The term agoraphobia derives from the Greek word Agorà which means square; in fact, the first uses of the word in psychology and psychiatry were aimed at people who were afraid of going to crowded places. In fact, patients with agoraphobia symptoms fear situations where it is difficult to escape or receive help. Consequently, they avoid such places in order to control anxiety related to the foreshadowing of a new panic crisis. So, what is Agoraphobia?
What is agoraphobia: what is it about?
Agoraphobia is an anxiety disorder characterized by marked fear and anxiety triggered by actual or anticipated exposure to a wide range of situations. Anxiety and / or fear are generated as a result of being alone in places or situations from which it would be difficult or embarrassing to get away. Or where help may not be immediately available.
People with agoraphobia experience thoughts that something terrible could happen to them. For example. “I can’t escape / go out” or “there is no one who could help me”.
Features and manifestations of agoraphobia
In most cases, agoraphobia is a problem that arises secondary to the onset of panic attacks or minor anxiety attacks. It occurs when the agoraphobic subject begins to systematically avoid all places, situations and contexts in which there could be obstacles to the possibility of being helped.
Agoraphobic avoidances and protective behaviors
Among the situations that are most frequently avoided by those who show symptoms of agoraphobia are:
- go out alone or stay home alone
- drive or travel by car
- go to crowded places like markets or concerts
- take the bus or the airplane
- be on a bridge or in an elevator
When these avoidances begin to compromise the daily activities and the socio-working functioning of the person then we speak of agoraphobia. Sometimes, the problem is more difficult to identify because the subject does not avoid certain feared situations but becomes unable to deal with them without the assistance of a trusted person.
In this regard, it is possible that instead of avoidance the agoraphobic subject uses protective behaviours in order to prepare to face a certain feared situation. Avoidances and protective behaviours, although in the short term they may prove useful for the subject, in the long term do not allow to face the problem and represent powerful factors in maintaining the disorder itself.
Agoraphobia and panic disorder
Agoraphobia can be diagnosed within panic disorder with agoraphobia or as agoraphobia without a history of panic disorder. In the latter case, the seizures that the patient avoids are characterized by panic-like anxiety symptoms, but without all the characteristics of the actual panic attack.
Symptoms of agoraphobia
Agoraphobia is in summary characterized by symptoms such as:
- Anxiety related to being in places where it would be difficult to get away, flee or ask for and receive help, in the event of a panic attack or an anxiety crisis.
- Dreaded situations are avoided or faced with great difficulty or with the support of a carer.
- Anxiety and avoidance limit the person’s socio-occupational functioning and do not derive from other types of fear or phobias. Such as, for example, avoiding elevators for the claustrophobic, avoiding social situations for the social phobic avoiding stimuli that resemble a traumatic event in PTSD.
- There may also be symptoms such as increased heart rate, excessive sweating, increased breathing rate, feeling dizzy, fear of losing control or dying. This is because those suffering from agoraphobia frequently experience the physical and psychological symptoms typical of a panic attack.
- You can find the presence of brooding , that is the continuous thinking and rethinking about the negative events that could happen, with the aim of predicting them, preventing them and preparing to face them.
Cognitive Behavioral Therapy
Standard cognitive-behavioral therapy for the treatment of agoraphobia, in addition to behavioural interventions based on situational exposure, includes initial psychoeducation and cognitive interventions. Within cognitive-behavioural psychotherapy, exposure techniques have been shown to be useful in reducing the behaviours that fuel agoraphobic anxiety.
Recently, strategies have been implemented to increase the subjects’ ability to stay in contact with anxious activation without fear of its catastrophic consequences. By promoting acceptance and decreasing the need to control anxiety symptoms. In some cases it is advisable for the psychotherapist to work in a multidisciplinary perspective with a psychiatrist to also evaluate the pharmacological help in the treatment of the disorder.
In general, however, psychotherapy is essential for the treatment of agoraphobia. Psychotropic drugs, containing anxiety symptoms and panic episodes, can be useful in the short term, but in the long run they generate a strong psychological dependence. Very often, moreover, the symptoms of agoraphobia recur after their suspension.