Is going at crowded places a nightmare for you?

Introduction

Have you ever avoided an important ceremony like your friend’s marriage or birthday party just because the place might be crowded? Do you avoid taking public transports, going at restaurants or movies thinking that you might just not be able to escape? Or if so ever you have to go, you try to leave that place as soon as possible because you feel an impending danger or fear. If answer to any of the above questions is YES than it is probable you might be having agoraphobia. Let us see what is agoraphobia, what are its symptoms and causes? And how can it be treated?

What is Agoraphobia?

Agoraphobia is an intense fear of being in a situation or public place where you feel escape might be difficult or embarrassing. Agoraphobia is not just fear of being at public places, a person having agoraphobia also tends to avoid cinemas, shopping malls, public transport, restaurants, coffee shops etc. The basic cause of all these fears is that the person feels escape from these places would be difficult or humiliating.

What are the symptoms of agoraphobia?

The symptoms of agoraphobia vary widely from anxiety to panic attack when in a situation from which escape is not possible or is difficult or embarrassing. These situations include using public transportation, being in open or enclosed places, being in a crowd, or outside of the home alone, being in cinema, shopping malls etc. The symptoms of panic attacks involve intense fear, disorientation, rapid heartbeat, dizziness, sweating, feeling of losing control, chest tightness, nausea or diarrhoea. Since patients learn to avoid these situations it becomes even more difficult to diagnose. Because of these facts some cases of agoraphobia are often thought to have vestibular function (related to balance disorders) association.

What are the causes of agoraphobia?

It is quite interesting to know that there is no single cause that has been contributed for the phobia but many scientists have put forth many theories that explain what causes agoraphobia. It is not only your genetics that causes agoraphobia but both genetic and environmental factors appear to play a role.

The genetic predisposition for agoraphobia cannot be ruled out. In spite of being caused by a number of factors, it tends to run in families. It has also been observed that first-degree relatives also have an increased prevalence of other anxiety and related disorders (e.g. social phobia), alcohol misuse, and depressive disorders.

  1. Learning theory: It states that conditioned fear responses lead to learned avoidance. It states that agoraphobia develops in response to repeated exposure to anxiety-provoking events which leads to learned avoidance of these specific situations or places.

  2. Psychoanalytical theory: It states and explains the unconscious conflicts that are repressed during child development and may be transformed by displacement into phobic symptoms.

What are the associated complications?

The severity and complications of agoraphobia can vary widely. While some individuals lead a normal lifestyle when accompanied by friends or family, while some restrict them to home. Restricting yourself to home even makes the situation worse.

It has been observed that panic disorder occurs in conjugation with agoraphobia and vice versa. There is also a likelihood that the person may have other anxiety disorders which makes the condition even more difficult to treat.

Who is at risk of having agoraphobia?

Women, middle-aged individuals, and individuals who are living alone or had an emotional setback are at increased risk of developing agoraphobia. Agoraphobia markedly develops in the mid-twenties or early thirties. It does not resolve by itself and needs a proper treatment. In later life agoraphobic symptoms may develop secondary to physical frailty, with the associated fear of exacerbating medical problems or having an accident.

Co-occurrence of other anxiety disorders with agoraphobia like panic disorder, social anxiety disorder, generalized anxiety disorder and alcohol abuse also increase the risk of agoraphobia.

When should you seek an expert advice?

If these symptoms start hampering your daily life and your daily chores you should consult your healthcare provider. Or if the frequency of panic attacks is increased and they are triggered by even stepping out of the house you should not refrain from consulting your healthcare provider. It is best to meet your doctor at the earliest signs of inexplicable anxiety and panic at public places. All anxiety disorders are best treated in the early stages.

What are the treatment options available?

  • Pharmacological: Medications as for panic disorder like SSRIs, beta-blockers and benzodiazepines are used for the treatment of agoraphobia. There is an associated risk with the use of benzodiazepines like overdose, addiction, or need for increasingly higher doses make it unfit for long use.

  • Psychological: Behavioural methods Exposure techniques (focused on particular situations or places), relaxation training and anxiety management. Cognitive methods teaching about bodily responses associated with anxiety/education about panic attacks, modification of thinking errors.

References


  1. Lelliott P, Marks I, McNamee G, Tobena A (1989) Onset of panic disorder with agoraphobia. Toward an integrated model. Archives of General Psychiatry 46, 1000.
  2. Oxford handbook of psychiatry, 1st edition.Editors: Semple, David; Smyth, Roger; Burns, Jonathan; Darjee, Rajan; McIntosh, Andrew
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Treatment Revision. Washington, D.C., 2000
  4. Bienvenu, O.J., Onyike, C.U., Stein, M.B., Chen, L., Samuels, J., Nestadt, G., and Eaton, W.W. Agoraphobia in adults: incidence and longitudinal relationship with panic. The British Journal of Psychiatry 188: 432-438, 2006.
  5. Biondi, M. & Picardi, A. Increased probability of remaining in remission from panic disorder with agoraphobia after drug treatment in patients who received concurrent cognitive-behavioural therapy: a follow-up study. Psychotherapeutic Psychosomatics 72(1): 34-42, 2003.
  6. Bruce, S.E., Yonkers, K.A., Otto, M.W., Eisen, J.L., Weisberg, R.B., Pagano, M., Shea, T., and Keller, M.B. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia and panic disorder: a 12-year prospective study. American Journal of Psychiatry 162: 1179-1187, 2005.
  7. Goodwin, R., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R., and Wittchen, H.U. The epidemiology of panic disorder and agoraphobia in Europe. European Neuropsychopharmacology 15(4): 435-443, 2003.
  8. Milrod, B. Emptiness in agoraphobia patients.Journal of the American Psychoanalytic Association 55(3): 1007-1026, 2007.
  9. Nascimento, I. Psychiatric disorders in asthmatic outpatients. Psychiatry Research 110(1): 73-80, 2002.
  10. Roberge, P., Marchand, A., Reinharz, D., and Savard, P. Cognitive-behavioral treatment for panic disorder with agoraphobia: A randomized, controlled trial and cost-effectiveness analysis. Behavior Modification 32(3): 333-351, 2008.
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