Panic Disorder Related Conditions Avoidance Behaviors and Agoraphobia How some deal with fear of panic attacks By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. Learn about our editorial process Updated on November 11, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Seb Oliver / Cultura / Getty Images Panic disorder is an anxiety disorder that is characterized by recurring and unanticipated panic attacks. These attacks involve many physical symptoms, including shaking, sweating, shortness of breath, chest pain, and nausea. Panic attacks may also occur with cognitive symptoms, such as derealization and depersonalization, in which the sufferer feels disconnected from themselves and their surroundings. Panic attack symptoms can be difficult to manage. While having a panic attack, it is not unusual for a person to perceive their experience as frightening. The person may fear that they are going to lose control of their mind. Some panic sufferers develop avoidance behaviors as a way to deal with their fears about panic attacks. What Is Agoraphobia? About one-third of those with panic disorder will develop this separate anxiety disorder. Agoraphobia involves a severe fear of being in certain situations and having panic attacks or other similar panic-like symptoms, such as fainting, feeling dizzy or lightheaded, vomiting, or experiencing a migraine headache. In particular, people with agoraphobia are afraid of having a panic attack in circumstances from which it would be extremely difficult and/or humiliating to escape. A person with agoraphobia may also be fearful of having a panic attack in a place where they feel no one would be able to help them. Fears associated with agoraphobia often lead to persistent avoidance behaviors. What Are Avoidance Behaviors? Common feared and avoided situations for people with agoraphobia include crowds, large open spaces, elevators, bridges, and traveling. Avoidance behaviors often occur in groups of related fears. For example, an agoraphobic who fears having a panic attack while driving may also begin avoiding other means of transportation, such as being a passenger on a bus, train, or plane. Avoidance behaviors tend to grow over time and can impair the agoraphobic’s quality of life. The person’s work, home, and other responsibilities may suffer. For example, an agoraphobic may not be able to travel to important appointments, attend special occasions, or perform common day-to-day activities. Avoidance behaviors can intensify to the point that the person becomes homebound with agoraphobia. It may be difficult to comprehend how a person can develop avoidance behaviors. To get a better understanding of avoidance behaviors, imagine that you have the panic disorder: you are in a crowded movie theater when you experience an unexpected panic attack. You begin to tremble, your chest hurts, your heart races, and you feel as though you are choking. You don’t want to make a scene, but you start fearing for your life. You wonder if you are having a medical emergency. You begin to feel as though you are watching yourself from a distance. You feel trapped in the movie theater, and despite your embarrassment, you run out of the theater. After you left and your symptoms have subsided, you feel ashamed about how you reacted. The next time a friend invites you to go see a movie, you decline, finding it too difficult to go again. You begin fearing having a panic attack in other similar situations and start avoiding other crowded areas, such as shopping malls or concerts. Your avoidance behaviors begin to put restrictions on your life. Overcoming Avoidance Behaviors Once a person develops avoidance behaviors, it can become extremely challenging to face feared situations. Avoidance behaviors may feel comforting, giving the person temporary relief from anxiety. But these behaviors only reinforce their fear and anxiety in the long run. Agoraphobia and avoidance behaviors can worsen if left untreated. Fortunately, there are treatment options that can help in managing agoraphobia and overcoming avoidance behaviors. A typical treatment will involve a combination of medication and therapy. A treatment process, known as systematic desensitization, is often utilized to help the person gradually face their avoided and feared situations. A person with agoraphobia often finds it comforting to confront their fears when accompanied by a trusted friend or family member. Through treatment and the support of loved ones, a person with agoraphobia can expect to manage their fears, experience fewer panic attacks and avoidance behaviors, and resume a more independent life. 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. 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Clin Psychol Rev. 2010;30(1):37–50. doi:10.1016/j.cpr.2009.08.011 Additional Reading American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision. Washington, DC: Author. By Katharina Star, PhD Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Panic Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.