Panic Disorder with Agoraphobia - Essay Example

?Introduction Panic disorder with agoraphobia is a devastating ailment that undermines psychological, social and occupational functioning of an individual tremendously. Panic disorders are classified into different subtypes, including panic disorder with agoraphobia and without. Stein, et al noted that panic disorder is a learned fear of a particular physical sensation while agoraphobia is a behavioral response in expectation of encountering physical sensations or complete panic attack (27). This paper examines panic disorder, focusing on panic disorder with agoraphobia. Panic disorder and agoraphobia Brown, et al (328) defined panic disorder, as “a form of anxiety in which the patient suffers from repeated attacks of severe fear that unpleasant event will happen unexpectedly.” In this respect, recurrence of unexpected panic attacks is the major defining characteristic of the disorder. According to APA (48), the DSM-IV-TR (Diagnostic and Statistical Manual for Mental Disorders Fourth Edition Text Revisions) defines panic attack as distinct period of extreme fear accompanied by some of the following symptoms that last for a maximum of ten minutes. The signs include accelerated pulse rate, palpitations, running short of breath, shaking or trembling and choking feelings (APA, 49-54) Other symptoms include pain in the chest or discomfort in the cavity accompanied by abdominal pains or nausea. In addition, panic attacks are characterized by dizziness, fear of losing control or ones mind and unexplained chills or flushes accompanied by fear of death (APA, 60). Patients suffering from panic attacks also experience some of the following symptoms for a moderate period of at least one month. The symptoms include constant worry of experiencing more panic attacks, anxiety about the adverse effects of attacks such as loss of control, death and fears of becoming mad (APA, 76). The fears increase the worry of the affected person and consequently, the patient engages in safety behavior to protect himself or herself from future attacks. The most common safety behavior includes avoidance of places and environment that initiate panic attacks. According to Rachman (57), avoidance or fear of places that could trigger panic attacks is referred as agoraphobia. According to Rachman (65), agoraphobia is characterized by considerable fear or anxiety of being in places, circumstances or events which would hinder escaping, embarrass the person or where assistance might not be available in case the person suffers from panic attack and other sever associated symptoms. Patients suffering from agoraphobia exhibit most of the above-mentioned symptoms of panic disorders. Stein, et al argue that agoraphobia anxieties are focused on particular situations, including but not limited to fear of staying in house alone, fear of being in a crowd, bridge anxiety while travelling in airplanes and motor vehicles among other modes of transport( 46). Therefore, people with agoraphobia avoid such situations and in unavoidable circumstances, they experience extreme agony of suffering from panic attacks and the associated symptoms. In order to cope with such situations, people suffering from agoraphobia demonstrate high level of dependency on other people and they must be accompanied in such situations or events. The extreme fear or anxiety about these situations affects their ability to undertake the particular activities, such as travelling to work place and other important destinations, living alone among other activities. The phobic behavior exhibited by patients suffering from panic disorder and agoraphobia is unique and no other mental ailment or medical condition exhibits similar symptoms. According to APA (55) panic disorders and agoraphobia are discrete medical conditions and they sometimes occur separately in patients. When agoraphobia occurs separately without panic disorder, the patient demonstrates almost all symptoms of panic disorder, but the fear is localized on the occurrence of debilitating, exceptionally embarrassing, horrific symptoms or occurrence of constricted symptoms instead of complete panic attack (Hoffman and Smits, 107). Some of the embarrassing symptoms include loss of bladder control. Particular stressors have been indentified as the precursors that lead to the progress and development of majority cases of panic attacks with agoraphobia. According to Rachman (88), majority of the stressors that cause panic attacks with agoraphobia are interpersonal in nature and issues that affect the physical wellbeing of an individual. Some of the stressors that are interpersonal in nature include disagreement with a spouse, while death of a close person in the family, drug abuse , job loss among other life changing events affect the happiness and disposition of an individual. The progress of panic attacks differ from persons to person but Clark( 73) noted that they occur when the patient is way from home and in situations characterized by apparent loss of control, perceived negative assessment, supposed insecure place that could result to severe consequences. Some of these situations include while driving in a busy highway, in the middle of an important meeting such as job interviews , being in unfamiliar places or while using devices such as elevators that have minimal exit routes. In such situations, the patient interprets the panic symptoms as dangerous and the fear that they would return becomes entrenched. To develop coping mechanisms of dealing with the feared and anticipated events, patients become extra cautious and they constantly keep vigil on their surroundings, their body or they even engage in taking safety precautions that includes avoiding situations that trigger the attacks (Brown, et al, 82) . Prevalence of panic disorder with agoraphobia and diagnosis According to Rachman (69), the prevalence of panic disorder with and without agoraphobia ranges from 2.5 to 5.3 percent in the population. However, women have a higher risk of developing the condition that men and the average age at which the condition start developing is about 25 years. However, Rachman (72) notes that panic disorders with or without disorders can develop in people of all ages. Generally, the symptomatic indications of panic disorders are continuous, with a reduction rate of about 40%. However, the rate of recurrence differs depending on the sex of the patient, whereby about 50 percent of men experience recurrence while women report higher recurrence rate of over 80 percent (Stein, et al 127). The diagnosis of panic disorders, with and without agoraphobia is subject to various medical interpretations mainly because avoidance and panic symptoms are not restricted to the above-mentioned mental illnesses alone. According to Stein, et al (142), various mental disorders that affect the mood and wellbeing of a person portray panic and avoidance symptoms, though at different intensities. However, accurate diagnosis of panic disorders from other mood illnesses can be made by accessing the context under which panic and avoidance occurs. In other mental or mood disorders, Rachman (26) argues that panic attacks are restricted to particular situation. Hence, in specific phobia, the affected person fears and avoids a particular stimulus (Stein, et al 158). In social phobia, another type mood disorder, the fears are localized to the negative appraisal from other people and it is not associated with the panic, leading to evasion of particular social events (Brown, et al, 107). In post traumatic stress disorders, Rachman (38) notes that the fears originate from a particular potentially fatal situation. Hence, the person affected with posttraumatic stress disorder adopts an avoidance stance in order to protect oneself from an imminent danger. In patients with general anxiety disorder, excessive worry is the most common symptom and panic attacks are virtually non-existent. In other mental illnesses such as depression, the patient exhibit avoidance behavior, mainly caused by depressive disposition and loss of vibrancy (Rachman 78). Therefore, in depressive patients, phobia of panic attacks and fear of losing control are absent. Panic disorders with or without agoraphobia also differs from schizophrenia, a common psychiatric disorder characterized by hallucinations. Although the hallucinations in schizophrenic patients do sometimes trigger extreme and unjustified fear of situations, Brown, et al (60) argue that the resulting phobia is not linked to panic attacks. In both schizophrenia and panic disorders, patients exhibit social avoidance but in the latter ailment, the cause of isolation is primarily motivated by the desire to protect oneself from perceived ill intention of other people (Hoffman, and Smits, 58). Before making accurate diagnosis of panic disorders with agoraphobia, it is important for physicians to make careful assessments because some diseases exhibit similar symptoms. These medical disorders include diseases that affect hormonal balance in the body such as hyperthyroidism and hypoglycemia. Other diseases that exhibit symptoms similar to panic attacks include heart disease such as cardiac arrhythmias, respiratory infections especially asthmatic attacks and some neurological diseases such ass multiple sclerosis. In addition, people who used drugs such as cocaine, alcohol and heroine demonstrate panic like symptoms while using them and as withdrawal signs (Hoffman and Smits, 119) Panic disorders with agoraphobia could occur in combination with other mental illnesses. According to Rachman (37), over 50 percent of patients diagnosed with the disorder, demonstrate high degree of anxiety, while over 20 percent show signs of major depression. In addition, 16 percent of patients suffering from panic disorder with agoraphobia show symptoms similar to general anxiety disorder while specific and social phobia portray some clinical symptoms similar to panic disorders. Moreover, Rachman( 46) notes that the panic disorder with agoraphobia could be mistaken with personality disorders that demonstrate dependence and social avoidance. Treatment and management of panic disorders with agoraphobia Panic disorder with agoraphobia causes severe physical, social and psychological impairments and it is important to formulate an effective medical and psychological intervention to treat the disorder. The treatment regimen for panic disorder is designed to enhance the quality of life of the patient. This entails minimizing the adverse effects that the disease has on the social, professional and mental wellbeing of the patient. Moreover, extensive therapeutic intervention for panic disorders addresses the underlying factors that contribute to the development of the disease in affected people. Finally, empowering the patient with appropriate adaptive and coping skills is an important goal of treatment (Stein, et al, 205) Therefore, the objectives of treatment include assisting the patient to cope and stop panic attacks, enhance his or her awareness of indentifying and stopping fear motivated by avoidance and to decrease the susceptibility of the patient to future attacks. To restore the mental health of a patient suffering from panic disorder with agoraphobia, medical professional apply both cognitive behavioral therapy (CBT) and psychiatric drugs. Cognitive behavioral therapy for treatment of panic disorders focuses on transforming the behavior of the patient. This method of intervention is the most effective approach if it is designed and executed (Brown, et al, 328). According to Stein, et al (107), cognitive behavioral therapy is the most effective method of treating panic disorder with 70-90 percent of patients recording considerable improvements. One of the major benefits of using cognitive behavioral therapy its effectiveness in treating co-morbid ailments, such as depression and general anxiety that accompany panic disorders. According to Stein, et al (94), cognitive behavioral therapy applies several psychological and physical techniques aimed at controlling panic and avoidance behavior. Some of the techniques include anxiety management therapy such a relaxed breathing, controlled exposure to situations that trigger panic attacks and those that transform anxiety and worrying thoughts. The objective of cognitive behavioral therapy is to assist the patient in developing a rational understanding of the physical changes that occur when suffering from panic attacks (Stein, et al, 98-105). Exposure therapy is one of the most important components of cognitive behavioral therapy. According to Brown, et al (68), exposure therapy is founded on two principles, which hold that “panic is paired with avoided circumstances through conventional conditioning and it is then reinforced negatively through avoidance or escapisms.” Consequently, patients suffering from panic disorders fail to delink fear from the events. Patients suffering from panic disorder with agoraphobia are exposed systematically to regulated experience. In the process, the patient under therapy develops a hierarchical sequence of fear as the intensity of fear provoking event is increased. During exposure therapy, patients should desist from retreating into safety behavior, such as avoidance (Clark, 120). According to Clark (123), ceasing safety behavior while undergoing exposure therapy promotes drastic reduction in development of disastrous thoughts and the resulting panic attacks. Other cognitive behavioral therapy methods of treatment include relaxation training and respiratory control. Relaxation training focuses on the reduction of physiological stimulation in situations that were previously triggering anxiety. The objective of respiratory control is to prevent hyperventilation of the lungs that normally occur when patients are in anxious mode that could cause panic (Stein, et al, 117). Stein, et al recommends diaphragmatic inhalation to minimize physiological stimulation when the patient starts feeling nervous about an impending panic attack (127). Other methods of treating panic disorder with agoraphobia include use of drugs such as antidepressants and benzodiazepines. According to Brown, et al(126) drugs are effective for attaining short-term recovery goals but not as effective in the long term. In addition, some drugs initiate allergic reactions and side affects that sometimes aggravate symptoms of the panic disorders. Conclusion Panic disorders with or without agoraphobia causes extreme suffering to the patient because it undermines the ability of the patient to engage in meaningful activities and other duties that enhance human wellbeing. The major factors that contribute to development of panic disorders include interpersonal issues and life changing events. Panic disorder can occur in conjunction with agoraphobia or separately. However, panic disorder and agoraphobia have subtle distinct medical symptoms that distinguish them from other mental illnesses such as depression, generalized anxiety among others. Cognitive behavioral therapy and use of drugs are the method commonly used to treat the disorder. However, cognitive behavioral therapy demonstrates better long-term recovery results that drugs. Work cited APA ( American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders. 4 ed text revision. Washington, DC: American Psychiatric Press, 2000. Brown, C., et al. “A Comparison of Focused and Standard Cognitive Therapy for Panic Disorder.” Journal of Anxiety Disorders 11(1997):325-349. Clark, D. Panic Disorder: From Theory to Therapy. New York: Guilford press, 1996. Hoffman, S., and Smits, J. “Cognitive Behavioral Therapy for Adult Anxiety Disorders: A Meta Analysis of Randomized Placebo -Controlled Trials.” Journal of Clinical Psychiatry 69(2008): 620-630. Rachman, S. “Agoraphobia: A safety signal perspective.” Behavioral Research and Therapy 22(1984): 56-75. Stein, M., et al. Practice Guidelines for the Treatment of Patients with Panic Disorder. Arlington, VA: American Psychiatric Association, 2009. Read More