Panic disorder with (PDA) or without (PD) agoraphobia can be an extremely debilitating disorder that is associated with psychological, social, and occupational impairment and diminished quality of life. In essence, panic disorder can be thought of as a learned fear of certain bodily sensations, whereas agoraphobia is the behavioral reaction in anticipation of experiencing such bodily sensations or a full-blown panic attack.
Panic disorder is characterized by recurrent, unexpected panic attacks.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR; American Psychiatric Association, 2000), a panic attack is a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes: palpitations; pounding heart or accelerated heart rate; sweating, trembling, or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feelings of being dizzy, unsteady, lightheaded, or faint; derealization or depersonalization; fear of losing control or going crazy; fear of dying; paresthesias; and chills or hot flushes.
In an effort to prevent future panic attacks, people engage in safety behaviors, which often entails avoiding places they fear will trigger the panic attacks. Thus, many individuals with panic disorder also experience agoraphobia. DSM-IV-TR defines agoraphobia as significant anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help may not be available in the event of having a panic attack or panic-like symptoms. Agoraphobic fears typically center on specific situations such as being outside the home alone, being in a crowd or standing in a line, being on a bridge, or traveling in a bus, train, or automobile. Such situations are avoided, are endured with marked distress about having a panic attack or panic-like symptoms, and often require the presence of a companion. Individuals' avoidance of these situations may impair their ability to travel or work or to carry out various responsibilities (e.g., grocery shopping, taking children to the doctor). For both panic disorder and agoraphobia, the anxiety or phobic avoidance is not better accounted for by another mental disorder, the direct physiological effects of a substance (e.g., drugs), or a general medical condition.
Whereas panic disorder and agoraphobia frequently co-occur, they can exist in isolation. The fundamental characteristics of agoraphobia without accompanying panic disorder are similar to those of PDA, except that fear is centered on the occurrence of incapacitating or extremely embarrassing panic-like symptoms or limited-symptom attacks rather than full-blown panic attacks. The "panic-like symptoms" include any of the 13 symptoms listed above for panic attack or other symptoms that may be incapacitating or embarrassing (e.g., loss of bladder control).
In over 70% of cases, a specific stressor can be identified as the precursor to the development of PD/PDA. Most often stressors are interpersonal (e.g., argument with spouse) or related to physical well-being (e.g., death in family, adverse experience with drugs). Initial panic attacks also often occur outside the home ...