First Panic Attack and Agoraphobia

Panic disorder commonly presents acutely with a first severe panic attack.  Many patients can distinctly remember their first attack even years after the onset of the disorder.

Agoraphobia may complicate panic disorder.  The word agoraphobia stems from the Greek word “agora” meaning gathering place.  The Greek agora was the common area for public assembly.

People with agoraphobia commonly fear situations where they may be in a crowd of people.  They often fear that in such situations a panic attack may occur and they will be unable to escape.  In the modern world, common settings for agoraphobia are crowded buses, airplanes or motor vehicles.

Not all individuals with panic disorder develop agoraphobia.  It is unclear why this pattern exists.  Agoraphobia does tend to occur with more severe and chronic panic disorder.  Individuals with relative few and mild panic attacks are less likely to develop agoraphobia.

A recent clinical research study from Japan suggests that the place where the first panic attack occurs may play a role in the risk of developing panic disorder.  Hara and colleagues studied a large group (n=830) of individuals with panic disorder and classified them into 5 groups based on the site of their first panic attack.  These five sites were:

  • home
  • school or office
  • driving a car
  • public transportation
  • outside of home
Individuals experiencing their first panic attack while driving or using public transportation had higher rates of agoraphobia.  The rank order for agoraphobia rates by site of first panic attack were: public transportation (61%), driving a car (56%), outside of home (49%), school or office (41%) and home (37%).
Although individuals experiencing their first panic attack at home had lower rates of agoraphobia they exhibited other markers of severity.  They had higher rates of endorsement of the symptom of “fear of dying”.  Additionally, individuals experiencing their first panic attack at home rated the severity of their first panic attack higher than the other 4 groups.
This study supports exploration of the setting and severity of the first panic attack in the assessment of panic disorder.  First panic attack setting may contribute to the pattern clinical symptoms and risk of agoraphobia.
Photo of black bear and yearling cub from Itasca State Park from the author’s files.

Hara N, Nishimura Y, Yokoyama C, Inoue K, Nishida A, Tanii H, Okada M, Kaiya H, & Okazaki Y (2012). The development of agoraphobia is associated with the symptoms and location of a patient’s first panic attack. BioPsychoSocial medicine, 6 (1) PMID: 22494552


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