another approach used to help sufferers of these disorders in developing new skills that enable them to cope with situations which may trigger the attack of panic or Agoraphobic episodes.

It enables them to better think their way out of the situations and lessen their fear or even stop the symptoms (Medi, 2011). With invivo exposure, one of the first psychological treatment methods, agoraphobic patients were instructed to re-enter the situations they had been avoiding or feared (Marks, Stern, et al, 1977). In recent years, research into Agoraphobia and its causes and effects has increased tremendously. An important advancement has been the distinction between panic anxiety or Agoraphobia and generalized anxiety, which is reflected in the DSM-III classification (DSM-III).

References

DSM-III. American Psychiatric Association. Dsm-III. Washington, D.C. General Authors. (2011). Olanzapine side effect: agoraphobia, a study from 3 people from ehealthme.com. eHelpMe, Retrieved from http://www.ehealthme.com/ds/olanzapine/agoraphobia

Marchand, A., et al, (2008). Treatment of panic disorder with agoraphobia: randomized placebo-controlled trial of four psychosocial treatments combined with imipramine or placebo. Unpublished manuscript, Department of Psychology, Argosy University Online, Arizona. Retrieved from http://web.ebscohost.com. Libproxy .edmc.edu/ehost/detail?sid=006bf961-3610-487b-9ca2-Ecba642e461e%40sessionmgr14&vid=1&hid=25&bdata=JnNpdGU9ZWhvc3Qtb Gl2ZQ%3d%3d#db=pbh&AN=33881091

Marks, I., & Stern, M., etal (1977). The effects of self-exposure instructions on agoraphobic outpatients. Science Direct, (Institute of Psychiatry), Retrieved from http://www.sciencedirect.com/science/article/pii/000579677990055X Mayo Clinic Staff (2011). Agoraphobia complications. Retrieved from
http://www.mayoclinic.com/health/agoraphobia/DS00894/DSECTION=complications

Mediresource. (2011). Agoraphobia – causes, symptoms, treatment, diagnosis. canada.com, Retrieved from http://bodyandhealth. Medi, resource. (2011). Agoraphobia – causes, symptoms, treatment, diagnosis. canada.com, Retrieved from http://bodyandhealth.canada.com/channel_condition_info_details.asp ?channel_id=11&relation_id=10899&disease_id=236&page_no=1# Factscanada.com/channel_condition_info_details.asp?channel_id= 11&relation_id=10899&disease_id=236&page_no=1#Facts

Mokhber, N., & Savadkoohi, F. (2011). P01-165 – the effects of olanzapine in treatment of panic disorder with and without agoraphobia . Unpublished manuscript, Department of Psychology, Argosy University Online, Arizona. Retrieved from http://www.sciencedirect.com.libproxy.edmc.edu/science/article/pii/S0924933811718764 Rugeley, C. (2001, August 11). Shooting rampage at Killeen luby’s left 24 dead: Looking Back. Chron.com, Retrieved from http://www.chron.com/life/article/Shooting- rampage-at-Killeen-Luby-s-left-24-dead-2037092.php