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the possibility of another panic attack triggers what is called anticipa-
tory anxiety.This condition can cause individuals to avoid people and
places; their goal becomes to be alone, rather than in a public place,
should a panic attack occur.
People who become anxious about panic attacks believe that if
they avoid the place where a previous panic attack took place, they
might be able to prevent future attacks. Over time they start avoid-
ing more and more places. Avoidance may temporarily relieve anxiety
over the fear of another attack, but it can make it nearly impossible
for a person to lead a normal life. Sufferers may find themselves avoid-
ing public places, events with friends, crowds, and other activities that
they enjoyed in the past. After having a panic attack while driving
on a highway, Traci Neal says that she changed her entire routine to
avoid similar roads. “I rerouted my commute, declined invitations,
stopped visiting friends and family, and asked others for rides to avoid
having to drive on the highway,”
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she says. However, such avoidance
does not stop future panic attacks.
Agoraphobia
In some extreme cases of panic disorder, a person’s avoidance of plac-
es and situations may lead to agoraphobia, a fear of public places and
open spaces. People with agoraphobia become anxious in situations
where they feel they cannot escape if a panic attack were to strike.
They may become anxious in unfamiliar environments or places
where they feel out of control and trapped, such as crowds or open
spaces.They may also avoid traveling in a car, bus, or airplane.
According to the University of Pennsylvania’s Perelman School
of Medicine, about one of every three people with panic disorder de-
velops agoraphobia. Becky, who lives in England, says that her ago-
raphobia developed after several years of intense anxiety and panic
attacks. “It used to be that when I experienced a panic attack I would
race outside for air, for distraction frommy thoughts and feelings and
to escape the almost claustrophobic sensations that I suffered,” she
says. But one day she felt faint and sick while outside, and she real-
ized she had developed agoraphobia on top of panic disorder. “My
biggest fear was that I would collapse in the street, all alone and that I
wouldn’t be able to get to safety,”
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she says. According to the Univer-
