Panic disorder and agoraphobia 

Panic disorder draws its name from the Greek god Pan, god of flocks. Pan was known for suddenly frightening animals and humans ‘out of the blue’. The spontaneous ‘out of the blue’ character of panic attacks is the principal identifying characteristic of panic disorder and central to its recognition and diagnosis. We know the syndrome that we currently call panic disorder with and without agoraphobia has probably existed since the beginning of recorded history. Hippocrates presented cases of obvious phobic avoidance around 400 bc. One of the first modern descriptions was by Benedikt around 1870, describing individuals who developed sudden anxiety and dizziness in public places. Certainly, our current modern ideas of panic disorder evolved essentially simultaneously in the United States and Europe in the early to mid-1960s. Donald Klein in the United States described in 1964 the panic syndrome and reported that it was responsive to imipramine. Isaac Marks in the United Kingdom also described panic attacks and agoraphobic avoidance, and treating the syndrome effectively with behaviour therapy. Until the last several decades, panic disorder and agoraphobia were actually thought to be rare syndromes. It is now clear that individuals with these difficulties are anything but rare. In fact, panic disorder is one of the most common presenting problems in individuals seeking mental health treatment and the fifth most common problem seen in primary care settings. It was thought to be a mild problem, but we now know that it is associated with significant dysfunction. The disability in social, occupational, and family life is in fact comparable to major depression. Although there are differences in the understandings of panic disorder and its treatments across the world, this chapter will review the current understanding about panic disorder, its characteristics, diagnosis, aetiology, and treatments.