Understanding Avoidance in Panic Disorderby Jerry Kennard, Ph.D. Medical Reviewer
It stands to reason that we prefer to avoid situations that make us feel very uncomfortable but in the case of panic disorder the nature and extent of avoidance can be so extreme as to affect a person’s entire personal life, their relationships, free time and employment.
Anxiety and avoidance are partners and the exact nature of avoidance is determined by the circumstances that cause anxiety. If we believe too much exertion will lead to a heart attack we’ll probably avoid exercising. A fear of heights and falling may well lead to the avoidance of high places, bridges, or stairs. Likewise, the person who fears suffocation may avoid small rooms, elevators or tunnels. There is a common thread with all these examples and that is ensuring safety. The most commonly avoided situations include:
Water (ships and boats)
Public transport (buses, trains)
Standing in line
Some people can tolerate threatening situations so long as they feel there is an easy or rapid escape route or a reliable person is with them to give support. In general, however, the biggest reason for avoidance is the prediction that a panic event (attack) is highly likely. Yet, like most anxiety-related conditions, a panic sufferer can have good and bad days. The reason for this variability isn’t obvious. It can appear irrational and perceived as a sign of greater instability or perhaps even authenticity. How is it the person insisted I accompany them to the shops yesterday, but seems able to go themselves today? A great deal of human behavior actually falls into the irrational category however – fear of harmless spiders, or refusal to walk under a ladder as examples.
Overcoming avoidance isn’t always easy. One or more panic attacks in a given situation will quickly increase fear, anxiety and reinforce predictions of further problems. Regaining confidence tends to be a slower process, even if repeated visits to a threatening situation prove that panic predictions are inaccurate. Avoidance has been described as a form of self-sabotage but with the right treatment and support it is something that can be overcome. Ultimately it comes down to whether you wish to control your anxiety or let it control you.