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Panic Disorder with Agoraphobia

a case presentation

vanessa villamia sochat


abnormal psychology
July 11, 2008
Panic Disorder with Agoraphobia An Introduction
Outline

• WHO is our client?


• WHAT are his symptoms and diagnosis?
• WHY did he develop this disorder?
• HOW do we treat it?
Who is our client? John Donahue

DEMOGRAPHICS
CLINICAL HISTORY

• What
Fortyattack
First five
does years
15 years
Johnago ago
think
• Alcoholism
Highofschool principal
his attacks?
• Anxiety
Father ofClinic
three

WHO WHAT WHY HOW ?


An example of John’s typical panic attack

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What are his symptoms  Diagnosis?

Symptoms of panic attack

Intense apprehension and terror


Impending doom Panic Disorder with
Labored breathing
Heart palpitations Do
Agoraphobia
John’s symptoms fit the
Nausea, chest pain disorder?
Choking and smothering recurrent unexpected
“Anxiety panic attacks
about situations
Dizziness at least 1 of attacks followed by month
Sweating of which would be embarrassing
Trembling or difficult to escape
concern about if panic
having another
Depersonalization attack
symptoms occurred”
Derealization concern about consequences of
Fears of losing control, going crazy
attack
change in behavior because of
attacks

WHO WHAT WHY HOW ?


What is John’s official DSM-IV-TR diagnosis?

Axis I:
300.21 Panic disorder with agoraphobia
Axis II:
No diagnosis on axis II DMS-IV-TR Diagnosis
Based on:
Axis III: 2)Anxiety about
None situations/events
Axis IV: 3)Avoidance of these
situations/events
Relocation to new state, job change, stressful
work schedule 4)Anxiety not better accounted
for by another disorder!
Axis V:
Global assessment of functioning = 58

WHO WHAT WHY HOW ?


Why did he develop this disorder?

Integrative Model of Causes and Maintenance of


Panic Disorder

Genetic factors
Social Factors
Etiology of Panic Disorder
Physiological Factors
with Agoraphobia
Cognition (personality)
Life Events “Fear of Fear” Hypothesis

WHO WHAT WHY HOW ?


Why did he develop this disorder? Genetic factors

Genetic vulnerability to alarm reaction

Psychological problems on mother's side:


* mother alcoholic, panic disorder with agoraphobia
anxious woman constantly concerned with her and her children's
physiological symptoms, worried a lot
* maternal grandfather and two aunts abused alcohol
* maternal grandmother and another aunt - panic disorder
* sister and younger brother, nothing

WHO WHAT WHY HOW ?


Why did he develop this disorder? social/environment
factors

Stressful environment triggers vulnerability


Physi
Factors

Behavioral Factors

Interoceptive conditioning (learned alarms)

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Why did he develop this disorder? cognition

Safety behaviors serve to maintain beliefs about the


consequences of panic

Safety behaviors and safety signals

24 access to anti anxiety medication


driving to side of road
holding onto stationary objects
remaining near walls

Lack of control over More attentive to signs


environment of threat

WHO WHAT WHY HOW ?


Why did he develop this disorder? The big picture

Negative life Psychological


event and biological
vulnerability
Anxiety

Somatic Belief that


symptoms symptoms
dangerous
First panic
GENETIC
attack
SOCIAL/ENVIRONME
Fear symptoms NTAL
BEHAVIORAL
Panic disorder COGNITIVE

WHO WHAT WHY HOW ?


Why does he still have it?

Summary of maintaining factors panic disorder


panic attack symptoms
    agoraphobic situations
    cognitions associated with panic attacks
    anticipatory anxiety
    safety behaviors and signals

WHO WHAT WHY HOW ?


How do we treat it? In vivo exposure

Exposure treatment
Cognitive behavioral treatment
Panic Control Treatment (PCT)
Situational exposure
(with relaxation technique)

Situational (in vivo) exposure


1) making list of situations that are avoided
2) arranging the list in a hierarchical fashion from least
to most avoided
3) beginning with least difficult situations

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How do we treat it? Course of treatment

OUTCOME: panic and medication free 6 months after final session

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Discussion

Why might women outnumber men?


Why do men turn to substance abuse, and women to
avoidance?
How might a psychoanalytical paradigm explain not
perceiving to have a sense of control?
Medication?
Why is remaining in feared situations important for in
vivo exposure?
Public awareness of this disorder?
How would you respond?
Advantages and disadvantages of having spouse/friend?

WHO WHAT WHY HOW ?


Works Cited

Brown, Timothy. Casebook in abnormal psychology. Thomson


Higher Education, Belmont CA, 2007: 18-35.

Kring, Ann. Abnormal Psychology. John Wiley and Sons,


United States, 20077: 121-155.

Panic Disorder and Agoraphobia.


http://en.wikipedia.org/wiki/Agoraphobia

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