Keywords: Panic disorder, agoraphobia, anxiety disorders, derealization, depersonalization, Nigeria.

Introduction.

Panic Disorder and Agoraphobia among Nigerians. Is panic disorder an anxiety disorder? How does panic disorder present? What is Agoraphobia? Do Nigerians suffer from panic disorder and agoraphobia? What are the causes of panic disorder and agoraphobia? How can someone self manage a panic disorder? What are the complications of untreated panic disorder and agoraphobia? Can panic disorder and agoraphobia be treated?

 Anxiety is a normal reaction to stress. We all need a little anxiety to enable us function adequately and not be too relaxed. But when this anxiety becomes excessive, there is a problem called an anxiety disorder. Anxiety disorder is a mental health condition.

Anxiety disorder comes with excessive and irrational fear and worrying, anticipation of a catastrophe and an avoidance of the situation. So the persons suffering from anxiety disorders have worrying thoughts that unconsciously intrude into their heads. It is unconscious because they cannot stop the thoughts from getting into their heads. And these prevent the persons from functioning well on daily bases at home, school, work and socially.

There are different types of anxiety disorders such as separation, specific phobias, panic, social, anxiety disorders. Others include agoraphobia, generalized anxiety disorders, etc. Only Panic Disorder and Agoraphobia among Nigerians will be elaborated here.

Panic Disorder.

Is panic disorder an anxiety disorder?

The answer is yes. This is because panic attack, which actually makes up panic disorder, is a prominent feature of anxiety disorders. Panic attack comes with intense and overwhelming irrational fear. It is actually an abrupt or sudden surge of intense fear that is accompanied by other symptoms. Four or more panic attacks in one month makes up a panic disorder. Actually, the panic attack can happen once in a week for months, or it can happen every day. There can be weeks or months without an attack, and then suddenly it starts again.

How does panic disorder present or what are the symptoms?

Excessive fear:

The symptoms of panic disorder come with sudden excessive fear of the unknown. This sudden intense fear can occur when the person is calm. That means that the fear can just come out of the blues. And it can even come on while the person is asleep and wakes up the person. The intense fear can be a build up from a normal fear. There is also fear of one losing control, fear of going crazy and fear of dying.

Worrying:

There is worrying about having more panic attacks and having a heart attack.   

Palpitations:

This is fast heart beat. The person may even hear his/her own heart beat.

Excessive sweating:

Then there is excessive sweating. The sweats appear more on the palms of the hand, the soles of the feet, the face and armpits. As one sweats, there are accompanying hot or cold flushes.

Tremors or shaking:

There are tremors or shaking of the body. The tremors may only affect the upper and lower limbs, or the entire body. The tremors maybe too much on the lower limbs, that the limbs may not be able to hold the body up. So the person will fall.

Shortness of breath:

There is usually shortness of breath with choking and the feeling of suffocation. This makes the person take fast and shallow breaths called hyperventilation. This hyperventilation is intended to take in more oxygen. But unfortunately, the amount of carbon dioxide in the blood also reduces. So, with the combination of reduced blood carbon dioxide and the hyperventilation, the person will feel dizzy and faint. This is because oxygen that is inhaled binds to the red blood cells and requires carbon dioxide to get it released from the blood cells. And since there isn’t enough carbon dioxide, oxygen does not get released. It is actually like someone shooting himself on the leg.

Derealization and depersonalization:

The person feels as if the things happening around him/her are not real it is life a film show. This person also feels unreal about himself or herself.

Avoidance:

So the person will avoid going to any place where he/she can have an attack. But most often it occurs in the person’s home.

What is agoraphobia?

Agoraphobia an anxiety disorder comes with excessive fear and excessive worrying when the person is in certain places. These places include open spaces, being in public transport, being in enclosed places and standing in line. Other places include being in crowded places or anywhere outside the home. The person suffering from agoraphobia is worried being in such environments. This is because when she is in such situations and develops a panic attack, escape or help will be difficult. So the best thing, she believes, is to avoid these places altogether. Thus she avoids going to the market, taking public transport, standing in line in the bank, etc. And after sometime, she may stop going out entirely, unless she has a companion. For this reason agoraphobia is nicknamed house bound syndrome.

The symptoms experienced in agoraphobia are like those of panic attack. There is excessive fear, irrational worrying, tremors, palpitations, etc. But agoraphobia can also present without the symptoms of panic attack. Here the person is afraid of going to these mentioned places because of either develop a migraine headache or vomiting. She can also urinate on oneself or even faint.

Do Nigerians suffer from panic disorder or agoraphobia?

Both panic disorder and agoraphobia do occur among Nigerians. In one study among patients who went for heart investigation known as ECG, 10% had panic attacks and 7% had panic disorder.

In one Nigerian hospital study among stroke patients, 42.8% had a disorder of agoraphobia with panic attacks. Among Nigerian adolescents, 1.4% suffer from panic disorder. And 4.7% suffer from agoraphobia.

What are the causes of panic disorder and agoraphobia?           

The full causes and risk factors to panic disorder and agoraphobia are not yet fully known. But some factors are known. These include;

Biological factors:

Genetics –  

Both panic disorder and agoraphobia are linked to genetic causes. This means that they run in the family. Agoraphobia has a 60% of heritable possibility, and panic disorder has 30% of heritability. This means that genes will more strongly predict who develops agoraphobia than who develops panic disorder. But environmental factors will more strongly determine who develops panic disorder than who develops agoraphobia.

Neurotransmitter and hormonal issues –

There are problems with the levels of serotonin, norepinephrine, dopamine, GABA, glutamate, etc. in the brain. Hormones such as cortisol, estrogen, testosterone, thyroid hormones, etc. are raised in their levels.

Brain structure or functional problems –

In the brain of these disorders, there are problems in the structure and functions of certain parts of the brain.

Environmental factors:

Traumatic life experiences –

For example adverse childhood experiences. These include child sexual abuse, physical abuse and death of parent. . Other traumatic life experiences include bereavement and interpersonal stressors like intimate partner violence, being attacked or mugged by thieves.

Parenting issues –

 Authoritarian parenting lack of love and warmth. Also where the parents are over protective

The abuse of substances –

This is another environmental risk factor. These substances are smoking, intake of excess caffeine and other stimulants.

How to stop a panic attack in progress.

There are self help ways to stop a panic attack that has started, be it in panic disorder or in agoraphobia.

Do self talk:

First of all talk to yourself and tell yourself the truth that you are not going to die. You can do other self quick talks like “this is under my control”, etc.

Calm down:

Then find a calm place to sit down and focus on your breathing. Place one of your hands on your chest and the upper part of your abdomen or belly. Try to slow down your breathing by breathing with your abdomen and not with your chest. So as you do the breathing process below, make sure that the hand on your belly is moving. This hand on the belly should be moving and not that on the chest. This is called abdominal breathing.

Do slow breathing:

Now take a deep breath in through your nose and not your mouth. So as you breathe in, close your mouth. Remember that during the panic attack, you have been breathing through your mouth. Then as you breathe out, use your mouth, to breathe out slowly. As you are breathing in and out you can count up to 5 during each in-breathing and out-breathing.

This abdominal breathing will reduce the fast breathing brought about by panic attack. And by slowing down the breathing, more carbon dioxide is made available in the blood to release the trapped oxygen. When more oxygen is available free in the blood stream, the breathing automatically reduced and all the other symptoms will stop.

Try distraction:

When the breathing has reduced, you can listen to calming music to help you distract your mind from the panic. You can also take a walk out in the fresh air, or call a friend and discuss things not related to the attack.

Complications of untreated panic disorder and agoraphobia.

If these conditions are left untreated, there can be both physical and psychological complications.

Physical complications:

The person can end up suffering from hypertension, heart diseases and may even have a stroke. Other complications are the emergence of diabetes, weakness of the immune system. This weakening of the immune system will predispose the person to frequent infections, like malaria, bacteria induced illnesses and viruses.  Even vaccines may not be potent on such people. So death is easier among such people.

psychological complications:

These include having other types of anxiety disorders combining with panic disorder and agoraphobia. Then other mental illnesses can also come in such as depression and even abuse substances such as alcohol, cannabis, etc. Suicidality is a possibility, such as suicidal thoughts acts. And some can actually die by suicide.

Social and economic complications:

Some may stop driving or going to social outings, etc. And finally become house bound. They can lose their jobs, drop out from school and become financially bankrupt.

Their family members also suffer including the spouse and children. This is because the family members receive less attention and more health complaints from the ill person. There are frequent visits to the hospital for the physical illnesses and the mental illnesses. And this drains the family purse.

Can panic disorder and agoraphobia be treated?

Yes, treatment is possible and advisable. Treatment is advisable so as to prevent the complications.

It is very important to consult with specialists such as a psychiatrist and a psychologist. The psychiatrist will make use of medications for the treatment and the psychologist will use talk therapy. This talk therapy is called psychotherapy and different types are used. One is called cognitive behavioural therapy, with which the person is thought how to rearrange his/her thought processes. There is the individual therapy when the person is taught about helpful exercises, diets, good sleep, etc.

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