Agoraphobia is defined as the fear of the outside or being in a kind of situation from which a person (who suffers the condition) believes it is difficult to escape or even find help to escape. Some examples of such situations include wide-open spaces and certain social situations like those that may be met with in airports, on public transport, in shopping malls and on bridges. It can also be triggered by simply leaving the home.
Generally, onset of the phobia occurs between 20 and 40 years of age and it is more common in women. It is estimated that approximately 2.2% of the US adults between 18 and 54 years of age suffer from agoraphobia.
The phobia is often compounded because of a person’s fear of a social embarrassment that an onset of panic attack can cause. This is referred to as social agoraphobia.
It manifests itself in a variety of differing ways. Some people who suffer from agoraphobia fear open spaces, whereas some others feel anxious when left at home alone. Some individuals also feel a type of separation anxiety disorder when other individuals leave the house temporarily. Another associative disorder commonly experienced by persons suffering from agoraphobia is the fear of death, necrophobia.
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Agoraphobia Symptoms And Treatment Options
The most common trigger for agoraphobia is as a result of a panic disorder or episode. A simple, one off panic attack can create the worry of a repeat episode when in a similar environment or situation again. This anxiety builds up to the point that the situation or environment is avoided. Thus begins the development of the phobia.
As with most phychological conditions the exact cause is often difficult to pinpoint and varies case to case. It’s believed that a combination of both biological and psychological factors together are often contributory factors.
Whilst there may be no conclusive proof, biological factors involved in panic disorders may be caused by a malfunction in the natural reaction of the body when perceived to be in danger. This includes either (or both):
- The body’s natural protection mechanism that we know as the “fight or flight” reflex.
- The natural release of certain hormones to ready the body to fight against impending danger
Another theory is that agoraphobia may also be caused an imbalance, incorrect wiring or malfunction in parts of the brain which control emotions or the neurotransmitters which affect behaviour and moods.
There’s also an assumed link between panic disorders and spatial awareness which can result in a disorientation and confusion in crowded places. In this case the vestibular function in a disproportionate number of people having agoraphobia has been found to be weak and therefore they rely on visual signals. When the visual cues that are available to them are limited or overwhelming (as in open spaces or in crowds), they may experience disorientation.
As with other anxieties and phobias psychological factors can also be the trigger for the onset of agoraphobia.
Among the most commonly associated factors are traumatic or stressful events, unhappiness, being dominated by a partner, bullying and abuse (especially at a young age), drug misuse (including alcohol) and previous psychological conditions of varying nature.
The onset of agoraphobia has also been connected with chronic usage of sleeping pills such as benzodiazepines and tranquilizers.
Sometimes however agoraphobia is not triggered by a panic disorder but instead is caused as a result of a specific fear or phobia. In this case the trigger for the phobia needs to be established.
Symptoms of Agoraphobia
When an agoraphobic finds themselves in a stressful situation will often experience symptoms similar to those of a panic attack. Symptoms such as a racing heartbeat, rapid, shallow breathing causing hyperventilation, and a feeling of nausia, accompanied with a rise in temperatiuse and perspiration.
Left unchecked and situations which trigger the anxiety start to be avoided and this starts to have a detrimental effect on life in general.
There are three main types of symptoms:
Physical symptoms can be rare as most people who have agoraphobia avoid situations which they think can trigger panic. However, when they do occur, they can include: Increased heart beat, rapid or shallow breathing, flushing, feeling hot, stomach upset, diarrhea, trouble in swallowing, sweat breakout, nausea, trembling, dizziness and light headedness.
Fear that others will notice panic attack which causes embarrassment and humiliation.Fear that the heart may stop and result in death at the time of a panic attack.Fear that he/she may go crazy.Low self-esteem and self-confidence.Depression.General feeling of anxiety and dread.
Avoidance: Agoraphobics avoid situations and environments that are likely to trigger anxiety.Reassurance: An agoraphobic will need the reassurance of another person.Safety behavior: A person suffering from this phobia needs to take or have with them something when they face situations or go to places that can trigger anxiety.Escape: The agoraphobic leaves a place or situation that is causing him/her stress and goes straight back home.
Agoraphobia Treatment Options
Cognitive behavioral treatments. Exposure treatment: This treatment method may provide relief that is long lasting to people with agoraphobia and panic disorder. The focus of this treatment should be elimination of subclinical and residual agoraphobic avoidance and not just panic attacks. Cognitive restructuring: The treatment involves coaching an agoraphobic by means of a dianoetic discussion. The intention is to substitute beliefs that are irrational and counterproductive with factual as well as beneficial ones. Relaxation techniques: An agoraphobic can be taught to develop relaxation skills which will him/her to stop or prevent panic and anxiety symptoms.
Treatments using medications. Anti-depressants belonging to the class of drugs called selective serotonin reuptake inhibitors (SSRI) may be prescribed by doctors for anxiety disorders. Such medications include paroxetine, sertraline and fluoxetine. Other medications that are commonly prescribed for agoraphobia include benzodiazepine tranquilizers, tricyclic antidepressants and MAO inhibitors. Generally, a treatment using antidepressants is supplemented with exposure or cognitive behavior therapy. This is because studies show that they work better in combination.
Alternative treatments. Eye movement desensitization and reprogramming (EMDR): This therapy is recommended if the cognitive-behavioral approaches are not effective or if a person has developed agoraphobia following trauma. Self-help or support groups, stress management techniques, meditation, visualization techniques and aerobic exercises have been found to be helpful to agoraphobics.
Natural Remedies. Herbs that are recommended as remedies for include nerve relaxants and those that have antispasmodic properties. Some such herbs are chamomile (matricaria recutita), kava (piper methysticum) and passionflower (passiflora incarnate).
Agoraphobia – Self Help Treatment
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