Understanding Anxiety
Panic Disorder and Agoraphobia

Panic attacks consist of a period of intense fear or discomfort during which at least four of the following symptoms develop abruptly and peak within 10 minutes: palpitations, sweating, trembling or shaking, sensations of shortness of breath, feeling of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, lightheaded or faint, feelings of unreality or being detached from oneself, fear of losing control or going crazy, fearing of dying, numbness or tingling sensations, chills or hot flashes. Panic attacks may occur within the context of another anxiety. For example, someone with social anxiety disorder may experience a panic attack before or during an oral presentation. Panic disorder is specifically characterized by sudden, unexpected panic attacks followed by at least one month of persistent concern about having another attack. Given the strong physiological component of panic disorder, many people who suffer from panic disorder often visit emergency rooms or doctors, believing that they have a serious life-threatening illness.

Some people experience panic disorder with agoraphobia. Agoraphobia (technically defined as fear of open spaces) refers to a morbid fear of having a panic attack or panic-like symptoms in situations in which help would not be available or escape would be difficult or embarrassing. Those who suffer from agoraphobia typically avoid public places or places where they have experienced a panic attack. They may become restricted to their home or fixed routes or territories in which they feel safe.  Approximately one in three people with panic disorder develops agoraphobia.  Agoraphobia does not tend to develop until age 18 or older.

Panic disorder affects approximately 4% of adolescents, whereas panic attacks are relatively common among adolescents (35-65%).  On average, one’s first panic attack occurs between the ages of 15 and 19.  Panic disorder is extremely rare in prepubertal children.  Panic disorder is more common in females than males.  Agoraphobia occurs in 2.4% of youth between the ages of 13 and 18 and is more common in females.

 

References:

  • Bernstein, G. A., Borchardt, C. M., & Perwien, A. R. (1996). Anxiety disorders in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1110-1119.
  • Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006). The epidemiology of panic attacks, panic, disorder, and agoraphobia in the national comorbidity survey replication. Archives of General Psychiatry, 63(4), 415-424.
  • King, N. J., Ollendick, T. H, & Mattis, S. G. (1994). Panic in children and adolescents: Normative and clinical studies. Australian Psychologist, 29, 89-93.
  • Last, C. G., & Strauss, C. C. (1989). Panic disorder in children and adolescents. Journal of Anxiety Disorders, 3, 87-95.
  • Ollendick, T. H., Mattis, S. G., & King, N. J. (1994). Panic in children and adolescents: A review. Journal of Child Psychology and Psychiatry, 35, 113-134.

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Symptoms

According to DSM, the following symptoms would suggest Panic Disorder.

A. Recurrent unexpected panic attacks; and

B. At least one of the attacks has been followed by > 1 month of > 1 of the following:

  • Persistent concern about having additional attacks
  • Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, or going crazy)
  • A significant change in behavior related to the attacks
 

A panic attack is defined as the abrupt onset of intense fear that reaches a peak within a few minutes and includes at least four of the following symptoms:

  • a feeling of imminent danger or doom
  • the need to escape
  • heart palpitations
  • sweating
  • trembling
  • shortness of breath or a smothering feeling
  • a feeling of choking
  • chest pain or discomfort 
  • nausea or abdominal discomfort 
  • dizziness or lightheadedness 
  • a sense of things being unreal, depersonalization 
  • a fear of losing control or "going crazy" 
  • a fear of dying 
  • tingling sensation 
  • chills or heat flush

Agoraphobia

Some people stop going into situations or places in which they've previously had a panic attack in anticipation of it happening again. These people have agoraphobia, and they typically avoid public places where they feel immediate escape might be difficult, such as shopping malls, public transportation, or large sports arenas. Their world may become smaller as they are constantly on guard, waiting for the next panic attack. Some people develop a fixed route or territory, and it may become impossible for them to travel beyond their safety zones without suffering severe anxiety.
 

Red Flags

Some Red Flags that your child might be suffering from Panic Disorder or Agoraphobia are:

  • Complains of nausea
  • Stomachaches/ headaches
  • Sweating
  • Dizzy, faint, or light headed
  • Heart racing or beating faster than normal
  • Shaking or feeling jittery
  • Avoidance of crowds or far away places or “new” places
  • Avoidance of sleepovers
  • Anxiety upon separation from a safety person or place because they are worried about having physical symptoms (not because they’re worried they will miss that person or something bad will happen to them if they’re not close by).

Coping Cat Parents

CopingCatParents.com was developed to serve as a comprehensive and evidence-based resource on child and adolescent anxiety. Here you will get only information backed by research and tips and strategies that have evidence to support their use. We have brought together relevant resources, tools, and tips from the experts in the field that will be informative, and help you feel confident as you move forward in helping your child. 
 
Click on any of the links below to learn more:

Symptom Checker

If you’re not sure where to start, take a moment to complete our “Symptom Checker”. Our symptom checker allows you to click on the symptoms that are consistent with what you’re seeing in your child and provides personalized feedback on your child’s symptom status and recommendations for next steps.  
 
By answering a few short questions, you will get some feedback about which categories to learn more about next.
 
                                                                         

Child Anxiety Tales

The Child Anxiety Tales program is an online parent-training program designed to equip parents with skills and strategies they’ll need to help their children better manage anxiety. The program is based on the latest evidence in the treatment of child anxiety and on cognitive-behavioral principals shown to be effective in helping anxious youth. Child Anxiety Tales is an interactive and engaging program that can be completed at your own pace from the privacy and convenience of your own computer. It is not a treatment but an online educational program for parents. 
 
Click below to view a demo or to learn more: