NON TECHNICAL TOPIC

AGORAPHOBIA
 Contents

• 1 Introduction
• 2 Causes and contributing factors
• 3 Alternate theories
o 3.1 Attachment theory
o 3.2 Spatial theory
• 4 Diagnosis
• 5 Association with panic attacks
• 6 Treatments
o 6.1 Cognitive behavioral treatments
o 6.2 Psychopharmaceutical treatments
o 6.3 Alternative treatments
Introduction:

Agoraphobia (from Greek ἀγορά, "marketplace"; and φόβος/φοβία, -phobia) is an

anxiety disorder. Agoraphobia may arise by the fear of having a panic attack in a setting from
which there is no perceived easy means of escape. Alternatively, social anxiety problems may
also be an underlying cause. As a result, sufferers of agoraphobia avoid public and/or
unfamiliar places, especially large, open spaces such as shopping malls or airports where
there are few places to hide. In severe cases, the sufferer may become confined to his or her
home, experiencing difficulty traveling from this safe place. Although mostly thought to be a
fear of public places, it is now believed that agoraphobia develops as a complication of panic
attacks. However, there is evidence that the implied one-way causal relationship between
spontaneous panic attacks and agoraphobia in DSM-IV may be incorrect. Onset is usually
between ages 20 and 40 years and more common in women. Approximately 3.2 million
adults in the US between the ages of 18 and 54, or about 2.2%, suffer from agoraphobia.[4]
Agoraphobia can account for approximately 60% of phobias; two thirds of the population
who have agoraphobia are women. Agoraphobia as studies have shown, has two age groups
at which the first onset generally occurs; early to mid twenties and in the early thirties thus
helping to distinguish between simple phobias in child and adolescent years (Gelder, Mayou
& Geddes, 2005).

In response to a traumatic event, anxiety may interrupt the formation of memories and
disrupt the learning processes, resulting in dissociation. 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, however. Some agoraphobics have a fear of
open spaces. Agoraphobia is also a defined as "a fear, sometimes terrifying, by those who
have experienced one or more panic attacks". In these cases, the sufferer is fearful of a
particular place because they have experienced a panic attack at the same location in a
previous time. Fearing the onset of another panic attack, the sufferer is fearful or even avoids
the location. Some refuse to leave their home even in medical emergencies because the fear
of being outside of their comfort area is too great.
 The sufferer can sometimes go to great lengths to avoid the locations where they have
experienced the onset of a panic attack. Agoraphobia, as described in this manner, is actually
a symptom professionals check for when making a diagnosis of panic disorder. Other
syndromes like obsessive compulsive disorder or post traumatic stress disorder can also cause
agoraphobia, basically any irrational fear that keeps one from going outside can cause the
syndrome.

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, such as a parent or spouse, or when the agoraphobic is left home alone. Such
temporary conditions can result in an increase in anxiety or a panic attack.

Another common associative disorder of agoraphobia is necrophobia, the fear of

death. The anxiety level of agoraphobics often increases when dwelling upon the idea of
eventually dying, which they consciously or unconsciously associate with being the ultimate
separation from their mortal emotional comfort and safety zones and loved ones, even for
those who may otherwise spiritually believe in some form of divine afterlife existence.

Gender differences

Agoraphobia occurs about twice as commonly among women as it does in men. The
gender difference may be attributable to social-cultural factors that encourage, or permit, the
greater expression of avoidant coping strategies by women. Other theories include the ideas
that women are more likely to seek help and therefore be diagnosed, that men are more likely
to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional
female sex roles encourage women to react to anxiety by engaging in dependent and helpless
behaviors. Research results have not yet produced a single clear explanation as to the gender
difference in agoraphobia.

Causes and contributing factors

The exact causes of agoraphobia are currently unknown, although some clinicians that
have treated or attempted to treat agoraphobia offer valid theories. The condition has been
linked to the presence of other anxiety disorders, a stressful environment or substance abuse.
Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to
causing agoraphobia. When benzodiazepine dependence has been treated and after a period
of abstinence, agoraphobia symptoms gradually abate.

Research has uncovered a linkage between agoraphobia and difficulties with spatial
orientation. Individuals without agoraphobia are able to maintain balance by combining
information from their vestibular system, their visual system and their proprioceptive sense.
A disproportionate number of agoraphobics have weak vestibular function and consequently
rely more on visual or tactile signals. They may become disoriented when visual cues are
sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be
confused by sloping or irregular surfaces. Compared to controls, in virtual reality studies,
agoraphobics on average show impaired processing of changing audiovisual data.

Alternate theories

Attachment theory

Some scholars have explained agoraphobia as an attachment deficit, i.e., the

temporary loss of the ability to tolerate spatial separations from a secure base. Recent
empirical research has also linked attachment and spatial theories of agoraphobia.

Spatial theory

In the social sciences there is a perceived clinical bias in agoraphobia research.

Branches of the social sciences, especially geography, have increasingly become interested in
what may be thought of as a spatial phenomenon. One such approach links the development
of agoraphobia with modernity.

Diagnosis

Most people who present to mental health specialists develop agoraphobia after the onset of
panic disorder (American Psychiatric Association, 1998). 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. In rare cases where agoraphobics do not meet the criteria used to diagnose panic
disorder, the formal diagnosis of agoraphobia without history of panic disorder is used
(primary agoraphobia).

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, or they could be
embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the
body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building
to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.
Symptoms of a panic attack include palpitations, a rapid heartbeat, sweating, trembling,
nausea, vomiting, dizziness, tightness in the throat and shortness of breath. Many patients
report a fear of dying or of losing control of emotions and/or behavior.

Treatments

Cognitive behavioral treatments

Exposure treatment can provide lasting relief to the majority of patients with panic
disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance,
and not simply of panic attacks, should be the aim of exposure therapy. Similarly, Systematic
desensitization may also be used. Many patients can deal with exposure easier if they are in
the company of a friend they can rely on (Gelder, Mayou and Geddes 2005). 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, Mayou and Geddes 2005).

Cognitive restructuring has also proved useful in treating agoraphobia. This treatment
involves coaching a participant through a dianoetic discussion, with the intent of substituting
irrational, counterproductive beliefs with more factual and beneficial ones.

Relaxation techniques are often useful skills for the agoraphobic to develop, as they
can be used to stop or prevent symptoms of anxiety and panic.
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,
paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic
antidepressants are also commonly prescribed for treatment of agoraphobia. Antidespressants
are important because some have antipanic effects (Gelder, Mayou and Geddes 2005).
Antidepressants should be used in conjunction with exposure as a form of self-help or with
cognitive behaviour therapy (Gelder, Mayou and Geddes 2005). Some evidence shows that a
combination of medication and cognitive behaviour therapy is the most effective treatment
for agoraphobia (Gelder, Mayou and Geddes 2005).

Alternative treatments

Eye movement desensitization and reprogramming (EMDR) has been studied as a

possible treatment for agoraphobia, with poor results. As such, EMDR is only recommended
in cases where cognitive-behavioral approaches have proven ineffective or in cases where
agoraphobia has developed following trauma. 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). Sharing
problems and achievements with others as well as sharing various self-help tools are common
activities in these groups. 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. So can service to others
which can distract from the self-absorption that tends to go with anxiety problems. There is
also preliminary evidence that aerobic exercise may have a calming effect. Since caffeine,
certain illicit drugs, and even some over-the-counter cold medications can aggravate the
symptoms of anxiety disorders, they should be avoided.