Agoraphobia

Description:
Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations in which a person fears and avoid places or situations that might cause him or her to panic and make him or her feel trapped, helpless or embarrassed.As the person perceives their environment to be unsafe with no easy way to escape.These situations can include open spaces, public transit, shopping centers, or simply being outside their home. Peersons fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd. Being in these situations may result in a panic attack. The symptoms occur nearly every time the situation is encountered and last for more than six months. Those affected will go to great lengths to avoid these situations. In severe cases people may become completely unable to leave their homes.

Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. In the DSM-5 agoraphobia is classified as a phobia along with specific phobias and social phobia. Other conditions that can produce similar symptoms include separation anxiety, posttraumatic stress disorder, and major depressive disorder. Those affected are at higher risk of depression and substance use disorder.

Without treatment it is uncommon for agoraphobia to resolve. Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT). CBT results in resolution for about half of people. Women are affected about twice as often as men. The condition often begins in early adulthood and becomes less common in old age. It is rare in children.

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Symptoms:
Agoraphobia is a condition where sufferers become anxious in unfamiliar environments or where they perceive that they have little control.
Typical agoraphobia symptoms include fear of:

*Leaving home alone
*Crowds or waiting in line
*Enclosed spaces, such as movie theaters, elevators or small stores
*Open spaces, such as parking lots, bridges or malls
*Using public transportation, such as a bus, plane or train
*These situations cause anxiety because you fear you won’t be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

Panic disorder and agoraphobia:
Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you’re totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Signs and symptoms of a panic attack can include:

*Rapid heart rate
*Trouble breathing or a feeling of choking
*Chest pain or pressure
*Lightheadedness or dizziness
*Feeling shaky, numb or tingling
*Excessive sweating
*Sudden flushing or chills
*Upset stomach or diarrhea
*Feeling a loss of control
*Fear of dying

Causes:
Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.

Research has uncovered a link between agoraphobia and difficulties with spatial orientation. Individuals without agoraphobia 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. In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with nonsuffering subjects.

Substance induced:
Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia. In 10 patients who had developed agoraphobia during benzodiazepine dependence, symptoms abated within the first year of assisted withdrawal. Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to the long-term effects of alcohol misuse causing a distortion in brain chemistry. Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.

Attachment theory:
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. Recent empirical research has also linked attachment and spatial theories of agoraphobia.

Spatial theory:
In the social sciences, a perceived clinical bias[26] exists in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space, on one hand, and the contraction of private space on the other, thus creating in the minds of agoraphobic-prone people a tense, unbridgeable gulf between the two.

Evolutionary psychology:
An evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attack, though, may be an avoidance response secondary to the panic attacks due to fear of the situations in which the panic attacks occurred.

Risk factors:
Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors for agoraphobia include:

*Having panic disorder or other phobias
*Responding to panic attacks with excessive fear and avoidance
*Experiencing stressful life events, such as abuse, the death of a parent or being attacked
*Having an anxious or nervous temperament
*Having a blood relative with agoraphobia

Agoraphobia can also lead to or be associated with:

*Depression
*Alcohol or drug abuse
*Other mental health disorders, including other anxiety disorders or personality disorders

Diagnosis:
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder. 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. Early treatment of panic disorder can often prevent agoraphobia. Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other anxiety disorders such as depression. 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 (primary agoraphobia).

Treatment:
Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Psychotherapy:
Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Cognitive restructuring has also proved useful in treating agoraphobia. This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.

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.

Medications:
Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. Benzodiazepines, monoamine oxidase inhibitor, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia. Antidepressants are important because some have antipanic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy. A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.

Benzodiazepines, antianxiety medications such as alprazolam and clonazepam, are used to treat anxiety and can also help control the symptoms of a panic attack. If taken for too long, they can cause dependence. Treatment with benzodiazepines should not exceed 4 weeks. Side effects may include confusion, drowsiness, light-headedness, loss of balance, and memory loss.

Alternative medicine:
Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.[39] As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.

Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests 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.

Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before one takes any of these for agoraphobia, should talk with the health care provider. Although these supplements are available without a prescription, they still pose possible health risks.

Yoga: Regular Yoga exercise with meditation under an expart improves self confidance and may get rid of Agoraphobia.

Prevention:
There’s no sure way to prevent agoraphobia. However, anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places over and over again before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

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:
https://en.wikipedia.org/wiki/Agoraphobia
https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987

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