Agoraphobia: what it is, causes, symptoms and treatment

In the 1990s, one of the first films appeared in which a case ofagoraphobia. The psychologist who stars in this piece of fiction feel anxiety by the mere fact of leaving his apartment for a few seconds to reach the newspaper.

Of course, and as striking as the scene may seem, it is still a resource to introduce one of the main characters. It does not serve to understand what this anxiety disorder consists of, but rather confronts us with an extreme case of agoraphobia so that we can see to what extent it can put the quality of life of a person to the limit and we understand the behavior of that person. At the same time, it evidences the fact that the anxiety attacks produced by this disorder can be very shocking and be present in many of the spheres of a human being's life.

But, despite the fact that agoraphobia is so shocking and its consequences can be so palpable, it cannot be said that it is easy to understand what it consists of. Read what comes next can help to form a somewhat more detailed image of this type of phobia

, and by the way know its main symptoms, causes and ways to treat agoraphobia.

Agoraphobia, fear of open spaces?

It is commonly assumed that agoraphobia consists of an irrational fear of open spaces, such as large avenues, parks, or natural surroundings. The very etymology of the word suggests a relationship between the phobia and the squaresagoras, a word from the Greek), and it is easy to take as agoraphobia certain cases of people who simply do not like to leave the house or with problems related to social isolation.

However, it is not entirely true that agoraphobia equates to fear of open or public spaces. It is a way of feeling fear and anguish whose origin is something more abstract than the simple visualization of this type of environment.

The fact of perceiving open or crowded spaces plays a role in triggering panic attacks in people with agoraphobia, but fear is not produced by these spaces per se, but for the consequences of being exposed to that place. This nuance is key and is often overlooked.

Then... What is agoraphobia? Definition

A first superficial approach to the concept of agoraphobia consists in defining it as an anxiety disorder that is expressed by noting that you are not in a safe context in which you can receive help in a crisis. That is, their symptoms are based on a strong anguish produced by situations in which the person who suffers from it feels unprotected and vulnerable to anxiety attacks that are beyond their control. control. The root of the problem is something like a fear of fear. And that means that once you have entered the dynamic of fearing the symptoms of agoraphobia, that favors its appearance. It is a disorder that is often based on self-fulfilling prophecy, or whiting that bites its tail linked to fear and anxiety.

The anguishing fear that someone with this anxiety disorder experiences is based, basically, on anticipation of panic attacks. Therefore, where there is agoraphobia there is also a loop based on the afraid. A vicious cycle of recurring thoughts that is difficult to escape.

Somehow agoraphobia feeds itself through the anticipation of both sensations unpleasant events associated with these crises as well as the dangers of losing control over one's own acts. Therefore, the way in which this feeling of anguish is expressed also reproduces the structure of a loop: not the open space is feared, but the possibility of suffering a panic attack or an anxiety attack by the fact of being there, and at the same time the consequences of being in that place when that happen.

Definitely, agoraphobia consists of the fear of loss of control on the physiological activation itself and on the results to which this can lead, in addition to the fear of subjective feelings of discomfort that this would produce in real time. This is what explains why anxiety attacks can appear not only in large spaces, but also in an elevator or anywhere other than the house itself. Agoraphobia usually expresses itself in any place that is perceived as especially unsafe, that is, where we have less control over things.

The myth of agoraphobia as a watertight compartment

From what has been said above we can reach a conclusion: the symptoms of agoraphobia are not always the same, and its triggers can take many different forms. The situations and places that can produce anguish or anxiety are neither stereotypical nor the same in all people diagnosed with this disorder, as would be expected if agoraphobia were expressed in a way similar to how the fear of vampires is expressed in popular culture. crucifixes. In fact, it sometimes happens that anxiety attacks occur even when the person is in a "safe" place, due to internal causes unrelated to how the environment is perceived.

Because of this variability, it is common for people with agoraphobia to be diagnosed with other disorders as well, such as panic disorder or post traumatic stress disorder, since several of its symptoms may overlap. As we can see, there are common confusion about the symptoms and signs of this psychological disorder.

Diagnosis and symptoms

Roughly, some of the characteristics of people with agoraphobia They are:

• Being exposed to open places, very crowded or unfamiliar produces a strong feeling of anguish.
• This feeling of anguish it is intense enough for the person to adopt the strategy of living avoiding these types of places, despite the fact that this has a negative impact on their quality of life.
• These outbreaks of anxiety and anguish cannot be explained for other disorders already diagnosed.
• The possibility of attract the attention of strangers or make a fool of yourself Because of an anxiety attack it also plays an important role.

It is very important to highlight the fact that this information is only indicative and that only a specialist can diagnose case by case when there is a case of agoraphobia and when not.

When diagnosing this type of disorder, it is essential to take into account whether the person perceives what is happening to them as something that limits their quality of life and is therefore disabling. That is, the existence or not of agoraphobia does not depend only on the symptoms, but also on the context in which they occur, both subjective (does the patient believe that it is problematic?) and objective (symptoms appear when anxiety is unjustified?).

That is why you have to consider to what extent anyone without anxiety problems can present to a greater or lesser extent any of these general characteristics associated with the agoraphobia.

Causes

It is one thing to describe a disorder, and quite another to talk about its causes.. On this, it is common to believe that phobias in general, among which is agoraphobia, appear simply because of a stressful lifestyle, or that they are the expression of some kind of trauma or internal conflict that is expressed symbolically through fear of open spaces.

However, these types of explanations are currently not very useful (and in the case of the second it cannot even be demonstrated by the fundamentals epistemological of that approximation), among other things because they overlook the possible organic causes. That is, those that have to do with the biological functions that determine our thoughts and our moods.

While is true that it is not known what exactly causes agoraphobia, a link has been detected between this type of disorder and abnormally low serotonin levels in certain parts of the brain. These low levels of serotonin they can be caused by a genetic mutation, but they can also be due to a chemical decompensation originated by certain experiences or by the consumption of certain substances, or being the product of all this to the time.

Regardless of whether this finding ends up being correct or not to explain the mechanisms behind this disorder, what is clear is that there is no single cause of agoraphobia, but several, as occurs in practically any psychological phenomenon, pathological or not.

Agoraphobia appears and is expressed through biological and genetic factors, but also cultural and based on the learning that each person has carried out and that constitute their regards. Psychologically, human beings are bio-psycho-social in nature, and the same is true of mental disorders.

Treatment

Once diagnosed, agoraphobia can be treated both from psychological intervention and through drugs. Next we will see what these two types of treatment for agoraphobia are, but it is important emphasize that only a mental health professional is authorized to carry out therapy effective.

1. Drug treatment

In pharmacological treatment, both antidepressants (SSRI) as anxiolytics (clonazepam and diazepam). However, these medications should only be taken under strict medical supervision and only with a prescription, and in any case they are not used to cure the disorder, but to cope with its symptoms.

It is also important to bear in mind that, as always happens with drugs, they can produce significant side effects and adverse effects, such as the appearance of serotonin syndrome. This occurs because, as with all drugs in general, those used to combat the symptoms of phobias not only act on the parts of the brain involved in keeping anxiety high, but impacts the whole body in general, and this can produce a maladjustment depending on the genetic and biological predispositions of the individual.

Therefore, there is always a certain risk when using these substances either against agoraphobia or against any other psychological disorder, and it is task of mental health professionals to determine if the hazard is low enough to use a certain dose, and how it should be used.

2. Psychological therapy

Regarding the psychotherapeutic approach, highlight the interventions based on the Cognitive-Behavioral Therapy. It is a type of therapy whose benefits have been scientifically proven.

The advantages of this option is that its benefits tend to last longer than the effects of drugs After the last doses, it is a brief intervention and has no side effects as it does not act directly on the regulation of hormones and neurotransmitters.

Among its drawbacks compared to drug treatment are the relative slowness with which progress appears and the need for the person with agoraphobia to be in a position to collaborate and achieve the objectives proposed in the therapy. This is important, because progress with these types of interventions it means trying hard and dealing with unpleasant situations to gradually generate greater resistance to what is feared, with professional supervision and in a controlled environment.

From the Cognitive-Condutual perspective, we will work both on the beliefs that the person has about their disorder and on their daily habits and actions, so that the changes carried out in both dimensions, mental and behavioral, are reinforced between Yes. In addition, it is also frequent to resort to relaxation techniques to train in the ability to manage anxiety.

In many cases it will be recommended to use both pharmacological and psychological intervention, to alleviate the immediate effects of this anxiety disorder and at the same time train the patient to that he is able to expose himself more and more to the feared situations and to manage the feeling of nervousness. However, this will only happen if it is considered strictly necessary, and the drugs should only be consumed under medical indication.

Bibliographic references:

• Adamec, C. (2010). The Encyclopedia of Phobias, Fears, and Anxieties, Third Edition. Infobase Publishing. p. 328.
• American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing.
• Badós, A. (2006). Treating panic and agoraphobia. Madrid: Pyramid.
• Hersen, M. and Last, C. (1985/1993). Behavior therapy case manual. Bilbao: Desclée de Brouwer.
• Lydiard, R.B.; Ballenger, J.C. (1987). Antidepressants in panic disorder and agoraphobia. Journal of Affective Disorders. 13 (2): 153 - 168.
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