agoraphobia

Agoraphobia: description

The term agoraphobia derives from the Greek. The term “agora” = “market place” and “phobia” = “fear” indicates that people with agoraphobia are afraid of public places. The agoraphobia is therefore also referred to as “claustrophobia”. This is often confused with the fear of space (claustrophobia), which describes the fear of narrow and closed spaces, and which belongs to the so-called specific phobias.

The agoraphobia can occur even in confined spaces. However, those concerned are not afraid of the narrowness or closeness of the space itself. They are afraid that in case of an emergency they will not be able to escape from there or receive no help. They also try to avoid situations where retreating from an anxiety attack would be embarrassing – for example, during a theater performance. When entering a public space, they always try to be near an exit.

Agoraphobia, unlike many other anxiety disorders, does not refer to a particular situation or object. It can occur in very different places, such as in the cinema, on the bus or on bridges. Without therapeutic help, agoraphobia leads to severe impairment of quality of life. Some do not dare to go out of the house at all, or need escorting, and always carry their medicines and a mobile phone with them for emergencies.

Agoraphobia and panic disorder

Agoraphobia is very common in combination with panic attacks. Around 35 to 56 percent of patients suffer from agoraphobia with panic disorder. Panic attacks are violent anxiety attacks, which usually last a few minutes. Those affected experience them as extremely threatening, because in addition to the mental symptoms also severe physical complaints occur. These include rapid palpitations, sweating, dizziness, and many other symptoms that patients consider life threatening. Fear intensifies increasingly.

“Fear of fear”

A central feature of agoraphobia is that those affected are afraid of possible panic attacks or anxiety in public. This phenomenon is called “fear of fear” or “phobophobia”. The fear is also confirmed mostly because the fear of anxiety triggers physical tension. Those affected pay close attention to the slightest physical changes that could indicate a panic attack, and respond to them overly anxious. In the interplay of psyche and body can arise so strong anxiety or even a panic attack.

For fear of uncertain situations, those affected plan appointments or events down to the smallest detail. The many pondering and worrying in advance is at least as aggravating, if not worse, than the actual situation for them.

How many are affected?

Anxiety disorders are common. About four percent of the population suffer from agoraphobia at least once in their lives. Women are affected three times as often as men. The onset of the mental disorder is in late adolescence or young adulthood.

Very few patients suffer from a pure agoraphobia. Many also develop other anxiety disorders, but also depression, alcohol dependence and personality disorders.

Agoraphobia: symptoms

For the diagnosis of agoraphobia sufferers must show certain symptoms according to the ICD-10 classification of mental disorders.

As a major criterion, they must avoid or at least suffer from two or more of the following situations:

• crowds
• Public places
• Travel alone
• Traveling far from home

In addition, there must be at least two of the following physical or mental anxiety symptoms that also occur together.

Physical symptoms

People with agoraphobia always suffer from one or more of the following symptoms:

• Palpitations, increased heart rate
• sweating
• Tremble
• dry mouth

Common chest and abdominal complaints are:

• difficulty breathing
• tightness
• Chest pain or abnormal sensations
• Nausea or discomfort in the stomach
• Feeling dizzy, insecure, weak or dizzy
• Feeling that one or the environment is not real (depersonalization or derealization)
• Fear of losing control
• Afraid to go crazy
• Afraid to die

Common mental symptoms

People with agoraphobia are particularly afraid of panic attacks or fainting in public. All patients with agoraphobia are afraid of crowds. The reasons are different. People who suffer from a pure agoraphobia without panic attacks fear embarrassing situations, for example, to wet themselves with fear. In an agoraphobia with panic attacks, it is less the embarrassment of anxiety attacks that bothers those affected, but rather the fear of not receiving help and dying as a result of physical symptoms.

Those affected suffer greatly from their fears. However, you are aware that they are overdrawn. But with this knowledge alone, fear can not be tamed. It becomes more and more intense over time and already occurs when patients merely imagine the dreaded situation.

At first, they only shun a few places, and later, hardly any place seems safe. Their leisure activities severely limit their ability to work and become a challenge. The agoraphobia therefore has serious consequences, both professionally and financially, as well as in private and social life.

Agoraphobia: causes and risk factors

There is evidence of a hereditary component of agoraphobia. Children whose parents have agoraphobia are at an increased risk of developing this mental disorder as well. The messenger substances in the brain also have an influence on the development. Malfunction of the serotonin and norepinephrine releasing system are possible causes. Whether the disorder really develops, however, also depends largely on the psychosocial factors.

Strains as a cause

Stressful life events increase the likelihood of agoraphobia in people who are drowsy. People with agoraphobia have often had traumatic childhood experiences. Losing a parent through death or divorce, as well as illness or sexual abuse can later contribute to anxiety. In adulthood, stress can trigger agoraphobia. People in partnerships are less likely to suffer from the anxiety disorder than single people.

anxiety sensitivity

Some people are more anxious than others, and thus more susceptible to agoraphobia. They perceive physical changes, such as heart palpitations, more strongly and perceive them as more threatening. Often they then paint catastrophic scenarios. The result is anxiety, which in turn increases the physical symptoms.

In many cases, the agoraphobia begins with a panic attack. In a safe, public place sufferers suddenly experience strong body reactions such as palpitations or dizziness. Such complaints can be created or intensified by coffee, sugar or other factors.

The real trigger for the panic attack is that those affected overvalue the symptoms and experience them as a threat. Fear and physical reactions then rock each other up and down. As a result of this experience, people avoid the place where these symptoms occurred. Over time, anxiety also extends to other situations and places.

Psychological factors

An important factor that contributes to anxiety is the feeling that you have no control over the physical reactions during anxiety. Therefore, those affected avoid unknown places. They fear that they will be helplessly exposed to the situation and the strangers.

Agoraphobia: examinations and diagnosis

At the beginning of treatment, the doctor must conduct a medical examination to exclude physical illness as the cause of the condition. There are a number of physical problems that can trigger severe anxiety. These include, for example, heart problems, thyroid and lung diseases or balance disorders. In addition to a detailed conversation, the examination includes a blood count and an electrocardiogram (ECG) to check the heart. If necessary, the doctor will make further investigations.

To determine if your fears have a psychological cause, the doctor might ask you the following questions:

• Do you sometimes experience strong anxiety associated with physical symptoms, such as palpitations, sweats, or shortness of breath?
• Are there places or situations that you avoid for fear of anxiety attacks?
• How do you feel in large crowds or in public places?

If your descriptions match the symptoms of agoraphobia, the doctor will refer you to an outpatient psychotherapist or a psychosomatic clinic. A psychotherapist or psychologist is able to make an accurate diagnosis. Using a questionnaire, the specialist can find out if there are any other mental disorders that require treatment.

Agoraphobia: treatment

Psychotherapy and / or medication are used for agoraphobia therapy. Experts recommend for the treatment of agoraphobia especially the cognitive behavioral therapy. Psychodynamic psychotherapy is an alternative.

Cognitive behavioral therapy

Cognitive behavioral therapy addresses the exaggerated anxiety thoughts and works on the avoidance strategies that patients have developed over time. For a successful therapy, the affected person must deal intensively with his fears.

According to reports by the poet Johann Wolfgang von Goethe and the psychoanalyst Sigmund Freud, these great personalities also suffered from agoraphobia. Both have avoided certain places out of fear. They were able to overcome the fear of fear by intuitively using the confrontation with their fears for therapy.

The confrontation with anxiety-prone places and situations is what therapists call exposure today. Patients are encouraged to face situations involving anxiety or panic attacks. After the confrontation, the patient reports what symptoms he felt during the attack. As part of the therapy, he experienced first-hand that, for example, the faster heart rate is not a life-threatening threat and calm down after a while by itself. The patient experiences that the fear of anxiety is worse than the experience itself.

The therapist also gives the affected person to closely observe his thoughts and to recognize unreal fears. The severity of the mental disorder is not related to the intensity or frequency of the anxiety symptoms, but to how dangerous these are perceived by the patients. Therefore, the review and, if necessary, revision of thoughts as well as the appropriate interpretation of physical reactions are very important therapeutic contents. They enable the decisive steps to overcome the fear of fear.

Over time, there will be fewer and fewer places where fear occurs. After about fifteen sessions, most patients are able to go fearlessly into many dreaded situations.

Psychodynamic psychotherapy

As part of psychodynamic psychotherapy, the therapist assumes that there is an unresolved conflict behind the symptoms of anxiety. This conflict needs to be recognized and dealt with so that the fear can be overcome. This can be, for example, separation, repressed anger or even sexual problems. The therapist’s concern is to make unconscious processes in conversation clear so that the patient can recognize and process them.

Medication

Selective serotonin reuptake inhibitors (SSRIs), for example citalopram or paroxetine, are mainly used for the treatment of agoraphobia. Another possible drug is venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI). All reuptake inhibitors ensure that the respective messenger substance (serotonin or norepinephrine) can work longer in the cell.

Rarely, tricyclic antidepressants are given because they have more side effects. SSRIs and SNRIs do not lead to dependency. Common side effects, however, include nausea, vomiting, sleep disorders and sexual dysfunction. The effect of the medication does not occur until about fourteen days. The compatibility of each drug is individually very different.

Additional treatment measures

In addition to therapy, experts also recommend exercise. Endurance training should help to improve the symptoms. Participation in self-help groups is often a helpful support for those affected.

Agoraphobia: disease course and prognosis

The agoraphobia often begins suddenly with a first anxiety attack in a public place. Only in a few cases does the mental disorder go by itself. Without treatment, agoraphobia is usually chronic. The longer the mental disorder, the more likely to be other problems, such as alcohol abuse or depressive symptoms.

An agoraphobia often runs in phases. The constitution of those affected can vary from day to day. Even after a long period without symptoms, the symptoms of anxiety can recur.

The sooner the patients seek therapeutic help, the better the prognosis is, as a rule. Especially the confrontation therapy could help many people, theirs agoraphobia to cope and regain her life.