NON TECHNICAL TOPIC

AGORAPHOBIA

Contents • • • 1 Introduction 2 Causes and contributing factors 3 Alternate theories o o 3.2 Psychopharmaceutical treatments 6.1 Cognitive behavioral treatments 6.2 Spatial theory • • • 4 Diagnosis 5 Association with panic attacks 6 Treatments o o o 6.3 Alternative treatments .1 Attachment theory 3.

Agoraphobia may arise by the fear of having a panic attack in a setting from which there is no perceived easy means of escape. However. Alternatively. suffer from agoraphobia. has two age groups at which the first onset generally occurs.Introduction: Agoraphobia (from Greek ἀγορά. Agoraphobia as studies have shown. . the sufferer is fearful of a particular place because they have experienced a panic attack at the same location in a previous time. anxiety may interrupt the formation of memories and disrupt the learning processes.2 million adults in the US between the ages of 18 and 54. Approximately 3. In response to a traumatic event. Although mostly thought to be a fear of public places. there is evidence that the implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV may be incorrect. however. social anxiety problems may also be an underlying cause. 2005). early to mid twenties and in the early thirties thus helping to distinguish between simple phobias in child and adolescent years (Gelder. -phobia) is an anxiety disorder. sufferers of agoraphobia avoid public and/or unfamiliar places. or about 2. sometimes terrifying. and φόβος/φοβία. it is now believed that agoraphobia develops as a complication of panic attacks. As a result. resulting in dissociation. the sufferer may become confined to his or her home. In severe cases. experiencing difficulty traveling from this safe place. Agoraphobia is also a defined as "a fear. Fearing the onset of another panic attack.[4] Agoraphobia can account for approximately 60% of phobias. Mayou & Geddes.2%. Some refuse to leave their home even in medical emergencies because the fear of being outside of their comfort area is too great. especially large. two thirds of the population who have agoraphobia are women. by those who have experienced one or more panic attacks". Onset is usually between ages 20 and 40 years and more common in women. open spaces such as shopping malls or airports where there are few places to hide. In these cases. "marketplace". Some agoraphobics have a fear of open spaces. the sufferer is fearful or even avoids the location. Depersonalization (a feeling of disconnection from one’s self) and derealisation (a feeling of disconnection from one's surroundings) are other dissociative methods of withdrawing from anxiety Not all agoraphobia is social in nature.

as described in this manner. which they consciously or unconsciously associate with being the ultimate separation from their mortal emotional comfort and safety zones and loved ones.The sufferer can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. and that traditional female sex roles encourage women to react to anxiety by engaging in dependent and helpless behaviors. The condition has been linked to the presence of other anxiety disorders. or when the agoraphobic is left home alone. Other syndromes like obsessive compulsive disorder or post traumatic stress disorder can also cause agoraphobia. The gender difference may be attributable to social-cultural factors that encourage. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed. such as a parent or spouse. the greater expression of avoidant coping strategies by women. that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic. The anxiety level of agoraphobics often increases when dwelling upon the idea of eventually dying. Agoraphobia. although some clinicians that have treated or attempted to treat agoraphobia offer valid theories. Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to . is actually a symptom professionals check for when making a diagnosis of panic disorder. the fear of death. It is not uncommon for agoraphobics to also suffer from temporary separation anxiety disorder when certain other individuals of the household depart from the residence temporarily. basically any irrational fear that keeps one from going outside can cause the syndrome. Such temporary conditions can result in an increase in anxiety or a panic attack. or permit. Another common associative disorder of agoraphobia is necrophobia. a stressful environment or substance abuse. Gender differences Agoraphobia occurs about twice as commonly among women as it does in men. Causes and contributing factors The exact causes of agoraphobia are currently unknown. even for those who may otherwise spiritually believe in some form of divine afterlife existence. Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia.

have increasingly become interested in what may be thought of as a spatial phenomenon. When benzodiazepine dependence has been treated and after a period of abstinence. Spatial theory In the social sciences there is a perceived clinical bias in agoraphobia research. agoraphobia symptoms gradually abate. Alternate theories Attachment theory Some scholars have explained agoraphobia as an attachment deficit. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Diagnosis Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association. Compared to controls.. their visual system and their proprioceptive sense. especially geography. Branches of the social sciences. Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system. In rare cases where agoraphobics do not meet the criteria used to diagnose panic . One such approach links the development of agoraphobia with modernity. Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur. Likewise. in virtual reality studies. Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. the temporary loss of the ability to tolerate spatial separations from a secure base. they may be confused by sloping or irregular surfaces. agoraphobics on average show impaired processing of changing audiovisual data. Recent empirical research has also linked attachment and spatial theories of agoraphobia. 1998).e. i.causing agoraphobia.

Cognitive restructuring has also proved useful in treating agoraphobia. sweating. the formal diagnosis of agoraphobia without history of panic disorder is used (primary agoraphobia). Symptoms of a panic attack include palpitations. During a panic attack.disorder. . trembling. Mayou and Geddes 2005). Similarly. and rarely lasts longer than 30 minutes. Many patients can deal with exposure easier if they are in the company of a friend they can rely on (Gelder. nausea. triggering the body's natural fight-or-flight response. vomiting. Treatments Cognitive behavioral treatments Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. as they can be used to stop or prevent symptoms of anxiety and panic. Relaxation techniques are often useful skills for the agoraphobic to develop. dizziness. This treatment involves coaching a participant through a dianoetic discussion. Association with panic attacks Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control. help would be difficult to obtain. A panic attack typically has an abrupt onset. tightness in the throat and shortness of breath. building to maximum intensity within 10 to 15 minutes. Disappearance of residual and subclinical agoraphobic avoidance. or they could be embarrassed. with the intent of substituting irrational. It is vital that patients remain in the situation until anxiety has abated because if they leave the situation the phobic response will not decrease and it may even rise (Gelder. a rapid heartbeat. should be the aim of exposure therapy. epinephrine is released in large amounts. Systematic desensitization may also be used. Many patients report a fear of dying or of losing control of emotions and/or behavior. Mayou and Geddes 2005). counterproductive beliefs with more factual and beneficial ones. and not simply of panic attacks.

with poor results. Since caffeine. So can service to others which can distract from the self-absorption that tends to go with anxiety problems. Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference call support groups or online support groups being of particular help for completely housebound individuals). and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders. EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.Psychopharmaceutical treatments Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class and include sertraline. As such. Sharing problems and achievements with others as well as sharing various self-help tools are common activities in these groups. they should be avoided. Alternative treatments Eye movement desensitization and reprogramming (EMDR) has been studied as a possible treatment for agoraphobia. . Mayou and Geddes 2005). Some evidence shows that a combination of medication and cognitive behaviour therapy is the most effective treatment for agoraphobia (Gelder. In particular stress management techniques and various kinds of meditation practices as well as visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Mayou and Geddes 2005). Mayou and Geddes 2005). Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy (Gelder. paroxetine and fluoxetine. certain illicit drugs. Benzodiazepine tranquilizers. Antidespressants are important because some have antipanic effects (Gelder. MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia. There is also preliminary evidence that aerobic exercise may have a calming effect.

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