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Many people who suffer from panic attacks go on to develop agoraphobia, a severely handicapping disorder that often prevents its victims from leaving their homes unless accompanied by a friend or relative--a "safe" person. The first panic attack may follow some stressful event, such as a serious illness or the death of a loved one. (The agoraphobic often doesn't make this connection, though.) Fearing more attacks, the person develops a more-or-less continual state of anxiety, anticipating the next attack, avoiding situations where he would be helpless if a panic attack occurred. It is this avoidance behavior that distinguishes agoraphobia from panic disorder. Two different types of anxiety appear to afflict the person with agoraphobia--panic and the "anticipatory anxiety" engendered by expectations of future panic attacks.
If you have agoraphobia, chances are it developed something like this: One ordinary day, while tending to some chore, taking a walk, driving to work--in other words, just going about your usual business--you were suddenly struck by a wave of awful terror. Your heart started pounding, you trembled, you perspired profusely, and you had difficulty catching your breath. You became convinced that something terrible was happening to you, maybe you were going crazy, maybe you were having a heart attack, maybe you were about to die. You desperately sought safety, reassurance from your family, treatment at a clinic or emergency room. Your doctor could find nothing wrong with you, so you went about your business, until a panic attack struck again. As the attacks became more frequent, you spent more and more time thinking about them. You worried, watched for danger and waited with fear for the next one to hit.
You began to avoid situations where you had experienced an attack, then others where you would find it particularly difficult to cope with one--to escape and get help. You started by making minor adjustments in your habits--going to a supermarket at midnight, for example, rather than on the way home from work when the store tends to be crowded.
Gradually, you got to the point where you couldn't venture outside your immediate neighborhood, couldn't leave the house without your spouse, or maybe couldn't leave at all. What started out as an inconvenience turned into a nightmare. Like a creature in a horror movie, fear expanded until it covered the entire screen of your life.
To the outside observer, a person with agoraphobia may look no different from one with a social phobia. Both may stay home from a party. But their reasons for doing so are different. While the social phobic is afraid of the scrutiny of other people, many investigators believe that the agoraphobic is afraid of his or her own internal cues. The agoraphobic is afraid of feeling the dreadful anxiety of a panic attack, afraid of losing control in a crowd. Minor physical sensations may be interpreted as the prelude to some catastrophic threat to life.
Agoraphobics may abuse alcohol in an effort to keep the anticipatory anxiety in check. Their pattern of abuse appears to be different from the binging characteristic of alcoholism, however. The agoraphobic usually takes small amounts of alcohol, avoiding loss of control. Other drugs may also be abused.
Agoraphobia typically begins during the late teens or twenties. Women are affected two to four times as often as men. The condition tends to run in families.
Recent surveys have found that many people are afraid to leave their homes. Most likely they are not all suffering from agoraphobia. Some people may stay confined because of depression, fear of street crime, or other reasons. These surveys also show, however, that many agoraphobics may have never suffered a panic attack. This finding suggests that their agoraphobia may have developed in ways different from that outlined above.
(Source: National Institute of Mental Health Useful Information On . . . Phobias and Panic.)
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