Panic Disorder and Agoraphobia

What are Panic Disorder and Agoraphobia?

Children and teens with Panic Disorder experience unexpected and repeated panic attacks. This is typically followed by at least one month of concern about having additional attacks and/or a fear of something bad happening because of the panic attack (such as going crazy, losing control, or dying). In addition to having panic disorder, many children and teens will also develop agoraphobia, although these two diagnoses can exist independently so that youth can have panic disorder, or agoraphobia, or both. Youth with agoraphobia experience significant fear of being in at least two locations where escape appears difficult or they might be unable to get help, and therefore will avoid these situations as much as possible. Examples of situations include, using public transportation, riding in elevators, being in theatres or stores, or being outside the home alone, and more.

Facts

  • Although young children can have panic attacks, panic disorder typically emerges in late adolescence
  • Girls are more likely to experience both panic attacks and agoraphobia than boys, and thus are twice as likely than boys to develop either panic disorder or agoraphobia
  • Approximately 2% of teens have panic disorder and 2% have agoraphobia during the adolescent years
  • Children and teens with a family history of anxiety or depression are at greater risk for developing panic disorder
  • Problems associated with panic disorder and agoraphobia include low self-esteem, poor school performance, problems with peer and family relationships, difficulty separating from parents or transitioning from home to school, sleep problems, and depression, as well as drug or alcohol use

Signs & Symptoms

A panic attack is a sudden rush of intense fear or discomfort, which reaches a peak within 10 minutes, and includes at least four of the following physical sensations or thoughts:

  • Racing or pounding heart
  • Sweating
  • Shaking or trembling
  • Shortness of breath or feelings of being smothered
  • Feeling of choking
  • Chest pain or discomfort
  • Chills or hot flashes
  • Nausea or upset stomach
  • Dizziness or lightheadedness
  • A sense of things being unreal or feeling detached from oneself (derealization)
  • Numbness or tingling sensations
  • Fear of losing control or "going crazy"
  • Fear of dying

In addition to the physical sensations and thoughts that occur in a panic attack, there are also a variety of common emotions and behaviors.

Emotions:

  • Anxiety/fear
  • Terror
  • Anger
  • Shame
  • Embarrassment
  • Helplessness

Behaviors:

  • Avoiding going to places where a panic attack has happened before
  • Carrying medicine, gum, or a water bottle
  • School refusal
  • Being in contact with a safety person by phone/text at all times
  • Skipping school
  • Sitting near an exit or in an aisle seat
  • Wearing loose, cool or less restrictive clothing
  • Avoiding exercise, caffeine or any activity that activates the body

 

 

Note:
Panic attacks are fairly common, and having one does not mean that your child has panic disorder. Panic attacks become a problem when someone worries about having more attacks, or fears something bad will happen because of a panic attack. Also, panic attacks can occur in other anxiety disorders. For example, children or teens with a phobia of dogs might have a panic attack when they are near a dog. In this case, however, the panic attack is expected, and the child is afraid of the dog, not the panic attack. In panic disorder, the panic attacks are unexpected or there is no clear reason for the panic attack to have occurred.

Common Situations or affected Areas

  • School attendance
  • Hanging out with friends
  • Going on field trips
  • Taking public transportation
  • Travel
  • Reduced independence
  • Reassurance seeking

Be sure to watch our video below for more information... press the play button to start.

How panic disorder and agoraphobia impacts the child at different ages

Children, especially if they are young, may have trouble describing their symptoms. Instead, they are more likely to talk about their physical symptoms such as pounding heart, upset stomach, chest pain, or nausea, rather than psychological symptoms, such as a fear of "going crazy". For young children having a panic attack, they may suddenly become very frightened or upset for no clear reason. They may insist something is wrong or that something bad will happen; however, they may be unable to identify exactly what is going to happen. Rather, what you may notice is a change in behaviours such as being unusually clingy, crying, tantrumming, and refusal to do activities that were previously not an issue.

As children mature into adolescence their skills at describing and expressing their feelings and internal experiences are generally more sophisticated than in young children. Thus, teens may be better at describing a panic attack than younger kids. Furthermore, “panic attack” is a common term used in Western society, so for many youth they may already be familiar with this term and are able to state, “I had a panic attack,” and provide details. However, despite the shared use of this term, teens might be embarrassed by their symptoms, and may not want to openly discuss what is happening. In addition, not all children and teens are able to recognize that their behaviour is extreme or unreasonable given the situation. Gently supporting your adolescent in having the courage to share with you what is happening may be a good strategy, rather than telling them there is nothing to be afraid of.

Note: If you suspect that your child has Panic Disorder, it is advisable to take him or her to a family physician for a medical check-up. Medical problems (such as diabetes, inner-ear disorders, hypoglycemia, or thyroid problems), excessive caffeine use, or adverse reaction to medication (such as asthma medications) may be playing a role in your child's anxiety or panic-like reactions.  

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Stories

 

Andrea’s Story
Ben’s Story
Ms. Jassal’s story
Millie's Story

Andrea is an 11-year-old girl, who lives with her parents and older brother. As a baby, she had terrible colic, often crying for hours on end, slept poorly, and experienced numerous food sensitivities and other allergic reactions. As she matured, she had difficulty tolerating change and struggled with transitions into daycare, school, and managing other routine demands. Andrea’s parents say that Andrea is simply wired to be sensitive. They joke that whereas their son is easy going and predictable, that Andrea is just the opposite. More recently, Andrea has started worrying about her school performance and pending transition into high school. About a month ago, she had her first panic attack just before taking a test at school. She reported chest pain and trouble breathing, and that her heart was racing uncontrollably. Her teacher thought it was a medical emergency and an ambulance was called. Since then, Andrea has had several panic attacks at school. Each time, the school nurse calls Andrea's mother, who comes, picks her up and takes her home. Recently, Andrea had another panic attack while out for dinner with her family. Now, she refuses to go to restaurants and has missed several days of school because of a fear of having another attack.

 

Ben is 15 years old, and lives with his family in an apartment building in a large center. Four months ago, while riding the elevator to his apartment, Ben said his throat started to tighten and he couldn’t breathe. His mother noticed that he was very upset, and immediately took him to the E.R., where he was tested for allergies. The results were negative. Although he eventually settled and was able to breathe normally, he was shaken by the experience and was unsure why it happened. Unexpectedly, Ben had the same choking sensation a week later, while sitting alone in his bedroom. This time, he also felt dizzy and nauseous. Since the first attack in the elevator, Ben has experienced 10 more episodes. Each time, the sensations come on suddenly and intensely, lasting for 5-10minutes, and then passing within 10-20 minutes, although he continues to feel “amped” for at least half an hour or more. Ben has started to worry about having additional attacks, and is refusing to ride in elevators, which means he must walk six flights of stairs up and down to his apartment. He refuses to ride the subway or buses, go to the movies, be in crowded locations, and insists on carrying his cell phone with him at all times in case he needs to dial 911.

 

Ms. Jassal is taking care of her 14-year-old granddaughter, Mina, afterschool and on weekends while her daughter gets her nursing degree. Her daughter has warned Ms. Jassal that Mina has been experiencing panic attacks in recent months and that she should protect Mina’s from unnecessary stress and demands that might bring on the attacks. However, Ms. Jassal has spoken with her doctor who told her that panic attacks are harmless and the best way to cope with them is to learn to float with the panic rather than fight it, and that avoidance only strengthens symptoms.  While Ms. Jassal trusts her doctor’s advice, she isn’t sure how to convince her daughter and Mina that avoiding stress and demands is not the best strategy. Furthermore, Ms. Jassal is afraid if she tries to help Mina “float with panic” her daughter might get angry and forbid her to care for Mina.