Panic and Anxiety                                          

Panic disorder can be diagnosed in the presence of other anxiety difficulties, similar to panic but not identical with it. The presence of more than one psychological disorders in the same person at the same time is referred to as comorbidity. When a patient with panic disorder suffers from additional anxiety problems, the course of panic disorder will depend not only on the intervention that aspires to address panic disorder, but also on the successful treatment of these additional anxiety concerns.

A comprehensive understanding both in the mind of the clinician and in the mind of the patient of any possible comorbid concerns is, perhaps, the most important element in every panic disorder treatment. This is because, although the success of the treatment for panic is not necessarily dependent on the parallel reduction of the symptoms in the additional anxiety profile, the long-term therapeutic effect of every treatment for panic disorder cannot be securely established when comorbid anxiety problems remain untreated. Therefore, the comorbid problems, when undiagnosed or untreated, open a subtle but secure gate to relapse. That is why some patients return to psychological well-being and remain in that state, after a successful therapy for panic disorder, and others either do not respond at all to any treatment for panic disorder or benefit only from time limited results.

The most classic example of comorbidity is the diagnosis of panic disorder with agoraphobia. Agoraphobia refers to a chronic, although not always activated, fear about possible frightening experiences in the presence of other people and in places beyond one’s private home base (restaurants, shopping malls, theatres). Patients suffering from panic disorder with agoraphobia will only achieve permanent remission from panic disorder if the agoraphobic element in their clinical picture is successfully treated along with the symptoms of panic disorder. Research suggests that even minor residual agoraphobic avoidance at the end of treatment predicts relapse for panic disorder accurately.

Other anxiety comorbid conditions that may interfere with therapeutic interventions for panic disorder include generalized anxiety disorder, specific phobias and obsessive-compulsive anxiety disorder. These anxiety diagnoses are not identical with panic disorder and are easily diagnosed, when they independently inform the clinical picture of a patient. However, they remain undiagnosed or underdiagnosed when they are comorbid psychological realities with panic disorder. This because the anxiety that is associated with panic disorder far exceeds the amount of anxiety these other disorders create in the organism of the patient and are easy to underestimate during diagnostic procedures.  But even if they are diagnosed and their existence is brought into the attention of the patient, remission from panic disorder after a successful intervention produces such a positive feeling in the patient that he/she is reluctant to address these other problems because he/she does not know and has not understood the connection between comorbidity and relapse of panic disorder.

If you suffer from chronic panic disorder, with periods of experiencing panic attacks and periods without panic attacks but with a lasting although not intense apprehension of future panic occurrences and if you had had therapy in the past with limited success, ask you clinician about any untreated anxiety difficulties that may create an obstacle to permanent remission from panic disorder.