According to its etymology, the term Agoraphobia means fear of open spaces. However, this anxiety disorder “goes much further,”. In reality, it is the “fear or anxiety that occurs when we find ourselves in situations that we perceive as difficult to escape or in which we feel that we have no control if something dangerous happens”.
Agoraphobia tends to avoid potentially anxiogenic situations, such as using public transport, going to the movies, shopping centres or concerts. In general, they are “places where there are a lot of people and from which it is difficult to leave,” says the psychologist. This represents a severe problem on a day-to-day basis. “In the end, he avoids all the potentially agoraphobic places and never leaves the house in the most serious cases.”
Others affected do go out, but they do so with a lot of effort and fillers, that is, if they take anti-anxiety medication to deal with the situation or go in the company of a certain person (mother, father, partner) or other supports.
This disorder is not very common; According to the psychologist, it has a lower prevalence than simple phobias (dogs, aeroplanes, spiders).
Causes
Some cases of Agoraphobia develop after a traumatic experience, but many do not. “The origin of this type of disorder is complex and multi-causal.
More than the fact of having experienced an unpleasant situation in a place where it is difficult to escape, the psychologist emphasises that this disorder has to do with “a combination of personality characteristics, such as the tendency to self-control and to ruminate on worries, the low tolerance for uncertainty, low self-confidence, a deficit in coping capacity.
The development of this disorder is, therefore, closely related to learning and managing emotions. When faced with a situation in which we feel bad, the response is to avoid it or escape, ultimately perpetuating it.
Symptoms
The main symptom of this disorder is fear, which can manifest itself in different ways :
- Fear of being or being alone.
- Fear of being in places where you might have difficulty getting out.
- Fear of losing control in public places.
- Present changes in behaviour and temperament.
- The sensation of distance from the rest of the environment increases dependence on other people.
- Begin to believe that the environment and the things around you are unreal.
- Do not leave the house for long periods.
Some of the above manifestations correspond to the close relationship between agoraphobia disorder and panic disorder, which occur in 50% of cases. Panic attacks are characterised by a feeling of fear and intense discomfort accompanied by several of the following symptoms: palpitations or increased heart rate, sweating, shaking or trembling, feeling of choking or shortness of breath, choking sensation, tightness or chest discomfort, nausea or abdominal discomfort, unsteadiness, dizziness or feeling faint, feeling numb or tingly, chills, flushing, and fear of dying, going crazy, or losing control.
Prevention
Since the origin of Agoraphobia is multifactorial and the specific causes that cause it are not always known, there are no specific measures to prevent its appearance.
However, in many cases, treating the specific triggers that can lead to distress and panic attacks can prevent Agoraphobia.
Rivera points out that, as in any psychological disorder, the best preventive attitude seeks to “cope with the situation” and “question catastrophic thoughts“. For example, thinking: “How many times have I felt dizzy when I thought I was going to get dizzy?”
The idea is that each person “knows how to identify how they deal with anxiety and normalise their emotions.”
types
The American Psychiatric Association classifies Agoraphobia into:
- Panic disorders with Agoraphobia.
- Agoraphobia without a history of panic disorder
- Panic disorder without Agoraphobia.
Some specialists can also classify this pathology according to the different situations that can be seen in an agoraphobic person:
Panic attack in an agoraphobic situation: In this situation, the attack is predictable and caused by an external stimulus. The patient has had attacks in the same situation and believes there is a high possibility of having them again, which increases his fear and, in the end, he ends up having the attack.
Predictable panic attack in a safe situation: The patient predicts that he will have an attack because he is very emotionally active, whether due to joy, stress, sadness, anger or worry, so he avoids having high levels of emotion.
Unpredictable panic attack in a safe situation: Panic is triggered when the person is in a place classified, according to their criteria, as safe.
In this case, the stimulus is internal. For example, your body interprets certain physiological functions or vital bodily changes that the person performs catastrophically, misunderstands and generates a great deal of anxiety that ultimately ends with a manic episode.
Anticipatory panic attack: The patient assures that he will have a seizure when exposed to the anxiety-triggering stimulus, which causes him to have a seizure before he has been exposed to the stimulus.
Diagnosis
The diagnosis of Agoraphobia begins with a medical and psychological evaluation by the specialist, who may also need to talk to people close to the environment to find out how they usually behave.
Rivera stresses that it is important to consult before the first demonstrations to prevent the problem from becoming chronic: “When you see that you begin to avoid certain situations, such as going by public transport.”
Treatments
The treatment that offers the best results in agoraphobes is exposure therapy, a cognitive-behavioural psychological therapy aimed at helping the affected person confront and manage their fears.
With the help of a specialist, the person progressively seeks out and gets in touch with what is causing their fears until their anxiety gradually eases due to the familiarity they acquire with the situation.
The psychiatrist may also prescribe antidepressants and anxiolytics, especially early in exposure therapy. “In the end, the patient has to be able to expose himself and manage some anxiety with his resources and without pharmacological support.
