PANIC DISORDER WITH AGORAPHOBIA


WHAT IS PANIC DISORDER WITH AGORAPHOBIA?

All children suffer from fears at one time or another, this is normal. But when a fear creates feelings of overwhelming danger that are disproportionate to the actual situation, the child is most likely suffering from an anxiety disorder. 

Panic Disorder is an anxiety disorder that causes children to have sudden and unexpected episodes of intense fear that leads to extreme physical and emotional discomfort. These episodes are called panic attacks and can last from minutes to hours, but they usually peak within minutes. The attacks can occur anywhere and at any time. Sufferers can feel like they're dying during an attack and their first instinct is to get help. While at first the panic attacks appear to be unexpected and random, over time, they can be triggered by certain situations. 

Agoraphobia is an anxiety disorder related to feeling trapped. Children with this disorder can feel trapped in crowds, wide-open spaces, or enclosed places, such as an outdoor market, the movies, or on a bus. They worry that something bad will happen to them; in many instances they fear a panic attack. Their anxiety symptoms intensify as they become terrified that they won't be able to escape or get help. This creates feelings of helplessness and embarrassment. To avoid intense anxiety symptoms, the sufferers try to avoid situations and places they believe will cause them to feel trapped. 


SYMPTOMS

Emotional symptoms of a child with Panic Disorder with Agoraphobia may include:  
·      a sense that something bad is about to happen to them and they won't be able to escape or get help
·      feeling trapped
·      fear of open spaces (like a bridge or park)
·      fear of enclosed spaces  (like on a bus or in a movie theater)
·      fear of waiting in a line or being in a crowd
·      a sense of losing control or dying
·      feeling panicked
·      fear of leaving parents
·      refusal to go to school 
·      afraid to leave parents
·      being anxious in anticipation of a feared situation 
·      expecting the worst possible consequences if in open or enclosed spaces
·      fear of being alone outside the home
·      difficulty concentrating
·      avoidance of situations that may lead to the feeling of being trapped

Physical symptoms may include:
·      panic attacks
·      rapid heartbeat
·      difficulty breathing
·      pressure on chest
·      headaches
·      stomachaches
·      shakiness and/or tingling
·      feeling weak
·      sweating
·      fatigue
·      difficulty sleeping                            

When Panic Disorder with Agoraphobia interfere with the child’s sleep, concentration, ability to have fun or function normally, intervention from a mental health professional is needed. 


CAUSES

Predisposition – Some children are prone to being more anxious than others and are less capable of handling stress.  

Genes - If the child comes from a long line of anxious people, chances are that the child will develop an anxiety disorder.

Environment – Situations that may be a factor in developing Panic Disorder with Agoraphobia in a child include: 
·      experiencing multiple panic attacks
·      a family history of panic attacks
·      losing a family member or other major stress event
·      a major family change, such as a move or a divorce
·      a traumatic event, such as a car accident 
·      living in a volatile home


TREATMENT

 Cognitive Behavioral Therapy (CBT) 

CBT helps children recognize their thought patterns and identify where and when those patterns help and where they hurt. In other words, how we think and act affects how we feel. By incorporating Graded Exposure into CBT, the child slowly and systematically faces his fears and learns to better manage the symptoms of his anxiety. With practice the child gains mastery over fear and experiences reduced symptoms.

Dr. Madeleine Vieira's Anxiety Disorder Series, I’M AFRAID, introduces CBT techniques to help children overcome their anxiety disorders. 

Pablo Parrot Is Afraid of Being Trapped! focuses on Panic Disorder with Agoraphobia. In this book, Pablo wants to attend the Mega Music Concert, but fears getting a panic attack in open or enclosed spaces or crowds, such as at an outdoor market or the movies. He worries about being able to escape or get help if he gets too panicky. To overcome his fear, Pablo uses a stepladder process (i.e., Graded Exposure) to gradually expose himself to situations that will trigger his anxiety symptoms. He starts with small steps and gradually builds up to more fearful situations. 

In treatment, mental health professionals help children to control their Panic Disorder with Agoraphobia and uncomfortable feelings using specific techniques such as:
·      Understanding that the imagined outcome associated with the anxiety isn’t realistic. 
·      Using self-talk to ‘fight’ the fear. The child might tell himself that what he thinks will happen won’t actually happen.
·      Using relaxation techniques. The child is taught to use controlled breathing exercises to help lessen anxious feelings.
·      Using role-playing techniques, such as practicing worst-case outcomes. The mental health professional will help the child realize that the outcomes are not possible or highly unlikely. 
·      Teaching the child that he can manage his uncomfortable feelings successfully without avoidance. This takes time, repetition, and practice!

Anti-Anxiety Medication

When a child’s Panic Disorder with Agoraphobia doesn’t fully respond to CBT, anti-anxiety medication prescribed by a child & adolescent psychiatrist may be beneficial.

Additional Help

Based on the therapeutic technique of Graded Exposure, a component of Cognitive Behavioral Therapy (CBT), Pablo Parrot Is Afraid of Being Trapped! demonstrates that it is possible for children to manage their anxiety. The story guides children through steps that research shows help them overcome the harmful habits and patterns they’ve developed while struggling with their fears. Along with the story, there is an About Anxiety page, a Coping Strategies page, and a Stepladder page. These additional tools can help alleviate anxiety symptoms. 


REFERENCES

  1. https://childmind.org/article/agoraphobia-in-children/

  2. https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987

  3. https://www.psychologytoday.com/us/blog/suffer-the-children/201111/the-agoraphobic-girl

  4. https://www.merckmanuals.com/home/children-s-health-issues/mental-health-disorders-in-children-and-adolescents/agoraphobia-in-children-and-adolescents

  5. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Panic-Disorder-In-Children-And-Adolescents-050.aspx

  6. https://childrensnational.org/visit/conditions-and-treatments/mental-health-behavioral-disorders/panic-disorder

  7. https://childmind.org/our-research/

  8. https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021