A common effect of recurring attacks is that victoms begin to avoid situations they assoicate with attacks they have had. At first there is no connestion betweem the attacks and the places or activities that they go to or participate in. Eventually, though, the fear that there might be a connection can become so strong that the places actually can triger an attack.
Places that seem harmlesss to most people such as resturants, busses, elevators, malls, often become forbudden territory for people with panic disorder. Her or she may become vulnerable to a lot of "what if" thinking: "what if I have another attack in the elevator and can't get out". Such thinking gradually leads them to avaoid places or situations they associate with having the attacks.Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may start phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them. Some people's lives become greatly restricted--they avoid normal, everyday activities such as grocery shopping, driving, or in some cases even leaving the house. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs. When people's lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia. Studies have shown that proper treatment--a type of psychotherapy called cognitive-behavioral therapy, medications, or possibly a combination of the two--helps 70 to 90 percent of people with panic disorder. Significant improvement is usually seen within 6 to 8 weeks.