Agoraphobia

Definition:
The word “agoraphobia” is an English adaptation of the Greek words agora (a) and phobos (ß), and literally translates to “a fear of the marketplace.”

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Panic disorder is characterized by repeated and unpredictable attacks of intense fear and anxiety. Agoraphobia, literally “fear of the marketplace”, develops from a panic disorder in more than one-third of cases.

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Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include crowds, wide open spaces or traveling, even short distances. This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public.

Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack.

It is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to their home, experiencing difficulty traveling from this “safe place.”

Agoraphobia is fear of being in places where help might not be available, and is usually manifested by fear of crowds, bridges, or of being outside alone.

Prevalence:
The one-year prevalence of agoraphobia in the United States is about 5 percent. According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with Panic Disorder progress to develop agoraphobia.

Gender differences
Agoraphobia occurs about twice as commonly among women as it does in men. The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviors. Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia.

Causes :
Agoraphobia often accompanies another anxiety disorder, such as panic disorder or a specific phobia.
If it occurs with panic disorder, the onset is usually in the 20s, and women are affected more often than men. People with this disorder may become housebound for years, which is likely to hurt social and interpersonal relationships.

There is no one single cause associated with agoraphobia.

There is no one single cause associated with agoraphobia. Instead, there are a number of factors that contribute to the development of agoraphobia. These factors include:

Family factors:

*Having an anxious parent role model.

*Being abused as a child
*Having an overly critical parent.
Personality factors:
*High need for approval.
*High need for control.
*Oversensitivity to emotional stimuli.
Biological factors:
*Oversensitivity to hormone changes.
*Oversensitivity to physical stimuli.
*High amounts of sodium lactate in the bloodstream.

.Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces. Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data.

Some scholars have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.

Symptoms:
*Fear of being alone
*Fear of losing control in a public place
Fear of being in places where escape might be difficult
*Becoming housebound for prolonged periods of time
*Feelings of detachment or estrangement from others
*Feelings of helplessness
*Dependence on others
*Feeling that the body is unreal
*Feeling that the environment is unreal
*Anxiety or panic attack (acute severe anxiety)
*Unusual temper or agitation with trembling or twitching

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Additional symptoms that may occur:
*Lightheadedness, near fainting
*Dizziness
*Excessive sweating
*Skin flushing
*Breathing difficulty
*Chest pain
*Heartbeat sensations
*Nausea and vomiting
*Numbness and tingling
*Abdominal distress that occurs when upset
*Confused or disordered thoughts
*Intense fear of going crazy
*Intense fear of dying

Diagnosis:
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.[16] In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used.

DSM-IV-TR diagnostic criteria
A) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.

B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.

C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).

D)The individual may have a history of phobias, or family, friends, or the affected person may tell the health care provider about agoraphobic behavior.
The individual may sweat, have a rapid pulse (heart rate), or have high blood pressure.

Treatments:
Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications. Treatment options for agoraphobia and panic disorder are similar.
The goal of treatment is to help the phobic person function effectively. The success of treatment usually depends upon the severity of the phobia.
Systematic desensitization is a technique used to treat phobias. The person is asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Graded real-life exposure has also been used with success to help people overcome their fears.

Cognitive behavioral treatments
Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. Similarly, Systematic desensitization may also be used.

Cognitive restructuring has also proved useful in treating agoraphobia. This treatment uses thought replacing with the goal of replacing one’s irrational, counter-factual beliefs with more accurate and beneficial ones.[citation needed]

Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.[citation needed]


Psychopharmaceutical treatments

Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia.


Alternative treatments

Eye movement desensitization and reprogramming (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.
Alternative treatments of agoraphobia include hypnotherapy, guided imagery meditation, music therapy, yoga, religious practice and ayurvedic medicine.

.
Additionally, many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided


Prognosis:
Phobias tend to be chronic, but respond well to treatment.

Possible Complications :
Some phobias may affect job performance or social functioning.

When to Contact a Medical Professional:
Call for an appointment with your health care provider if symptoms suggestive of agoraphobia develop.

Prevention:

As with other panic disorders, prevention may not be possible. Early intervention may reduce the severity of the condition.

.Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Agoraphobia
http://www.nlm.nih.gov/medlineplus/ency/article/000931.htm

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