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Panic Disorder and Agoraphobia

Clinical Appearance

Sudden and intense bursts of anxiety that occur unexpectedly and are accompanied by palpitations, dizziness, shortness of breath, lightheadedness, shivering, and hot or cold flashes, are the hallmark of panic disorder. If panic attacks occur repeatedly, a "fear of fear" may develop: a persistent, nervous, and tense state of expectation of the next attack.

In case the anxiety attacks do not occur exclusively at home, an agoraphobia may develop: the person starts to avoid certain situations where a panic attack would be most uncomfortable, e.g. in the midst of a crowd, in a moving underground carriage, an elevator etc. Unfortunately, avoidance of such situations brings only temporary relief. In the long run, anxiety tends to increase even further, and a vicious circle with ever extending avoidance behaviour and higher levels of anxiety ensues. In extreme cases, a person may neither be able to leave his flat, nor to stay there on his or her own.


As a rule, anxiety attacks occur in periods characterised by elevated levels of stress. The underlying factors, however, can be quite diverse. One person may be confronted with extraordinary pressure on the job, while another person may be in the midst of relationship problems, and someone else might face financial worries that may be the root cause of the development of a panic attack. Because a panic attack typically occurs when the person is at rest, i.e. he or she does not momentarily have to perform a task (e.g. on a holiday, or sitting on the couch, or lying in bed trying to fall asleep), most people fail to spot the association between the anxiety attack and the underlying stressors, which have often been present for some time.
As the underlying stressors are so diverse, and the extent of avoidance behaviour can vary considerably, a thorough diagnostic examination is essential. An additional medical check-up serves to rule out medical conditions as the cause of the bodily symptoms that trigger the attacks.


Treatment is based on the diagnostic model derived from the examination of the patient, specifying trigger events and maintaining factors in the development of the disorder. In most cases, practical exercises will follow, which enable the patient to learn new ways of coping with bodily symptoms and frightening thoughts.