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. The psychologist who stars in this piece of fiction feels anxious about the mere fact of leaving her apartment a few seconds to reach the newspaper.
Of course, and as striking as the scene may seem, it is still a resource to present to one of the main characters. It does not serve to understand what this anxiety disorder consists of, but it confronts us with an extreme case of agoraphobia so that we can see to what extent the quality of life of a person can be limited and we understand that person’s behavior. At the same time, it evidences the fact that the anxiety crises produced by this disorder can become very impressive and be present in many of the spheres of a human being’s life.
But, although agoraphobia is so shocking and its consequences can become so palpable, it cannot be said that it is easy to understand what it is. Reading what comes next can help to form a somewhat more detailed picture of this type of phobia, and in passing know its main symptoms, causes, and ways to treat agoraphobia.
Agoraphobia, fear of open spaces?
It is usually assumed that agoraphobia is an irrational fear of open spaces, such as large avenues, parks, or natural environments. The etymology of the word itself suggests a relationship between the phobia and the squares (agoras, a word from the Greek), and it is easy to take certain agoraphobia cases of people who simply do not like to leave the house or with problems related to the social isolation.
However, it is not entirely true that agoraphobia equals fear of open or public spaces. It is a way of feeling fear and anguish whose origin is somewhat more abstract than the simple visualization of such environments.
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 that place. This nuance is key and is often overlooked.
What is agoraphobia? Definition
A first superficial approach to the concept of agoraphobia is to define it as an anxiety disorder that is expressed by noticing that it is not in a safe context in which it is possible to receive help in the event of a crisis. That is, their symptoms are based on strong anguish caused by situations in which the person who suffers feels unprotected and vulnerable to anxiety crises beyond their control. The root of the problem is something like a fear of fear. And that makes once the dynamics of fear of agoraphobia symptoms have been entered, that favors their appearance. It is a disorder that is often based on self-fulfilling prophecy or whiting that bites the tail linked to fear and anxiety.
The anguishing fear that someone with this anxiety disorder experiences is basically based on the anticipation of panic attacks. Therefore, where there is agoraphobia, there is also a loop based on fear. A vicious circle of recurring thoughts from which it is difficult to escape.
Somehow, agoraphobia feeds itself through anticipation of both the unpleasant sensations associated with these crises and the dangers of losing control over the acts themselves. Therefore, the way in which this feeling of anguish is expressed also reproduces the structure of a loop: it is feared not the open space, but the possibility of suffering a panic attack or an anxiety crisis due to being there, and at the same time the consequences of being in that place when that happens.
Ultimately, agoraphobia is the fear of loss of control over the physiological activation itself and 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 that anxiety attacks can appear not only in large spaces but also in an elevator or any place other than the house itself. Agoraphobia is usually expressed in any place that is perceived as especially insecure, that is, where we have less control over things.
The myth of agoraphobia as a tight compartment
From the above, we can reach a conclusion: the symptoms of agoraphobia are not always the same, and their triggers can have very different forms. The situations and sites that can cause anxiety or anxiety are neither stereotypical nor equal in all people diagnosed with this disorder, as would be expected if agoraphobia was expressed in a similar way to the fear expressed in popular culture. Vampires to the 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 also to be diagnosed with other disorders, such as panic disorder or posttraumatic stress disorder, since several of their symptoms may overlap. As we see, there is habitual confusion about the symptoms and signs of this psychological disorder.
Diagnosis and symptoms
Broadly speaking, some of the characteristics presented by people with agoraphobia are:
- Being exposed to open, crowded, or unfamiliar places produces a strong feeling of anguish.
- This feeling of anguish is intense enough for the person to adopt the strategy of living avoiding such places, even though this negatively impacts their quality of life.
- These outbreaks of anxiety and anguish cannot be explained by other disorders already diagnosed.
- The possibility of attracting the attention of strangers or of making a fool of yourself because of an anxiety crisis 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 these types of disorders, it is essential to take into account whether the person perceives what is happening to him as something that limits his quality of life and, therefore, is disabling. That is, the existence or not of agoraphobia depends not only on the symptoms, but also on the context in which they occur, both in the subjective (does the patient think it is problematic?) And in the objective (the symptoms appear when Is anxiety unjustified?)
That is why we must 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.
It is one thing to describe a disorder, and another is to talk about its causes. About 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 type of trauma or internal conflict that is expressed symbolically through from fear of open spaces.
However, these types of explanations are currently not very useful (and in the case of the second one, it cannot even be demonstrated by the epistemological foundations of that approach), 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 it is true that it is not known what exactly causes agoraphobia, a link between this type of disorder, and abnormally low serotonin levels in certain parts of the brain has been detected. These low levels of serotonin can be the cause of a genetic mutation, but they can also be due to a chemical decompensation caused by certain experiences or by the consumption of certain substances or be the product of all this at once.
Regardless of whether this finding ends up being successful or not to explain the mechanisms behind this disorder, what is clear is that there is not a single cause of agoraphobia, but several, as it happens in virtually any psychological, pathological phenomenon 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 goes for mental disorders.
Once it has been diagnosed, agoraphobia can be treated both from psychological intervention and through drugs. Next, we will see what these two types of agoraphobia treatment are, 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 and anxiolytics (clonazepam and diazepam) are usually used. However, these medications should only be taken under strict medical supervision and only by prescription, and in any case, they are not used to cure the disorder, but to cope with its symptoms.
It is also important to keep in mind that, as always happens with drugs, they can produce important side 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 maintaining high anxiety levels, but also impact the entire body in general, and this can cause 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 against any other psychological disorder, and it is the task of mental health professionals to determine if the danger is low enough to use a certain dose, and of Which way should it be used?
2. Psychological therapy
Regarding the psychotherapeutic approach, interventions based on Cognitive-Behavioral Therapy stand out. It is a type of therapy whose benefits have been proven scientifically.
The advantages of this option are that its benefits tend to last longer than the effects of drugs after the last dose, it is a brief intervention and has no side effects by not acting directly on the regulation of hormones and neurotransmitters.
Among its disadvantages compared to drug treatment is the relative slowness with which progress appears and the need for the person with agoraphobia to be able to collaborate and achieve the objectives proposed in the therapy. This is important because progress with these types of interventions means striving and facing unpleasant situations to 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, reinforce each other. In addition, it is also common to resort to relaxation techniques to train in the ability to manage anxiety.
In many cases, it will be recommended to use both the pharmacological and psychological intervention, to alleviate the immediate effects of this anxiety disorder and at the same time train the patient to be able to expose themselves more and more to the feared situations and manage the sensation of nervousness, However, this will only occur if it is considered strictly necessary, and the drugs should only be consumed under medical advice.
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