Content

Introduction

Introduction

Agoraphobia is the fear of finding oneself in situations from which it is not possible to escape or receive help in case of danger. It is a complex condition that does not only concern, as is commonly believed, the fear of open spaces.

A person suffering from agoraphobia may be afraid to travel on public transport, to visit a shopping center, to leave the house for fear of being faced with particularly stressful situations that could trigger the disorders (symptoms) typical of a panic attack: rapid heartbeat, rapid breathing (hyperventilation), feeling hot accompanied by sweating, feeling unwell.

Usually, therefore, he tends to avoid all those situations that could trigger anxiety; he prefers to leave the house only in the company of a friend or loved one; he orders his groceries online instead of going to a supermarket in person. behavior, aimed at avoiding the danger of getting sick, is defined as risk avoidance (avoidance).

Typically, agoraphobia develops as a complication of panic disorder, an anxiety disorder that includes moments of intense fear. Since returning to places, or reliving situations, where panic attacks have occurred in the past can trigger anxiety again, people with agoraphobia usually tend to avoid them.

In some cases, however, panic attacks do not occur and the malaise felt is linked to the fear of general situations such as crime, terrorism, disease, accidents.

Traumatic events, such as bereavement, can also contribute to the development of agoraphobia, as can some genes inherited from parents.

If you have any doubts about suffering from agoraphobia, it is advisable to talk to your doctor and describe your ailments (symptoms), the frequency with which they appear, the situations in which they occurred. The doctor may ask some questions to understand what is the source of stress that causes them and if the strategies are employed avoidance described above to avoid the appearance of disorders (symptoms).

While it can sometimes be difficult to talk about your feelings, emotions, and personal life, don't feel anxious or embarrassed about answering questions. The doctor needs to have as much information as possible about the symptoms (symptoms) to ascertain (diagnose) that they are really caused by agoraphobia and to recommend the most suitable treatment.

Most people find significant improvements by undergoing psychological treatment. Usually, a step-by-step approach is recommended for the treatment of agoraphobia and any resulting panic disorder:

  • phase one, acquire knowledge about the disease, about possible lifestyle changes to be implemented and about self-help techniques useful to relieve ailments (symptoms). Changes may include regular "physical activity; choosing" healthier, alcohol-free and caffeinated beverages such as tea, coffee and cola; the absence of drugs. The techniques of self-help, useful in the course of a panic attack, involve staying in the place you are focusing on something visible, and not perceived as threatening, and breathing slowly and deeply
  • phase two, subscribe, where available, to a guided self-help program institutionally accredited. This means using manuals that describe the different types of problems that might occur and provide practical advice on the best way to deal with them
  • phase three, undertake more intensive care such as cognitive-behavioral therapy (CBT) or taking medications

About a third of people with agoraphobia achieve complete recovery. In about half, the complaints (symptoms) improve although in case of severe stress they can intensify again. Despite treatment, however, about one fifth continue to have ailments (symptoms).

Agoraphobia is twice as common in women than in men. It usually occurs between 18 and 35 years of age.

Symptoms

Symptoms

The severity of agoraphobia can vary greatly from individual to individual.

People with severe agoraphobia may be unable to leave the house, while others with mild forms are able to travel short distances without problems.

Disorders (symptoms) of agoraphobia can be classified into three types:

  • physicist
  • cognitive
  • behavioral

Physical ailments

Because people generally carefully avoid circumstances that can cause anxiety, they rarely experience physical ailments. However, when they do occur they resemble those typical of a panic attack and may include:

  • rapid heartbeat (tachycardia)
  • rapid breathing (hyperventilation)
  • feeling hot and sweaty
  • malaise
  • chest pain
  • difficulty swallowing (dysphagia)
  • diarrhea
  • tremor
  • dizziness
  • ringing in the ears (tinnitus)
  • feeling faint

Intellectual disorders

Cognitive disturbances consist of feelings or thoughts which, at times, can accompany physical disturbances. They include the fear of:

  • having a panic attack in front of other people and feeling embarrassed or looking foolish
  • be in danger of life, having a heart attack, cardiac arrest or not being able to breathe due to a panic attack
  • being unable to escape from a place, or from a situation, during a panic attack
  • lose mental health
  • losing control in public
  • having tremors and redness in public
  • attract the attention of others

Psychological disorders not related to panic attacks may also occur, such as, for example:

  • the feeling of not being able to act or survive without the help of others
  • the fear of being left alone in the house (monophobia)
  • a general feeling of anxiety or fear

Behavioral disturbances

Behavioral disorders include:

  • avoid situations that could lead to panic attacks like crowded places, public transport and queues
  • not being able to leave the house for long periods of time
  • leave the house only accompanied from a trusted person
  • not being able to stay away from home

Some people are able to force themselves to deal with uncomfortable situations, but still experience considerable fear and anxiety in doing so.

Causes

Causes

Agoraphobia, in most cases, develops as a complication of panic disorder.Since it often appears when the person is in situations or environments similar to those that have triggered an attack in the past, the fear that it may occur again leads to avoiding any risky circumstances.

Panic Disorders

The exact cause of panic disorder, as with many mental health diseases, is not fully identified. However, most experts believe that a combination of biological and psychological factors may be involved.

There are several theories about the type of biological factors linked to panic disorders.

The "one, argues that panic disorder is closely associated with the reaction"fight or flee", A defensive reaction"automatic"Implemented by the body in case of stress or danger. The body, in fact, in situations of anxiety or fear naturally releases hormones, including adrenaline, noradrenaline and cortisol, which increase the frequency of breathing and heartbeats and prepare the body for fight or flight.

In people with panic disorders the reaction "fight or flee"Can be activated in the wrong way, without an objective reason, and cause a consequent attack.

Another theory hypothesizes that an imbalance in the levels of substances that carry information between cells of the central nervous system (neurotransmitters in the brain) influence mood and behavior. This, in certain situations, would cause an excessive stress reaction, triggering the feeling of panic.

The theory of "network of fear"Instead, he argues that the brains of people with panic disorders may have different connections than most people. The cause of the attacks would be a malfunction of the parts of the brain responsible for the sensation of fear and the corresponding physical effects.

Furthermore, links have been found between panic disorders and the so-called knowledge of space, namely the ability to judge where you are in relation to other objects and people. In fact, some individuals with panic disorders, having a weakened system of balance and cognition of space, experience a feeling of overwhelm and disorientation in crowded places that triggers a panic attack.

Psychological factors that increase the risk of agoraphobia include:

  • traumatic experiencesin childhood, such as the death of a parent or sexual abuse
  • stressful events such as bereavement, divorce or job loss
  • mental illness such as depression, anorexia nervosa, bulimia
  • alcohol abuse or drug abuse
  • unhappy relationships or relationships in which one is strictly controlled by the partner

Agoraphobia without panic disorder

Occasionally, a person may develop agoraphobia even if they have never had a panic disorder or attack.

This type of agoraphobia can be triggered by a number of irrational fears (phobias):

  • fear of being the victim of a violent crime or a terrorist attack if you leave home
  • fear of being affected by a serious infectious disease attending crowded places
  • fear of inadvertently taking actions that could be a source of embarrassment or humiliation in front of others
Diagnosis

Diagnosis

If you suspect that you suffer from agoraphobia, it is advisable to consult your doctor, describe the disorders (symptoms), their frequency and the situations in which they occur. Your doctor will also want to know which disorders (symptoms) affect your daily life the most. He could ask, for example, if leaving the house is a source of stress, if there are places or situations that you tend to avoid, if strategies have been used to avoid the onset of disorders (symptoms), for example asking others to do you shop for yourself.

While talking to strangers about personal problems can be difficult, don't feel anxious or embarrassed. The doctor, in fact, needs to know the disorders (symptoms) well to ascertain (diagnose) the causes and prescribe the most suitable treatments. To this end, after having carried out the medical examination, he may prescribe blood tests to make sure that the cause of the reported discomfort is not other diseases. An overactive thyroid gland (hyperthyroidism), for example, can cause symptoms similar to those of a panic attack. By ruling out other diseases, the doctor will be able to identify the cause of the ailments (diagnosis).

Confirmation of agoraphobia requires that:

  • a state of anxiety occurs when you are in places or situations, such as a bus or a crowded place, from which it is difficult to escape or get help if a panic attack occurs
  • avoid the situations described above or they are endured only with extreme anxiety or with the help of another person
  • no other diseases were detected that can explain the disorders (symptoms)

If in doubt about the diagnosis, it may be appropriate to consult a psychiatrist for a more detailed evaluation.

Therapy

Therapy

For the treatment (therapy) of agoraphobia and related panic disorders, usually proceed gradually by following some steps:

  • phase one, learn about the disease, about the changes you can make to your lifestyle and about the self-help techniques you can use to relieve ailments (symptoms)
  • phase two, enroll in an institutionally accredited guided self-help program
  • phase three, undertake more intensive care, such as cognitive-behavioral therapy (CBT), or evaluate the possibility of relieving disorders (symptoms) with drug treatment

For agoraphobia there are various treatments (therapies) that could be proposed by the doctor based on the severity of the disorders (symptoms).

Lifestyle changes and self-help techniques

Learning more about agoraphobia and its association with panic attacks can help you better control the disorders (symptoms). There are several techniques that you can use to get your emotions under control during a panic attack. Have more confidence. in one's ability to be able to control emotions can make one more confident in dealing with situations and environments that previously caused problems.

Some self-help techniques:

  • stay still, resist the temptation to run to a safe place during a panic attack; if you are driving, pull over and park in a "risk-free" area
  • to focus, focusing attention on visible and non-threatening things such as, for example, the hands of the clock or the products displayed in a supermarket; remember that scary thoughts and feelings are a sign of panic and that they will eventually pass
  • breathe slowly and deeplythe feeling of panic and anxiety may be made worse by breathing too quickly; try to focus on your breath counting slowly to three between one and the other
  • face fear, try to understand what causes it and overcome it; You can do this by continually reminding yourself that what you fear is not real and will soon pass
  • creative imagination, during a panic attack, try to resist the temptation to focus on negative thoughts such as the word "disaster"; instead, think of a place or a situation that makes you feel calm, relaxed and focus on that image
  • do not counter the panic attack, trying to fight the ailments (symptoms) can make things worse; instead try to reassure yourself by thinking that, although embarrassing and difficult to deal with, the panic attack is not a life threatening and will soon pass

Making lifestyle changes can also help:

  • exercise regularly it helps relieve stress and tension and improve mood
  • follow a healthy diet it is important because poor nutrition can make panic and anxiety disorders worse
  • avoid the use of drugs and alcohol because these substances can provide short-term relief but can make complaints worse in the long run
  • avoid caffeinated drinks, such as tea, coffee or cola. In fact, caffeine has a stimulating effect and can worsen ailments (symptoms)

Guided self-help

If the complaints (symptoms) do not improve following the self-help techniques and by changing your lifestyle, your family doctor might advise you to follow a guided self-help program. This approach is based on the use of manuals that deal with different types of problems and provide practical advice on how to deal with them.

THE guided self-help programs for agoraphobia they rely on therapy cognitive-behavioral (CBT), a technique that aims to change wrong thinking patterns by bringing about positive changes in behavior. Such therapy uses a type of treatment called exhibition therapy which consists in "gradually addressing the situation that generates fear using relaxation techniques and breathing exercises to reduce anxiety. Most self-help programs consist of a series of objectives to work on for about five or six weeks.

Intensive therapies

If the self-help program doesn't work, more intensive therapies can be used:

  • cognitive-behavioral therapy (CBT) with a therapist
  • relaxation techniques
  • medications

CBT is based on the idea that useless or distorted thoughts lead to negative behavior. It aims to induce new ways of thinking that can help you behave in a positive way. For example, many people with agoraphobia think wrongly that a panic attack can cause them to die. The therapist will try to foster a more positive approach by explaining that, while unpleasant, the panic attack is not fatal and will pass. This change in thinking will lead people to develop a greater willingness to deal with situations that previously caused fear. CBT is usually associated with exhibition therapy. At the beginning of the treatment, the therapist will set relatively modest goals such as, for example, persuading the sick person to go to the neighborhood store. As they become more confident, more demanding goals will be set, such as, for example, going to a large supermarket or busy restaurant.

Relaxation techniques are based on the premise that people with agoraphobia, and resulting panic disorder, have lost the ability to relax and are intended to teach them how to do so. The exercises are aimed at identifying the signs and sensations of tension, relaxing the muscles, teaching the use of relaxation techniques in situations of stress or normality to prevent tension and panic from occurring. As with CBT, a cycle of treatment consists of 12 to 15 weekly sessions lasting approximately one "hour.

In some cases, drugs can be used as the only cure for agoraphobia. In more severe situations they are used in combination with CBT or relaxation techniques.

Drug therapy usually consists of "the use of so-called selective serotonin reuptake inhibitors (SSRIs). These drugs were originally developed to treat tuberculosis and, later, depression but have subsequently proved to be effective in treating tuberculosis as well. other mood disorders such as anxiety, panic and obsessive thoughts.

Bibliography

Bibliography

Andrews G et al. Panic disorder and agoraphobia: manual for those suffering from the disorder, edited by Morosini P, Leveni D, Piacentini D. Scientific Center Publisher: Turin, 2004

Panic disorder and agoraphobia in general medicine: identification and indications for cognitive-behavioral psychotherapeutic treatment, edited by Calzeroni A, Contini A. Tognolli Grafiche: Motta Visconti, Milan, 2002

Disorders from panic attacks and agoraphobia, edited by Cassano GB. [S.l.]: Upjohn

Panic disorder and agoraphobia: questions and answers, edited by Cei V. Momento Medico: Fuorni, Salerno, 1999

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