Thursday, 4 June 2009

For Diver

Diver this post is in response to your comment about the Psycology text book. I will just write what appears on the page.

Agoraphobia is an anxiety disorder in which there is great fear of open or public places. This fear can be so great that agoraphobics are often reluctant to leave the safety of their homes. Agoraphobia on its own is rather rare. in most cases, patients who develop agoraphobia already suffer from panic disorder, and so the disorder becomes panic disorder with agoraphobia. The fact that agoroaphobics typically also suffer from panic disorder is important in understanding agoraphobia - agoraphobics try to avoid open or public places from which escape would be difficult if they were to experience a panic attack. Thus, they are frightened of what might happen to them in public rather than the public places themselves.

Before discussing the criteria for panic disorder with agoraphobia, we will consider the definition of a panic attack. According to DSM-IV-TR (APA 2000), a panic attack involves intense fear or discomfort, with four or more bodily symptoms suddenly appearing. These symptoms include palpitations, shortness of breath, accelerated heart rate, a feeling of choking, nausea, sweating, chest pain, feeling dizzy and a fear of dying. Panic attacks can be distinguished from other types of anxiety by the fact that they are typically short in duration and of great intensity.

The DSM-IV-TR criteria for panic disorder with agoraphobia are as follows (APA 2000):

  • Recurrent unexpected panic attacks.

  • At least one panic attack has been followed by at least one month of worry about the attack, concern about having more panic attacks, or changed in behaviour resulting from the attack.

  • Agoraphobia, in which there is anxiety about being in situations from which escape might be hard or embarrassing in the event of a panic attack.

  • The situations are either avoided, endured with marked distress, or manageable only with the presence of a companion.

According to ICD-10, one of the main criteria for agoraphioa is that anxiety is largely restricted to: crowds, public places, travelling away from home, and travelling alone. Another criteria is that there is frequent avoidance of the situations causing anxiety.

Approximately 3-4% of people develop panic disorder with or without agoraphobian during the course of their lives. Similar percentages have been found in many countries and ethnic groups. About 75% of those suffering from agoraphobia or panic disorder with agoraphobia are female. One likely reason why men show less agoraphobic avoidance than women uis because they are more likely to drink heavily so that they can go out in public.

Case Study : Lynn, An Agoraphobic for 8 Years

Friday 19th December

Today has been the biggest challenge. I woke up and immediately felt anxious. Too much time in bed and too much time to think have caused this. From 7am all i could think about was 'I need to go out, I havent been out in 2 days, what if i cant do it again'? I sat and i thought about it, and thought about it and thought about it. In the end I was so worked up that i could feel the panic attack getting closer. I ran to my bedroom and got dressed and went out. I knew if I just faced the problem instead of sitting thinking about it, i would feel much better. it worked. I went out and walked my usual route and felt fine. I enjoyed it actually even though it was freezing and pouring with rain. I ended up back in bed after this. Still not well at all and while suffering from the cold it is probably not a great idea to walk in the rain. but mentally i feel far better.

Saturday 20th December

Arrgghhh maybe that walk was a bad idea. I. AM. SO. ILL!!! There is no hope of me leaving my bed today. But i can rest easy and not obsess about not getting out again. I also have the added joy of looking after my three nephews tonight. I can barely look after myself right now.

Sunday 21st December

I feel so much better! Got up and took two of the boys out for a walk. We were out for quite a while. On returning home I learned my dad was heading out to do some Christmas shopping. I quickly jumped in the car with him and asked him to take me for a spin. I havent been in the car since Tuesday so i wanted to prove to myself that i can still do it. We went around the usual and then for some reason my dad took a wrong turn. The panic really does come over me in waves. One minute i felt it rise from my tummy to my head and then it would go down again. i think if i can mentally talk myself through this i will be ok but when taking the wrong turn my head just went 'No No No'.

How does Lynn's account tie in with what you know about agoraphobia?

Diver im not sure if this answers your question. After my case study it just goes on to sum up the Agoraphobia section. I would be interested to read peoples answers to the question though.


diver said...

Thanx Lynn, really interesting! And I think, pretty exciting to have your name up there 'in lights' like that :)

I wonder if their opening line, 'Agoraphobia is an anxiety disorder in which there is great fear of open or public places' might be a bit narrow though? I mean, I've read plenty of agoraphobic bloggers who seem to be ok with 'open spaces' but have trouble with relatively closed off 'indoor functions' (e.g theatres). Sometimes I think the issue has more to do with 'social confinement' than with the physical environment, that's all (i.e more about 'people' than 'open space').

The case study posts they used from your blog ... what they reprinted does show the Agoraphobia/Panic Disorder connection rather well, doesn't it. I thought your description of the panic rising in 'waves' was excellent too - it'll prove really instructive for students, as will those thought processes you report. It's great stuff Lynn, a genuine teaching tool!

Lynn said...

Thanks Diver. I do completely agree with you. I dont have a problem with open spaces really. For example, the other day i sat in the middle of grass which was about 4 football pitches in size. For me it is completely about the distance i travel from home. It looks like a good book though, i will give it a read I think. I am just passing time just now before i make the drive to the hospital where i will deal with the panic waves. It really would be much easier to just pull my duvet over my head and hide... but i wont.

Jason said...

That's pretty cool lynn. They made a good choice.

And I agree about the open spaces bit. I would take a wide open space over confinement any day. And for me, it's mostly about how quickly I can escape and get home anyway.

Anonymous said...

I agree with the open spaces too as I am actually quite comfortable in open spaces. Like yourself Lynn my own discomfort comes in every inch I move away from my home. Why? I think because at home I can focus on trying to deal with my panic alone and undisturbed which is an impossiblity for me outside and around people.

It is though a very interesting piece and I enjoyed reading it.

All the best


Louis said...

I am very proud of you for doing such a good job. You must know by now you have done something quite unique. Your way of showing detail and your openess may have helped more people than you ever thought you would help. Panic is so widely misunderstood by Doctors that you may have helped healers who will in turn help people who have panic. Congradulations and God Bless you for your efforts.

eilidhquitecontrary said...

Hey Lynn. How you doing?
I've been following your blog for a while and have been meaning to leave you a wee comment just to say hey really. So cool how your blogs been put into a book :), strange how its so easy of them to sum it all up into a paragraph, if only it was that simple lol.
Well hope your doing good. Your my only following haha i feel cool!

Anonymous said...

Hi lynn.

I chanced upon your blog when I was searching for some information on panic disorder and agoraphobia.

I feel blessed to have found your blog.

I am a 28 year old guy from Singapore.

I've recently been diagnosed as suffering from mild to severe panic disorder with agoraphobia in February, after silently suffering for so long (I had my first panic attack ten years ago).

I've finally decided to see the psychiatrist as it is beginning to affect my work.

I fear taking public transportation (bus, train, etc), crowded shopping malls, wide open road junctions, crowded coffeeshops and eateries, etc.

I am taking paroxetine as well as the occasional xanax, but I don't see how they can help with my fears. Paroxetine is an anti-depressant.

Anyway, I'll add your blog to my blogroll.