Like panic disorder, agoraphobia is one of several anxiety disorders. Agoraphobia may occur with or without panic disorder, but it is most frequently seen with panic disorder. Panic disorder progresses to agoraphobia for about one-third of the people with panic disorder, according to the National Institute of Mental Health (NIMH). If treated quickly and properly, panic disorder may not progress to agoraphobia. Once the condition progresses, it is all the more difficult to treat.
How It Begins
Agoraphobia may begin after the very first panic attack. A typical scenario is in an automobile on a crowded highway. The person experiences the first "out of the blue" panic attack and has no idea what caused it or even what it was. Many people end up in the emergency room after the first attack, believing they have had a heart attack. If, after the first attack, no diagnosis is made and/or (more importantly) no treatment is begun, the person often comes to the conclusion that something about driving on the highway caused the attack. Or the person decides that the last place to be if he or she has another attack is trapped alone in a car on a crowded highway. The panic attack was so horrible that the person continues to think about it and worries about having another attack. Eventually, the person may worry about having panic attacks in other places besides the car and so begins to avoid those places, even if he or she hasn't had an attack there.
Here's Where It Gets Complicated
The previous scenario may happen in as many different ways as there are individuals. A panic attack may occur anywhere -- even at night when a person is sleeping. Avoidance might not begin after the first attack. Avoidance might begin and end with only one situation, or it might escalate until a person is completely homebound. Some people become homebound, but they also have extreme difficulty being alone. On the other hand, some people with agoraphobia are able to go into phobic situations as long as someone is with them. On the outside, they might appear completely well, but really they are becoming more and more dependent on other people (usually an agoraphobic relies on one other person: the "safe" person). Even more complex is that many people continue to go into the situations they fear, even without a "safe" person. Without treatment, though, the ability to function will decrease. The condition may progress slowly or rapidly. A person may begin to get well only to decline once again.
