Most of us really enjoy being at home. It's a place with all our favorite things. It contains familiar faces and special memories. It houses our family members and pets that we love. It’s a safe and comfortable place to be.
This love of familiarity is often felt by our children as well. They like having their own space, a reprieve from an often demanding outside world.
Sometimes, however, it's more than that. What if your child never wants to leave? What if leaving their home or safe space causes them to spiral out of control, having panic attacks or uncontrollable irrational fears? It may seem like something more than average anxiety. It may be panic disorder with agoraphobia.(1)
Panic Disorder
Panic disorder is part of the family of anxiety disorders. It is characterized by sudden, unexpected episodes of intense fear. These episodes are often called panic attacks, and they cause extreme physical and emotional discomfort. Panic attacks can feel so intense that the person may mistake them for a heart attack or other physical issue.(2)
The symptoms and duration of panic attacks vary from person to person. Some people only experience one panic attack that lasts a few minutes, while other people may experience multiple panic attacks in a row with the whole episode lasting hours.
Sometimes it’s easy to pinpoint what triggers the panic attack, but other times they can pop up with little warning or explanation. With therapy and self-reflection, a person experiencing panic attacks may be able to anticipate the attacks and take steps to prevent them or decrease their severity.
Agoraphobia
Agoraphobia is an anxiety disorder that involves an intense fear of being trapped.(1) What exactly ‘trapped’ means can vary from person to person. Some people with agoraphobia feel trapped by small or crowded spaces. This could include places like elevators, the movies, or large events.
Conversely, others feel trapped by wide-open spaces, such as a bridge or park. Being in these situations can cause panic attacks. In some cases, the person does not even have to be in the situation for a panic attack to be triggered. They may simply be thinking about the anxiety-inducing place or be on their way to such places. Because of this, those with agoraphobia tend to avoid these situations if at all possible.
Symptoms
When a child experiences panic attacks along with their fear of being trapped, they may be diagnosed with panic disorder with agoraphobia.
Physical symptoms of panic disorder with agoraphobia include:(2)
Panic attacks
Rapid heartbeat
Difficulty breathing
Pressure or pain in the chest
Headaches
Stomachaches
Shakiness and/or tingling in hands and limbs
Feelings of weakness
Excessive sweating
Fatigue
Insomnia
Children may also experience emotional symptoms such as:
Feeling trapped with no escape
Sensing that something bad is about to happen to them
Fear of open spaces or enclosed spaces
Fear of long lines or crowds
Feeling like they are losing control or dying
Difficulty concentrating
Intense fear of separating from parents
Refusal to go to school or leave home
Feeling anxiety in anticipation of a feared situation
Expecting the worst possible consequences if in open or enclosed spaces
Avoidance of situations that may lead to the feeling of being trapped
These symptoms will often begin to interfere with a child’s day-to-day life. School may become more difficult. They may not get enough sleep at night. Concentrating on academic and fun tasks alike may be harder. This is the point at which a mental health professional is needed.
Causes
Panic disorder with agoraphobia is caused by three main factors: predisposition, genetics, and environment.(3)
Children’s personality or tolerance for stress can make them predisposed to developing anxiety disorders. Children with a family history of mental health illness are more likely to develop a mental illness themselves.
Certain experiences or events that invoke intense fear in a child can also bring on panic disorder with agoraphobia. A child may have a traumatic experience in a crowded or enclosed space. Or they may experience a traumatic event in some other part of their life, like a car accident, abuse, or parental divorce, and that event manifests into panic disorder as agoraphobia.
Treatment
Like with many other anxiety-related disorders, cognitive-behavioral therapy is the most widely-recognized and evidence-based treatment for panic disorder with agoraphobia.(4)
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a type of talk therapy that helps children recognize what their thought patterns are and how they may be affecting their emotions and behaviors.
CBT will walk a child through how the outcome that they are imagining is not realistic. It is easier to recognize that these outcomes are not realistic when a child is not in the midst of a panic attack, but they also need to be able to recognize this when they are in the moment. So, CBT gives tools, such as self-talk or relaxation techniques, to use when the fear and panic are starting to build.
A mental health professional will likely also use Graded Exposure. In this CBT technique, a child will slowly face their fear, employing the techniques CBT has given them to keep them calm. They will start with a situation that only makes them slightly uncomfortable and then work closer and closer to the feared situation.
An example of this would be starting off by being in a small space with one person, then with two or three people. Then, perhaps the child would be in a space with four or more people that is also noisy. Slowly they would go to places with more and more people until they can manage their anxiety effectively.
Implementing CBT Techniques
Children learn by seeing. They learn by watching someone walk through a situation and then mimicking what they saw.
If your child is suffering from panic disorder with agoraphobia, you may be struggling with how to help them, particularly if you don’t struggle with the disorder yourself. You don’t fully understand what they are experiencing or what their anxiety feels like.
Books like, Pablo Parrot Is Afraid of Being Trapped!, provide a great solution to both of these issues. Part of Dr. Madeleine Vieira’s anxiety disorder series, I’M AFRAID, this book specifically focuses on panic disorder with agoraphobia. Pablo Parrot experiences all the feelings and emotions that your child is about being trapped in certain situations. Your child will see themself in Pablo.
Pablo Parrot can help your child practice the CBT techniques, like Graded Exposure, that they are learning with their mental health professional. You will also get to play a vital role in your child’s treatment as you work through the exercises with your child. You will have actionable steps to help your child work through their anxiety and fear.
On the days when facing their fears feels extra tough, books like Pablo Parrot Is Afraid of Being Trapped!, can provide a reprieve. Your child will know they are not alone and they are strong enough to face their fear.
To learn more about the I’M AFRAID series, click here.
Medication
If the symptoms of panic disorder with agoraphobia persist even with therapy, medication such as SSRI may be recommended.(1) Medication should only be used under the direct guidance of a mental health professional and a doctor.
Panic disorder with agoraphobia can feel like a beast that needs to be tamed. It can rearrange your whole schedule if your child struggles intensely with leaving the house.
However, with the proper treatment, and enough time, returning to normal life is possible.
Would you like more information on childhood mental health? Check out my podcast, Genius Little Minds, for new episodes every two weeks.
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