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Panic disorder

In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. As noted earlier, this fear—called anticipatory anxiety or fear of fear—can be present most of the time and seriously interfere with the person's life even when a panic attack is not in progress. In addition, the person may develop irrational fears called phobias about situations where a panic attack has occurred. For example, someone who has had a panic attack while driving may be afraid to get behind the wheel again, even to drive to the grocery store.

People who develop these panic-induced phobias will tend to avoid situations that they fear will trigger a panic attack, and their lives may be increasingly limited as a result. Their work may suffer because they can't travel or get to work on time. Relationships may be strained or marred by conflict as panic attacks, or the fear of them, rule the affected person and those close to them.

Also, sleep may be disturbed because of panic attacks that occur at night, causing the person to awaken in a state of terror. The experience is so harrowing that some people who have nocturnal panic attacks become afraid to go to sleep and suffer from exhaustion. Also, even if there are no nocturnal panic attacks, sleep may be disturbed because of chronic, panic-related anxiety.

Many people with panic disorder remain intensely concerned about their symptoms even after an initial visit to a physician yields no indication of a life- threatening condition. They may visit a succession of doctors seeking medical treatment for what they believe is heart disease or a respiratory problem. Or their symptoms may make them think they have a neurological disorder or some serious gastrointestinal condition. Some patients see as many as 10 doctors and undergo a succession of expensive and unnecessary tests in the effort to find out what is causing their symptoms.

This search for medical help may continue a long time, because physicians who see these patients may fail to diagnose panic disorder. And, when doctors do recognize the condition, they sometimes explain it in terms that suggest it is of no importance or not treatable. For example, the doctor may say, "There's nothing to worry about, you're just having a panic attack" or "It's just nerves." Although meant to be reassuring, such words can be dispiriting to the worried patient whose symptoms keep recurring. The patient needs to know that panic disorder is real and that it can be treated effectively.

Agoraphobia

Panic disorder may progress to a more advanced stage in which the person becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. This condition is called agoraphobia. It affects about a third of all people with panic disorder.

Typically, people with agoraphobia fear being in crowds, standing in line, entering shopping malls, and riding in cars or public transportation. Often, these people restrict themselves to a "zone of safety" that may include only the home or the immediate neighborhood. Any movement beyond the edges of this zone creates mounting anxiety. Sometimes a person with agoraphobia is unable to leave home alone, but can travel if accompanied by a particular family member or friend. Even when they restrict themselves to "safe" situations, most people with agoraphobia continue to have panic attacks at least a few times a month.

People with agoraphobia can be seriously disabled by their condition. Some are unable to work, and they may need to rely heavily on other family members, who must do the shopping and run all the household errands, as well as accompany the affected person on rare excursions outside the "safety zone." Thus the person with agoraphobia typically leads a life of extreme dependency as well as great discomfort.

STRATEGIES FOR COPING WITH PANIC

1. Remember that although your feelings and symptoms are very frightening, they're not dangerous or harmful.
2. Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.
3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.
4. Do not add to your panic by thinking about what "might" happen. If you find yourself asking "What if?" tell yourself "So what!"
5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen.
6. Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.
7. When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backwards from 100 by 3's or snapping a rubber band on your wrist.
8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade.
9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.
10. Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

Courtesy Jerilyn Ross, M.A., L.I.C.S.W., The Ross Center for Anxiety and Related Disorders, Inc., Washington, DC. Adapted from Mathews et al., 1981.

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