Agoraphobia: what it is, causes, symptoms and treatment

What is agoraphobia and how can we help a person with this fear?

In the 1990s one of the first films appeared in which a case of agoraphobia was described in detail. described in detail a case of agoraphobia agoraphobia. The psychologist who stars in this piece of fiction feels anxious about the mere fact of leaving her apartment for a few seconds to reach the newspaper.

Of course, and as striking as the scene may seem, it is only a resource to introduce one of the main characters in the story.. 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 a person's quality of life to the limit and understand that person's behavior. At the same time, it is evidence of the fact that the anxiety crises produced by this disorder can be very shocking and present in many spheres of a human being's life.

But despite the fact that agoraphobia is so shocking and its consequences can be so palpable, it is not easy to understand what it is. Reading the following may help to form a somewhat more detailed picture of this type of phobia, and at the same time to know its main symptoms.and, incidentally, learn about its main symptoms, causes and ways of treating agoraphobia.

Agoraphobia, fear of open spaces?

It is usually assumed that agoraphobia consists of an irrational fear of open spaces, such as large avenues, parks or natural environments. The very etymology of the word itself suggests a relationship between the phobia and squares (agorasIt is easy to take for agoraphobia certain cases of people who simply do not like to leave home or with problems related to social isolation.

However, it is not entirely true that agoraphobia is equivalent to a 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 the fear is not produced by these spaces per se, but by the consequences of being exposed to them. by the consequences of being exposed to such a place.. This nuance is key and often overlooked.

So... 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 noticing that not being in a safe context in which it is possible to receive help in the event of a crisis.. That is to say, its symptoms are based on a strong anguish produced by situations in which the sufferer feels unprotected and vulnerable to anxiety crises beyond his or her control. The root of the problem is something like a fear of fear. And that makes that once it has entered in the dynamics of fearing the symptoms of agoraphobia, that favors its appearance. It is a disorder that many times is based on the self-fulfilling prophecy, or the fish that bites its own tail linked to fear and anxiety.

The anxious fear experienced by someone with this anxiety disorder is basically based on the anticipation of panic attacks. Therefore, where there is agoraphobia there is also a fear-based loop. A vicious circle of recurring thoughts from which it is difficult to escape.

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

In short, agoraphobia is the fear of loss of control. The fear of the subjective sensations of discomfort that this would produce in real time is also an important factor. This is what explains why anxiety attacks can appear not only in large spaces, but also in an elevator or any place other than one's own home. Agoraphobia is usually expressed in any place that is perceived as particularly unsafe, i.e. where we have less control over things.

The myth of agoraphobia as a watertight compartment

From what has been said above we can come to a conclusion: the symptoms of agoraphobia are not always the same, and their triggers can have very different forms.. The situations and places that can produce distress or anxiety are neither stereotypical nor the same in all persons diagnosed with this disorder, as would be expected if agoraphobia were expressed in a similar way to how vampires' fear of crucifixes is expressed in popular culture. 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 also be diagnosed with other disorders, such as panic disorder or post-traumatic stress disorder, as several of their symptoms may overlap. As we can see, there are common confusions about the symptoms and signs of this psychological disorder.

Diagnosis and symptoms

Broadly speaking, Some of the characteristics that people with agoraphobia present are are:

• Being exposed to open, crowded or unfamiliar placesBeing exposed to open, crowded or unfamiliar places produces a strong feeling of anguish.
• This feeling of anguish is sufficiently intense that the person adopts the strategy of avoiding such places, even though this has a negative impact on their quality of life.
• These outbreaks of anxiety and distress cannot be explained by other diagnosed disorders. by other already diagnosed disorders.
• The possibility of of attracting the attention of strangers or of making a fool of themselves because of an anxiety crisis also plays an important role.

It is very important to emphasize the fact that this information is only indicative and that only a specialist can diagnose each case on a case-by-case basis. only a specialist can diagnose on a case-by-case basis when a case of agoraphobia exists and when it does not..

When diagnosing this type of disorder, it is essential to take into account whether the person perceives what is happening to him/her as something that limits his/her quality of life and is therefore disabling. In other words, the existence or not of agoraphobia does not depend only on the symptoms, but also on the context in which they occur, both subjectively (does the patient believe it is problematic?) and objectively (do the symptoms appear when the anxiety is unjustified?).

That is why it is necessary to consider to what extent any person without anxiety problems can present to a greater or lesser extent any of these general characteristics associated with agoraphobia.

Causes

It is one thing to describe a disorder, and quite another to talk about its causes.. In this regard, it is often believed that phobias in general, including 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 the fear of open spaces.

However, at present these types of explanations are not very useful (and in the case of the latter it cannot even be demonstrated by the epistemological foundations of this approach), among other things because they overlook possible organic causes. That is, those that have to do with the Biological functions that determine our thoughts and moods.

While it is true that it is not known what exactly causes agoraphobia, a link has been found between agoraphobia and the biological functions that determine our thoughts and moods.agoraphobia, a link has been detected between this type of disorder and abnormally low serotonin levels in certain parts of the brain. These low serotonin levels may be caused by a genetic mutation, but they may also be due to a chemical imbalance caused by certain experiences or by the consumption of certain substances, or they may be the product of all of these at the same time.

Regardless of whether or not this finding is successful in explaining the mechanisms behind this disorder, what is clear is that there is no single cause for this disorder. there is no single cause of agoraphobia of agoraphobia, but several, as occurs in practically any psychological phenomenon, pathological or not.

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

Treatment

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

1. Drug treatment

In pharmacological treatment, both antidepressants (SSRIs) and anxiolytics (clonazepam and diazepam). However, these drugs should only be taken under strict medical supervision and only on 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 is always the case 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 the level of anxiety high, but impact the whole organism in general, and this can produce a mismatch 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 any other psychological disorder, and it is the task of mental health professionals to determine whether the danger is low enough to use a certain dose, and in what way it should be used.

2. Psychological therapy

As regards the psychotherapeutic approach, interventions based on Cognitive-Behavioral Therapy stand out. This is a type of therapy whose benefits have been scientifically proven.

The advantages of this option are 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 disadvantages compared to pharmacological 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 goals proposed in the therapy. This is important, because making progress with this type of interventions involves making an effort and confronting unpleasant situations in order to generate a greater resistance to what is feared, with professional supervision and in a controlled environment.

From the Cognitive-Cognitive-Cognitive perspective, work will be done both on the beliefs that the person has about his disorder and on his daily habits and actions, so that the changes carried out in both dimensions, mental and behavioral, reinforce each other. In addition, it is also common to use 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 anxiety.to alleviate the immediate effects of this anxiety disorder and at the same time train the patient to be able to expose him/herself more and more to the feared situations and to manage the feeling of nervousness. However, this will only occur if it is considered strictly necessary, and drugs should only be consumed under medical indication.

Bibliographical 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). Tratando pánico y agorafobia. Madrid: Pirámide.
• Hersen, M. y Last, C. (1985/1993). Manual de casos de terapia de conducta. 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.
• Jacobson, K. (2004). Agoraphobia and Hypochondria as Disorders of Dwelling. International Studies in Philosophy. 36 (2): 31–44.
• Luciano, M.C. (1996). Manual de psicología clínica. Infancia y adolescencia. Valencia: Promolibro.