What Is Panic Disorder with Agoraphobia? Recognizing the Causes, Symptoms, and Treatments
Most of us really enjoy being at home. It's a place with all our favorite things. It contains familiar faces and special memories. It houses our family members and pets that we love. It’s a safe and comfortable place to be.
This love of familiarity is often felt by our children as well. They like having their own space, a reprieve from an often demanding outside world.
Sometimes, however, it's more than that. What if your child never wants to leave? What if leaving their home or safe space causes them to spiral out of control, having panic attacks or uncontrollable irrational fears? It may seem like something more than average anxiety. It may be panic disorder with agoraphobia.(1)
Most of us really enjoy being at home. It's a place with all our favorite things. It contains familiar faces and special memories. It houses our family members and pets that we love. It’s a safe and comfortable place to be.
This love of familiarity is often felt by our children as well. They like having their own space, a reprieve from an often demanding outside world.
Sometimes, however, it's more than that. What if your child never wants to leave? What if leaving their home or safe space causes them to spiral out of control, having panic attacks or uncontrollable irrational fears? It may seem like something more than average anxiety. It may be panic disorder with agoraphobia.(1)
Panic Disorder
Panic disorder is part of the family of anxiety disorders. It is characterized by sudden, unexpected episodes of intense fear. These episodes are often called panic attacks, and they cause extreme physical and emotional discomfort. Panic attacks can feel so intense that the person may mistake them for a heart attack or other physical issue.(2)
The symptoms and duration of panic attacks vary from person to person. Some people only experience one panic attack that lasts a few minutes, while other people may experience multiple panic attacks in a row with the whole episode lasting hours.
Sometimes it’s easy to pinpoint what triggers the panic attack, but other times they can pop up with little warning or explanation. With therapy and self-reflection, a person experiencing panic attacks may be able to anticipate the attacks and take steps to prevent them or decrease their severity.
Agoraphobia
Agoraphobia is an anxiety disorder that involves an intense fear of being trapped.(1) What exactly ‘trapped’ means can vary from person to person. Some people with agoraphobia feel trapped by small or crowded spaces. This could include places like elevators, the movies, or large events.
Conversely, others feel trapped by wide-open spaces, such as a bridge or park. Being in these situations can cause panic attacks. In some cases, the person does not even have to be in the situation for a panic attack to be triggered. They may simply be thinking about the anxiety-inducing place or be on their way to such places. Because of this, those with agoraphobia tend to avoid these situations if at all possible.
Symptoms
When a child experiences panic attacks along with their fear of being trapped, they may be diagnosed with panic disorder with agoraphobia.
Physical symptoms of panic disorder with agoraphobia include:(2)
Panic attacks
Rapid heartbeat
Difficulty breathing
Pressure or pain in the chest
Headaches
Stomachaches
Shakiness and/or tingling in hands and limbs
Feelings of weakness
Excessive sweating
Fatigue
Insomnia
Children may also experience emotional symptoms such as:
Feeling trapped with no escape
Sensing that something bad is about to happen to them
Fear of open spaces or enclosed spaces
Fear of long lines or crowds
Feeling like they are losing control or dying
Difficulty concentrating
Intense fear of separating from parents
Refusal to go to school or leave home
Feeling anxiety in anticipation of a feared situation
Expecting the worst possible consequences if in open or enclosed spaces
Avoidance of situations that may lead to the feeling of being trapped
These symptoms will often begin to interfere with a child’s day-to-day life. School may become more difficult. They may not get enough sleep at night. Concentrating on academic and fun tasks alike may be harder. This is the point at which a mental health professional is needed.
Causes
Panic disorder with agoraphobia is caused by three main factors: predisposition, genetics, and environment.(3)
Children’s personality or tolerance for stress can make them predisposed to developing anxiety disorders. Children with a family history of mental health illness are more likely to develop a mental illness themselves.
Certain experiences or events that invoke intense fear in a child can also bring on panic disorder with agoraphobia. A child may have a traumatic experience in a crowded or enclosed space. Or they may experience a traumatic event in some other part of their life, like a car accident, abuse, or parental divorce, and that event manifests into panic disorder as agoraphobia.
Treatment
Like with many other anxiety-related disorders, cognitive-behavioral therapy is the most widely-recognized and evidence-based treatment for panic disorder with agoraphobia.(4)
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a type of talk therapy that helps children recognize what their thought patterns are and how they may be affecting their emotions and behaviors.
CBT will walk a child through how the outcome that they are imagining is not realistic. It is easier to recognize that these outcomes are not realistic when a child is not in the midst of a panic attack, but they also need to be able to recognize this when they are in the moment. So, CBT gives tools, such as self-talk or relaxation techniques, to use when the fear and panic are starting to build.
A mental health professional will likely also use Graded Exposure. In this CBT technique, a child will slowly face their fear, employing the techniques CBT has given them to keep them calm. They will start with a situation that only makes them slightly uncomfortable and then work closer and closer to the feared situation.
An example of this would be starting off by being in a small space with one person, then with two or three people. Then, perhaps the child would be in a space with four or more people that is also noisy. Slowly they would go to places with more and more people until they can manage their anxiety effectively.
Implementing CBT Techniques
Children learn by seeing. They learn by watching someone walk through a situation and then mimicking what they saw.
If your child is suffering from panic disorder with agoraphobia, you may be struggling with how to help them, particularly if you don’t struggle with the disorder yourself. You don’t fully understand what they are experiencing or what their anxiety feels like.
Books like, Pablo Parrot Is Afraid of Being Trapped!, provide a great solution to both of these issues. Part of Dr. Madeleine Vieira’s anxiety disorder series, I’M AFRAID, this book specifically focuses on panic disorder with agoraphobia. Pablo Parrot experiences all the feelings and emotions that your child is about being trapped in certain situations. Your child will see themself in Pablo.
Pablo Parrot can help your child practice the CBT techniques, like Graded Exposure, that they are learning with their mental health professional. You will also get to play a vital role in your child’s treatment as you work through the exercises with your child. You will have actionable steps to help your child work through their anxiety and fear.
On the days when facing their fears feels extra tough, books like Pablo Parrot Is Afraid of Being Trapped!, can provide a reprieve. Your child will know they are not alone and they are strong enough to face their fear.
To learn more about the I’M AFRAID series, click here.
Medication
If the symptoms of panic disorder with agoraphobia persist even with therapy, medication such as SSRI may be recommended.(1) Medication should only be used under the direct guidance of a mental health professional and a doctor.
Panic disorder with agoraphobia can feel like a beast that needs to be tamed. It can rearrange your whole schedule if your child struggles intensely with leaving the house.
However, with the proper treatment, and enough time, returning to normal life is possible.
Would you like more information on childhood mental health? Check out my podcast, Genius Little Minds, for new episodes every two weeks.
Don’t forget to subscribe to my newsletter to hear about new blogs and podcast episodes!
References
3 Things to Do if You're Raising an Anxious Child
The past couple of years have been hard on all of us. But if you’re a parent, you’re a real hero. Working and parenting from home—all while tackling crippling pandemic anxiety—has become the new norm for many people.
And your children are likely feeling anxious too. They may not use the exact phrase “I’m anxious,” but the pandemic hasn’t been easy on anyone. And they probably don’t even have the words to describe exactly what they’re feeling.
So it’s up to you to notice and tackle the issue head on.
Is the question, “Mom, what if…?” followed by the disaster of the day on repeat in your household?
The past couple of years have been hard on all of us. But if you’re a parent, you’re a real hero. Working and parenting from home—all while tackling crippling pandemic anxiety—has become the new norm for many people.
And your children are likely feeling anxious too. They may not use the exact phrase “I’m anxious,” but the pandemic hasn’t been easy on anyone. And they probably don’t even have the words to describe exactly what they’re feeling.
So it’s up to you to notice and tackle the issue head on.
Is the question, “Mom, what if…?” followed by the disaster of the day on repeat in your household?
No matter how many ways you assure them they’re safe—does their brain still get on an anxiety loop of worst-case scenarios?
And are you struggling to soothe them when their fear or worry becomes overwhelming?
Navigating a childhood anxiety disorder can be really taxing.
There are only so many ways you can assure your child they’re okay. When their brain gets on an anxiety loop of “what if… what if… what if…” it can feel impossible to flip the switch.
So how do you help them cope when you’re hanging on by a thread yourself?
You start with learning the signs and symptoms.
Signs of Anxiety in Children
Anxiety in children can look and sound different than anxiety in adults.
So What Does Childhood Anxiety Actually Look Like?
Crying spells
Frequent stomachaches and/or headaches
Being unwilling to go to school or attend social events with peers
Being afraid that something bad will happen to you or other loved ones
Changes in mood, sleeping and eating habits or behavior
Symptoms vary from disorder to disorder. That’s why seeking professional evaluation and treatment is so necessary and important.
Should I Be Worried About My Child’s Anxiety?
It’s completely normal for children to be anxious or worried sometimes. They are human, after all! Just like you and me, sometimes they get scared or nervous when facing a new challenge, meeting new people, or being in an unfamiliar environment.
But when a child has an anxiety disorder, they feel extreme fear and worry. And the anxiety they feel is disproportionate to the situation at hand. It might feel impossible for them to relax because their worry is so pervasive. Their “fight or flight” response is activated even when there isn’t any real danger present. And they might have symptoms that show they aren’t coping with their fear and stress very well.
Your child may try to hide their anxiety from you due to shame, fear, or just not knowing what’s going on inside their own body and brain. Try to cultivate a sense of safety so they share their feelings and experiences with you.
If your child’s anxiety is so severe they feel physically ill, don’t want to go to school, have trouble focusing on schoolwork, and you’re unable to soothe them, then you may want to seek professional help.
Anxiety disorders in children and teens are actually quite common. It’s estimated that 1 in 8 children in the US (1) and between 5 and 19% of children and adolescents in the UK have an anxiety disorder. (2)
If you suspect your child has an anxiety disorder, try not to stress yourself out. “Disorder” is not a dirty word! And even if your child has a diagnosable anxiety disorder, it doesn’t mean they’re doomed.
What Causes Childhood Anxiety?
There are a number of factors that contribute to children developing anxiety disorders.
Genetics
This may be hard to hear, but just like your child might have inherited your hair and eye color, they might have also inherited your anxiety. Children of parents with an anxiety disorder can be as much as seven times more likely to develop an anxiety disorder themselves. (8)
Not all children with anxious family members will develop anxiety.
But a 2016 literature review found that panic disorder, generalized anxiety disorder and social anxiety disorder are linked to specific genes. (5)
And predispositions to neuroticism, shyness, conscientiousness and low extraversion also tend to be associated with anxiety. (6)
Most researchers will tell you that genes play a part in a child developing clinical anxiety. But remember, you’re also a hero and role model! When your child sees you coping and using healthy strategies to deal with your anxiety, they learn that anxiety is manageable. Together, you can reduce worries, implement self-care routines, and make healthy choices.
Biology and Brain Chemistry
Biology can also play a role—sometimes children’s dopamine and serotonin neurotransmitters can get out of whack. Consulting with your child’s healthcare provider can help rule out or hone in on any imbalances that need to be addressed.
Anxiety and depression often present simultaneously, so be sure to keep an eye out for depressive symptoms in your child as well. In children and teens, depression may present as irritability. (7) Stay tuned for the upcoming podcast episode with more information on childhood depression and how you can help your child overcome it.
Environmental Factors
A child’s environment also plays a role in how anxious they are. Stressful living situations, major life changes, the death of a loved one, or family problems can make a child’s anxiety skyrocket.
Life can be stressful—that’s just a reality we all have to face. But do your best to come up with a plan with your child before a stressful event so they know what to expect.
And the more you can cope with your own stress and show support as your child learns age-appropriate ways to manage their anxiety, the better.
How Can I Help My Anxious Child?
Calming an anxious child is no easy feat.
Finding a therapist who specializes in anxiety disorders can be extremely helpful. Early detection and intervention can help reduce the severity of symptoms and improve your child’s quality of life. (3)
The best thing you can do is seek out professional help sooner rather than later. Licensed mental health professionals specializing in Cognitive Behavioral Therapy (CBT) and Graded Exposure Therapy are a great place to start. They can also provide training on what you as a parent or caretaker can do to help your child take small steps toward conquering their fears.
Here are 3 steps you can take to help your anxious child today.
1. Seek Out Professional Help
Therapy is safe and non-invasive. But it does require a medium to long-term commitment of weekly sessions. And those can range from a few months to over a year of treatment, depending on the severity of symptoms.
Cognitive Behavioral Therapy (CBT) is usually the first line of treatment for anxiety disorders, though in some cases medication is also useful. CBT is a form of talk therapy based on the idea that unhelpful thought patterns and behaviors can be changed into more realistic thoughts—which in turn has a positive effect on feelings and behavior. (4)
Under the CBT umbrella there are two therapeutic interventions that are particularly useful for treating anxiety:
Graded Exposure Therapy: With a stepladder approach, children are slowly and systematically exposed to the thing they fear, reducing their anxiety symptoms.
Exposure Response Prevention Therapy: This is the CBT-based therapy of choice for Obsessive-Compulsive Disorder (OCD). It helps children with OCD face their fears while refraining from engaging in compulsive behaviors.
2. Read Therapeutic Books Together
In addition to therapy, reading therapeutic books together can help your child understand their anxiety. Through storytelling and beautiful illustrations, your child will learn to overcome their fear-based behaviors.
The book series I’m Afraid, which is based on Graded Exposure Therapy, demonstrates that it is possible for children to manage their anxiety.
They’ll find themselves identifying with Sophia Swan Who’s Afraid of Water, Charlie Cub Who’s Afraid to Leave His Mother, or Khloe Kitten Who’s Afraid of Germs. These beautiful stories bring your child’s lived experience to the page. At the end of each story, they’ll see fears are conquerable. Pre-order my therapeutic book series about childhood anxiety disorders today!
3. Learn More About Childhood Anxiety Disorders
By learning about what your child is going through, you’ll be better equipped to help them cope. Children often have a hard time finding the words to express their anxiety. So being cognizant of the physical signs and behaviors is so important.
Listen to my two-part Childhood Anxiety Disorders series on my podcast, Genius Little Minds, where I unpack 8 anxiety disorders and how they present in children.
Listen here:
Childhood Anxiety Disorders: Part Two – My Child is Afraid of Messes! And Other Anxious Tendencies
And don’t forget to subscribe to stay up to date with the latest in children’s mental health!
References
Anxiety and Depression Association of America. Facts & Statistics. 2014. http://www.adaa.org/about-adaa/press-room/facts-statistics.
(2020, September). Anxiety Disorders in Children. NHS Inform. https://www.nhsinform.scot/illnesses-and-conditions/mental-health/anxiety-disorders-in-children
Generalized Anxiety Disorder. Boston Children’s Hospital. https://www.childrenshospital.org/conditions-and-treatments/conditions/g/generalized-anxiety-disorder-gad
(2017, July). What is Cognitive Behavioral Therapy. American Psychological Association https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
(2019, June). Is Anxiety Genetic? Healthline. https://www.healthline.com/health/mental-health/is-anxiety-genetic#symptoms
Personality Traits Associated With Anxiety. Brainsway. https://www.brainsway.com/knowledge-center/personality-traits-associated-with-anxiety/
The Relationship Between Anxiety and Depression. Hartgrove Behavioral Health System. https://www.hartgrovehospital.com/relationship-anxiety-depression/
(2020, August). Does Anxiety Run in Families? UNC Healthtalk. https://healthtalk.unchealthcare.org/does-anxiety-run-in-families/