Generality
Agoraphobia is an anxiety disorder triggered by open spaces or very crowded places.
From the clinical point of view, the subject who suffers from it is assailed by a feeling of anguish, strong discomfort, when he finds himself in unfamiliar situations, able to give the impression of not having easy escape routes and where no one could help . In most cases, agoraphobia is a problem that emerges secondarily to the onset of panic attacks, minor anxiety attacks and post-traumatic stress .
The severity of agoraphobia and the behaviors adopted to avoid feared situations can vary widely from person to person. In the most severe cases, physical symptoms or full-blown panic attacks, with cold or accentuated sweating, increased heart rate (tachycardia), nausea and a sense of suffocation can occur in addition to anxiety.
Like other phobias, agoraphobia can have negative repercussions in a person's daily life, in terms of limitations in social and working life. Fortunately, this disorder can be tackled through a course of psychotherapy, aimed at overcoming the phobia.
What's this
Agoraphobia: Definition
Agoraphobia is the fear of open spaces and places, from which it can be difficult or embarrassing to leave.
Therefore, the subject who suffers from this disorder:
- He has difficulty leaving home, if not accompanied;
- Feel uncomfortable traveling alone on public transport (such as the bus or airplane);
- Try to avoid busy public places (eg restaurants, markets, concerts, cinemas and shopping centers).
In addition to being accompanied by variable anxiety manifestations, agoraphobia often involves somatic symptoms such as: sweating, chills or hot flushes, rapid heart beat, nausea, a feeling that you lack oxygen and the fear of dying.
Consequently, the person suffering from agoraphobia tries not to expose himself to the phobic stimulus and ends up adopting strategies of avoidance or search for the continuous reassuring presence of a family member.
Agoraphobia is a disorder that can be very disabling, since those who suffer from it often:
- Become completely dependent on the home;
- He is forced to leave home only when he is accompanied.
Did you know that…
"Agoraphobia" derives etymologically from the Greek "agorà", which means "square" and "phóbos", that is "fear" or "phobia", therefore it literally means "fear of the square".
Causes and Risk Factors
What are the Causes at the origin of Agoraphobia?
Agoraphobia is a disorder in which the phobic stimulus is represented by the idea of being surrounded and free of spatial freedom around it.
The causes are not yet fully known. In most cases, however, this disorder appears to result from a traumatic experience experienced during childhood and adolescence: if the natural instinct to explore is discouraged, a block is generated that also affects the perception of oneself and one's own possibility. In adulthood, this reaction can be emphasized by low self-esteem.
Symptoms and Complications
Agoraphobia: How is it manifested?
Agoraphobia is a very complex condition, which does not only concern the fear of open spaces, large and vast, or in the crowd . In fact, the fear of being in particularly stressful situations or from which it is impossible to escape or receive help in case of danger can trigger the symptoms of this phobic disorder.
Therefore, a person suffering from agoraphobia may be afraid of specific situations, such as:
- Being in an open and wide space (supermarket, parking lot or bridge);
- Leaving home, if not accompanied;
- Wait in the queue or be in the crowd;
- Travel on public transport (for example: trains, buses or planes);
- Visit a mall;
- Attend very crowded public places (eg restaurants, markets, concerts, cinemas and shopping centers).
There are cases, then, in which the perceived malaise is related to the fear of general situations, such as crime, accidents and illness.
What are the Symptoms of Agoraphobia?
Clearly, the symptoms and severity of agoraphobia may vary from case to case:
- Some people experience mild anxiety or discomfort only when they are in unfamiliar surroundings.
- Other agoraphobics, on the other hand, show a serious sense of anxiety and, in extreme cases, full-blown panic attacks.
Like other phobic disorders, agoraphobia can also cause physiological reactions, such as:
- Accelerated beats;
- Chills and goose bumps;
- Cold sweat or, on the contrary, hot flushes;
- Tingling and itching;
- Nausea and / or vomiting;
- Sense of fainting or dizziness;
- Headache;
- Confusion and feeling of "empty head";
- Difficulty breathing (wheezing, feeling of suffocation);
- Visual disturbances, such as eye fatigue, sprains or optical illusions;
- Whistling in the ears;
- Dry mouth;
- Tremors;
- Cry;
- Numbness;
- Urinal urgency;
- Sense of oppression or chest pain.
Some people report having the perception of being choking. Others try to get out and / or move away from the agoraphobic situation by any means possible. In severe cases, agoraphobia can lead to fear of passing out, losing control or even dying .
Agoraphobia: known to Somatic Symptoms
The physical symptoms that manifest themselves in agoraphobia, as well as in other phobias, signal the occurrence of an abnormal response to an emotional level: the body is responding to the phobic stimulus with an extreme expression of the physiological reaction of " fight or flight ". In other words, the mind interprets the thought that open or crowded spaces are a threat to a potential danger, so it automatically prepares the body to fight for survival. This excessive emotional response is one of the clearest signs that a person is prey to a phobic disorder.
Possible consequences of Agoraphobia
As briefly anticipated, agoraphobia can severely limit the lives of sufferers. In severe cases, the symptoms of phobic disorder are activated even just thinking about situations that typically trigger fear.
In most cases, agoraphobia can trigger panic attacks at the thought of:
- Do not receive public aid in the event that an anxiety crisis occurs;
- Being in a place without an immediate emergency exit, available to the eye, which allows you to go to a reputedly safer place (the latter is considered one of the key features of the agoraphobic situations).
Agoraphobia can also lead to various solutions such as, for example, not going to particularly crowded parties or avoiding traveling by bus or plane. The anxiety related to the phobic disorder is also responsible for a persistently high state of stress, which, in the long run, can be harmful to health .
Agoraphobia: Associated disorders
Agoraphobia can be associated with depression and obsessive behavior . The disorder can then be related to anxiety disorders and other phobias, such as social disturbance, darkness, heights and air travel.
Did you know that…
Agoraphobia is generally considered the antithesis of claustrophobia .
To learn more: Claustrophobia - Definition, Characteristics and Therapy »Diagnosis
Agoraphobia can be a highly debilitating disorder, as it can affect multiple daily activities and contexts. For this reason, if the symptoms significantly limit normal everyday life and have been present for over six months, it is advisable to consult a doctor, psychiatrist or psychologist. In some cases, the diagnosis of agoraphobia may emerge during a consultation carried out by the patient for another problem related to anxiety.
Agoraphobia: How is the Diagnosis Established?
The initial evaluation of agoraphobia is essential to understand the reasons behind the discomfort, identifying its meaning and quantifying its scope.
Therefore, the doctor:
- He asks the patient for a description of the symptoms and what triggers them;
- Try to establish how severe the symptoms are;
- Excludes other types of anxiety disorders or general pathology.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), agoraphobia is defined by some criteria:
- Fear is unreasonable, excessive, persistent and caused by the presence of a specific situation or involves anticipatory anxiety with respect to it;
- In case of exposure to the stimulus, an anxiogenic response is evoked: in adults, this can take on the features of a sudden panic attack;
- Adults recognize that their fear is groundless and disproportionate to the perceived threat or danger;
- Avoidance measures and strategies are adopted to avoid the feared situation, as well as showing a tendency to face new experiences with a certain sense of anxiety;
- The person's anxiety reaction, anticipation or avoidance interferes with daily life and relationships or causes significant distress.
Furthermore, to formulate the diagnosis, agoraphobia persists for some time (usually 6 months or more) and involves symptoms that cannot be attributed to another mental condition, such as obsessive-compulsive disorder (OCD) or the disorder post-traumatic stress disorder (PTSD).
Treatment and Remedies
Agoraphobia: How Can You Deal with and Overcome?
Agoraphobia can be addressed with different therapeutic options, even in combination with each other. The choice depends on the person and the severity of the clinical picture. The most effective interventions include relaxation techniques, meditation and cognitive-behavioral psychotherapy aimed at overcoming the fear of open spaces.
These interventions aim to induce the patient to rationalize his morbid fear, trying to focus on the possibility of reacting to anxiety-provoking thoughts and dealing with the negative beliefs associated with agoraphobia.
drugs
In combination with psychological treatment, the psychiatrist can prescribe drug therapy to control the symptoms associated with the phobic disorder, such as anxiety.
The drugs that are usually indicated are benzodiazepines, beta-blockers, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOI).
It should be emphasized that the use of medicines can temporarily calm the problem, but it does not resolve it definitively.
Exposure Therapy and Desensitization
An effective result in the treatment of agoraphobia is the presentation of phobic stimuli to the patient in controlled conditions, until a systemic desensitization is obtained.
The therapy involves gradual and repeated exposure over time to the situation that he considers agoraphobic, to learn to manage anxiety and deal with negative ideas associated with the fear of open spaces, unfamiliar places and without an immediate emergency exit.
Cognitive-behavioral therapy
Desensitization can be practiced in combination with cognitive and behavioral techniques, in order to modify the vicious circle of agoraphobia and work on the meaning of phobic stimuli for the patient.
In this way, the agoraphobic subject is exposed to the feared situations, with the possibility of learning techniques of emotional self-control, which allow him to reduce his fear.
To learn more: Cognitive Behavioral Psychotherapy - What is it? What is it for? »Relaxation Techniques
To address agoraphobia effectively, psychotherapy can be practiced in association with relaxation techniques, such as autogenic training, breathing exercises and yoga. These treatments can help manage the anxiety related to the situation that he considers agoraphobic.
Another approach that may prove useful for some people is hypnosis . This alternative treatment provides a state of relaxation such as to induce the person concerned to recognize the causes of his fears and overcome them.
