house of agoraphobics

Panic attacks are periods of intense fear or discomfort that arise suddenly and unexpectedly and in the absence of any external danger or threat. They often take place when you are engaged in a perfectly normal activity such as travelling on a bus or doing the shopping.

© Channel 4

Everyone feels stressed sometimes, and many people get panic attacks. But what if those attacks were so severe that you were afraid to go outside and your home became a prison? Agoraphobia with Panic Disorder is a fear of situations where escaping would be difficult, including busy outdoor locations, streets, traffic, and public transport. The condition can have devastating effects on the lives of sufferers and their families. Following on from last year's successful series about Obsessive Compulsive Disorder, House of Agoraphobics follows three sufferers as they attempt to tackle their condition with the help of leading anxiety expert Professor Paul Salkovskis.

Su, a single mum from Birmingham, can't leave the house to take her eight-year-old daughter to school. Archana is an expectant mother and qualified GP whose fear of motorways means she lives apart from her husband, which is putting her marriage under huge strain. And Simon is a young graphic designer who stills lives with his 75-year-old father and rarely ventures from his bedroom.

Professor Salkovskis and his team of therapists from the Maudsley Hospital Centre for Anxiety Disorders and Trauma have pioneered an intensive 14-day treatment plan to help people such as Su, Archana and Simon to confront their fears. As their treatment begins they face their anxieties to see whether they can overcome them. But even as they make tentative steps forward, the condition constantly attempts to drag them back.

panic attacks and panic disorder

by Professor Paul Salkovskis

panic attacks and panic disorder | help and info

panic attacks

A panic attack is a sudden episode of intense fear, accompanied by four or more symptoms from the following:

• palpitations or rapid heart rate
• breathlessness
• feeling unsteady, dizzy, light-headed or faint
• trembling or shaking
• sweating
• having a hot flush or chills
• chest pain or discomfort
• numbness or tingling sensations
• feeling as if you or surroundings are unreal
• nausea or churning stomach
• choking
• fear of dying
• fear of losing control or going crazy.

Different people have different combinations of symptoms, but the general pattern is usually the same:

• a sudden increase in anxiety
• a range of unpleasant sensations in the body
• fear that something terrible is going to happen. Often people are afraid that they may collapse, lose consciousness, have a heart attack, lose control, go mad or even die.

Panic attacks usually come on very suddenly and reach their peak within 10 minutes. The peak generally lasts for 5-10 minutes, but it can take much longer for all the anxiety to subside. In a panic, normal fear reactions are happening at the wrong time: the body's 'alarm system', which is designed to help you deal with emergencies, gets triggered off, exactly as if you were in real danger.

limited symptom panic attacks

These are panic attacks with less than four symptoms. For example, a sudden episode of intense dizziness or nausea, accompanied by fear that something terrible is about to happen. Many people have a mixture of full and limited symptom panic attacks.

panic disorder

This means having repeated, frequent panic attacks. People with panic disorder are often very apprehensive about having more attacks, and may change their behaviour or lifestyle as a result of the attacks.

Between one and four people in 100 have panic disorder at some stage in their life. It is twice as common in women as in men. It usually starts between the ages of 15 and 19 or between 25 and 30 years of age.

panic disorder with agoraphobia

Together these create anxiety about being in places or situations for fear of having a panic attack or panicky feelings. Situations may include being away from home, queuing, travelling on public transport or using lifts. Some people avoid these situations completely. Others force themselves into feared situations, but feel anxious and panicky throughout.

agoraphobia?

The word agoraphobia is derived from fear of the 'agora' - the marketplace. People with agoraphobia typically fear being out in crowded places where it may be difficult to escape or find safety. The fear of being embarrassed also features, although this is also a feature of social phobia. Agoraphobics usually, but not always, fear crowded places; some may also fear being alone, because they are concerned that they may panic when no-one is there to help them. Most people suffering from agoraphobia also feel anxious about or avoid public transport, because they feel it is difficult to escape. For some people their car can become an extension of home and allows them to travel greater distances. Again, most people with agoraphobia prefer to be accompanied if they go out, usually with someone they know well and trust. The avoidance typically interferes with the person's ability to work and socialise, often to the point of being housebound.

Although agoraphobia commonly occurs in people suffering from panic disorder, there are many people who suffer from agoraphobia alone. Some may have other problems which make them fear leaving their house, including irritable bowel syndrome, epilepsy and osteoporosis.

what happens during a panic attack?

In a panic attack people typically become frightened of the sensations of anxiety itself. For example, a person walking down the street may notice that their heart is beating quickly and pounding. This, or other physical sensations, although harmless can trigger off ideas such as 'I'm having a heart attack'. Not surprisingly, that kind of thought increases anxiety which in turn increases bodily sensations which seem to confirm the idea that the person is having a heart attack further increasing anxiety and so on in a vicious circle.

Notice that a panic can be triggered by physical sensations but also by feeling anxious or upset and by the thoughts themselves. The type of things which people typically fear in a panic vary from ideas of losing control over your behaviour through to more physical catastrophes such as having a heart attack, a stroke or fainting. Once the panic attacks begin, a number of things can keep them going. Particularly important is the things that people do; the person who is in the supermarket when they have their panic attack rushes out thinking that they 'just got away with it'. In fact, by rushing out what really happened is that they didn't get the opportunity to discover that the thing they are afraid of didn't happen!

These understandable behaviours such as avoidance, or more subtle behaviours which occur during a panic attack, can become very prominent and indeed sometimes become the problem itself. Thus, in agoraphobia the avoidance can often become more of a problem than the panic attacks.

However, it is not a matter of 'just pull yourself together'. Everyone who suffers from an anxiety disorder tends to think this kind of thing. The reality is that nobody wants to suffer from an anxiety problem and if the sufferer knew how to pull themselves together they would do so. Very often what the person needs is guidance on how best to set about 'pulling themselves together'.

practical advice

Here are some important facts about panic attacks:

• no matter how bad it feels, panic attacks cannot actually harm you or make you go mad
• panic attacks do not last forever, they always pass after a while
• how you think will affect how bad the panic is and how long it lasts
• if you run away from a panic attack, you are making life harder for yourself in the longer term and your life will become more and more restricted
• during a panic, remind yourself that you are not going to die, go mad or lose control
• try and just let the panic attack wash over you, without fighting it – just wait for it to subside by itself
.

what help is available?

Cognitive therapy has been shown to be a very effective way of treating panic disorder and agoraphobia relatively quickly. This therapy is very practical and active: it focuses on your thoughts and the way you behave. You and your therapist work together to find out what is keeping the problem going, and how to overcome it. You may already have started to make efforts in this direction. Cognitive therapy will offer you new techniques, and will strengthen your own efforts. For more information see our feature on cognitive behaviour therapy.

The team at the clinic in the Maudsley has played a leading role in developing and improving cognitive therapy for panic and agoraphobia. The clinic has an ongoing therapy and research programme which aims to increase the understanding and treatment of this condition.

If you have panic disorder, or panic with agoraphobia, the first step is to visit your GP. Your GP will be able to refer you to a cognitive behavioural therapist or a clinical psychologist. They may also offer you medication.

 

(December 2006)

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