Rego Panic Disorder and Agoraphobia

2025
ISBN: 978-1-61334-405-7
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 108 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

This new and indispensable volume in the Advances in Psychotherapy series has been meticulously crafted to address the nuances of diagnosing, assessing, and treating panic disorder and agoraphobia, using the latest interventions derived from cognitive behavioral therapy. Designed as a brief but comprehensive resource for treatment providers at all levels, this book gives a description of panic disorder and agoraphobia, reviews well-established, empirically derived theories and models, and guides readers through the diagnostic and treatment decision-making process before outlining a 12-session treatment. Each chapter offers practical guidance, specialized insights, and adaptable strategies to tailor the treatment to individual patients. The step-by-step approach, a detailed case vignette, and downloadable worksheets will enable practitioners to feel confident and competent when empowering patents to overcome their often debilitating fears and reclaim their lives. This is an ideal resource for clinical psychologists, other mental health professionals, and students.

Zielgruppe

Clinical psychologists, psychiatrists, psychotherapists, and counselors, as well as students.

Autoren/Hrsg.

Rego, Simon A.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychopathologie

Leseproben

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Description

1.1  Terminology

Panic disorder first appeared as a specific diagnostic entity in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association [APA], 1980), when the former DSM-II diagnosis of anxiety neurosis (APA, 1968) was divided into two separate entities: (1) panic disorder, which was characterized by spontaneous episodes of intense anxiety; and (2) generalized anxiety disorder, a residual category created for patients with chronic, sustained anxiety but without a reported history of panic attacks. Controversies surrounding the validity of the diagnostic criteria for panic disorder led to alterations of the definitions in both the DSM III-R (APA, 1987) and DSM-IV (APA, 1994). Also notable in the DSM-IV was the fact that panic attacks first became considered transdiagnostic (not exclusive to panic disorder). Instead, what became critical for making a diagnosis of panic disorder was the persistent fear of experiencing panic attacks, concern about the possible implications of a panic attack or the consequences of an attack, and/or the making of major behavioral changes due to a fear of the attacks. Finally, because a substantial number of patients reporting agoraphobia do not appear to experience panic symptoms, panic disorder and agoraphobia were unlinked in the DSM-5 (APA, 2013). In so doing, the former DSM-IV diagnoses of panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without a history of panic disorder were replaced in DSM-5 by two diagnoses in the International Statistical Classification of Diseases and Related Health Problems (10th ed.; ICD-10; World Health Organization, 2016): 300.01 (ICD-10 code F41.0) panic disorder and 300.22 (ICD-10 code F40.00) agoraphobia. As each of these diagnoses now has its own separate diagnostic criteria, the co-occurrence of panic disorder and agoraphobia should be coded by giving two diagnoses.

1.2  Definition

Panic disorder and agoraphobia are both classified as anxiety disorders in the DSM-5. The central feature of panic disorder is the experiencing of recurrent, unexpected panic attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort (which can occur from either a calm or anxious |2|state) that reaches a peak within minutes, and during which time four or more of a list of 13 physical (e.g., palpitations, pounding heart, or accelerated heart rate) and cognitive (e.g., fear of losing control or “going crazy”) symptoms occur. At times, cultural concepts of distress (e.g., wind attacks in Cambodians in the US and Cambodia; ataque de nervios among Latin Americans, etc.) may also be observed, but these would not count toward the four required symptoms in the DSM-5. A panic attack that contains the abrupt surge of intense fear/discomfort that reaches a peak within minutes but with less than four of the 13 symptoms is a limited symptom attack.

Of note in the diagnostic features in the DSM-5 are the terms “recurrence” and “unexpected” as, taken together, this means that the person must have experienced more than one attack (i.e., a single attack would not warrant the diagnosis), and that at least one attack must have appeared to come on “out of the blue” (i.e., when the person was in a calm or relaxed state and with the person being unable to describe any obvious trigger at the time it happened). This may include panic attacks that occur as the person emerges from sleep (also known as nocturnal panic attacks – see Craske & Rowe, 1997). This distinction may in fact be helpful in differentiating panic disorder from other anxiety disorders, as it is typically the case with other anxiety disorders that the panic attacks have specific cues or triggers (e.g., patients with social anxiety disorder may get so anxious in social situations that they have a panic attack) and have never occurred in an unexpected manner. Interestingly, the frequency and severity of panic attacks can vary widely – both among patients diagnosed with panic disorder and throughout the course of the disorder in a patient diagnosed with panic disorder. According to the DSM-5, patients who have infrequent panic attacks resemble patients with more frequent panic attacks in terms of panic attack symptoms, demographic characteristics, comorbidity with other disorders, family history, and biological data (APA, 2013).

Finally, outside of the typical DSM-5 exclusionary criteria (e.g., the disturbance cannot be better accounted for by another mental disorder or by the physiological effects of a substance or medical condition), to be diagnosed with panic disorder, individuals must have at least 1 month of persistent concern/worry about experiencing further panic attacks or their physical consequences (e.g., having an undiagnosed, life-threatening illness), or social consequences (e.g., embarrassment and/or fear of being judged negatively if seen having a panic attack), and/or make significant maladaptive behavioral changes due a fear of the panic attacks (i.e., make substantial changes to their daily routines in order to avoid experiencing more panic attacks). If these maladaptive changes in behavior represent attempts to minimize or avoid panic attacks, or their consequences extend to two or more agoraphobic situations, then a separate diagnosis of agoraphobia would also be given.

The diagnostic criteria for agoraphobia, which was unlinked from panic disorder in the DSM-5, were derived from the DSM-IV descriptors for agoraphobia, with the main change in the DSM-5 being that the patient must endorse a marked fear of two (or more) of five common agoraphobia situations (i.e., public transportation, being in open spaces, being in enclosed |3|places, standing in lines or being in crowds, being outside the home alone), as this is believed to be a robust means for distinguishing agoraphobia from specific phobias (APA, 2013). In addition, the criteria for agoraphobia were extended to be consistent with the criteria sets for other anxiety disorders (e.g., the fear, anxiety, or avoidance must be persistent for 6 months or more, must cause clinically significant distress or impairment, cannot be better explained by another mental disorder).

1.3  Epidemiology

Despite decades of research on the epidemiology of anxiety disorders, surprisingly little has been published on their incidence. In fact, in a systematic review of the literature published between 1980 and 2004 reporting findings of the prevalence and incidence of anxiety disorders in the general population, Somers et al. (2006) found that “An insufficient number (n = 5) of incidence studies were available for inclusion, signaling an important omission in the epidemiologic literature” (p. 100). They concluded that, “Further knowledge is required about the onset of anxiety disorders, including risk and protective factors, as well as social variables that may mediate the expression of these disorders and help explain the level of heterogeneity observed in the present study” (p. 111).

Fortunately, much more data exist on their prevalence. For example, according to the National Institute of Mental Health (NIMH), the lifetime prevalence estimate for panic disorder across the US adult population is 4.7% (Kessler, Berglund et al., 2005). According to the DSM-5, the 12-month prevalence estimate for panic disorder across the US and several European countries in the general population is about 2–3% in adults and adolescents. While children do experience panic attacks, panic disorder (and agoraphobia) are low-prevalence conditions in childhood (1% or lower), with slightly higher prevalence rates (2–3% for panic disorder and 3–4% for agoraphobia) found in adolescence (Beesdo et al., 2009). While the low rate of panic disorder in children could relate to difficulties in symptom reporting, this seems to be unlikely given that children are capable of reporting intense fear or panic in relation to separation and difficult objects or phobic situations (APA, 2013).

The prevalence rates of panic disorder show a gradual increase during adolescence, particularly in females (who ultimately end up diagnosed at twice the rate of males) and possibly following the onset of puberty, and peak during adulthood (APA, 2013). According to the...