Panic disorder and agoraphobia

An anxiety disorder is a psychological disorder in which severe anxiety is experienced. These fears are often not rational and have no real basis, which means that a person is disturbed. There is a phobia here. There are different types: stress disorder and PTSD, simple phobia, panic disorder, obsessive-compulsive disorder, social phobia and generalized anxiety disorder.


  • Repeated unexpected panic attacks;
  • Attacks followed by at least one month of constant worry about new attacks, worrying about the consequences of a new attack, or behavior change due to attack;


Panic Attack:

Discrete period of intense anxiety with at least four symptoms of the following (reaching a peak within ten minutes):

  • Beating or pounding heart, an accelerated heart rate;
  • To sweat;
  • Trembling and shaking;
  • Feeling of suffocation;
  • Feelings of shortness of breath;
  • Pain and discomfort in chest;
  • Nausea and stomach upset;
  • Dizziness, unsteadiness, lightheadedness and weakness;
  • Derealization and depersonalization (feeling of no longer being yourself);
  • Fear of loss of control and insanity;
  • Fear of dying;
  • Tingling and numbness;
  • Cold shiver or gusts of heat.

These attacks must be unpredictable and not tied to a situation. With agoraphobia (also colloquially called agoraphobia), people are also afraid of finding themselves in situations where escape would be difficult or humiliating. There is a fear of open spaces. Patients then have difficulty finding themselves in any situation other than one outside the familiar environment. You often see that these people hardly leave home and withdraw very much from the (social) environment. When agoraphobia also involves panic attacks, it is mainly a fear of fear: the expectation of having a panic attack. This will help people avoid situations in which they think they will panic .


Depending on the group you’re looking at. The prevalence is highest in primary care: 7-13%. There is a 4.7% chance that a person will develop a panic disorder at least once in their life.

Scientifically found causes

Biological: An inconsistent picture is found with different systems and organs that would become dysfunctional. One study finds that there is a hypersensitive respiratory center, in another a hypersensitivity of the hypothalamic-pituitary-birenal axis, or a low heart rate variability. Evidence of a hyperactive noradrenergic system and abnormal functioning of the serotonin, cholecystokinin, and benzodiazepine (GABA) systems have also been found.

Cognitive model: According to this model, biological abnormalities are not sufficient in explaining the disorder, but rather the catastrophic interpretation. The method of interpretation can increase fear.

Learning theory: According to this theory, the sympathetic nervous system is an alarm system, in which a panic disorder is caused by a learned alarm (alarm theory). There is a sensitivity to fear (FOF; fear of fear). People are afraid of the fear and panic.

Genetics: The disorder is more common in identical than fraternal twins (but it can also be a predisposition alone, and it can still be a shared environment because they grew up together).

Epidemiological: Greater risk due to early traumatic experiences (in interaction with genetic predisposition) leading to hypervigilance and selective attention to fearful situations.


Cognitive behavioral therapy is mainly prescribed. For agoraphobia, gradual exposure in vivo is often used (using a fear hierarchy in which steps are taken from the least fearful situation to the most fearful situation) of 1-2 hours (70-80% show improvement).

Breathing exercises do not appear to increase the effect of cognitive behavioral therapy. This does not necessarily have to be added.

Psychotropic drugs/medications (particularly high-potency benziazepines and antidepressants) can be used, but relapse is seen after discontinuation of medication;

Cognitive behavioral therapy plus antidepressants is even more effective, but also leads to many dropouts due to side effects of the medication. In the long term, medication adds nothing to cognitive behavioral therapy.


Beneficial with adequate treatment, but if not (correctly) treated it has a chronic course.

Leave a Comment