Panic Disorder with Agoraphobia (PDA)
Diane’s recollections indicate that PDA, like SAD, developed in her childhood. Though she was able to cope with certain traumatic events (see Case History ) by focusing on her hobbies, Diane frequently suffered nightmares in which she revisited these repressed memories. At a young age (pre-ST), Diane channeled her feelings of frustration and detachment into her play with her Teddy Ruxbin doll, enacting cycles of aggression and reconciliation, abuse and forgiveness.
OBs and early symptoms of PDA in Diane were more apparent in her school activities. She remembers having difficulty concentrating in certain subjects, particularly math and science. Her fear of being called on was a source of acute discomfort for her, and her preoccupation with this nervousness and dread inhibited her from absorbing her lessons. Diane’s teachers often misinterpreted Diane’s reticence and lack of participation as boredom or disinterestedness, and endeavored frequently to call on her in order to keep her engaged, further aggravating the problem. Eventually, Diane resorted to avoidance of anxiety-producing places and situations. She often skipped class, sought isolated places to eat lunch, and avoided extracurricular activities (OBs). The greater the potential for stress and discomfort in situations, the more extreme the measures Diane took to avoid them. The progressive increase in these situations caused Diane to become more and more reclusive. We believe that it was this defensive tactic, that is, her tendency to completely avoid all situations in which she felt uncomfortable, that eventually resulted in Diane’s total withdrawal into her parents’ basement.