Agoraphobia: what it is, causes, symptoms and treatment

In the nineties appeared one of the first films in which a case of agoraphobia . The psychologist who plays 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 however striking the scene may seem, it is still a resource to present one of the main characters . It does not help 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 it can push the quality of life of a person to the limit and understand that person's behavior. At the same time, it evidences the fact that the anxiety crises produced by this disorder can be very shocking and be present in many of the spheres of a human being's life.

But, despite the fact that agoraphobia is so shocking and its consequences can be so palpable, it can not be said that it is easy to understand what it consists of. Read what comes next can help when it comes to forming a somewhat more detailed picture of this type of phobia , and in passing to know its main symptoms, causes and ways to treat 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 suggests a relationship between phobia and the squares (agora, word from Greek), and it is easy to take for agoraphobia certain cases of people who simply do not like to leave the house or with problems related to social isolation.

But nevertheless, 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 something more abstract than the simple visualization of this type of environment.

The fact of perceiving open spaces or very crowded plays a role when triggering panic attacks in people with agoraphobia, but fear is not produced by these spaces in itself, but for the consequences of being exposed to that place . This nuance is key and is often overlooked.

So ... 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 noting that you are not in a safe context in which it is possible to receive help in a crisis . That is to say, that their symptoms are based on a strong anguish produced by situations in which the person who suffers feels unprotected and vulnerable to anxiety crises that are beyond their control. The root of the problem is something like a fear of fear.

The anguished fear that someone experiences with this anxiety disorder 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 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: 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 consequence of being in that place when that happens.

Definitely, Agoraphobia consists of fear of loss of control on the physiological activation itself and on the results to which this can lead, in addition to the fear of the subjective sensations 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 home itself. Agoraphobia is usually expressed in any place that is perceived as especially insecure, that is, in which we have less control over things.

The myth of agoraphobia as a watertight 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 . Situations and sites that can produce 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 how popular culture expresses the fear of vampires to crucifixes.In fact, sometimes it happens that anxiety attacks occur even when the person is in a "safe" place, due to internal causes not related to how the environment is perceived.

Because of this variability, it is common for people with agoraphobia to be diagnosed also with other disorders, such as panic disorder or post-traumatic stress disorder, since several of their symptoms may overlap. As we can see, there are habitual confusions about the symptoms and signs of this psychological disorder.

Diagnosis and symptoms

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

• Be exposed to open places , very crowded or unfamiliar produces a strong feeling of anguish.
• This feeling of anguish It is intense enough for the person to adopt the strategy of living avoiding these types of places, although this negatively affects their quality of life.
• These outbreaks of anxiety and anguish can not be explained for other disorders already diagnosed.
• The possibility of attract the attention of strangers or make a fool of yourself 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 case by case when there is a case of agoraphobia and when not .

When diagnosing this type of disorder, it is essential to take into account if the person perceives what is happening as something that limits their quality of life and that, therefore, is incapacitating. That is why we must take into account 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 your Causes . On 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 kind of internal trauma or conflict that is expressed symbolically through of fear of open spaces.

However, nowadays this type of explanations are not very useful (and in the case of the second, it can not even be demonstrated by the epistemological foundations of that approach), among other things because they ignore the possible organic causes. That is, those that have to do with the biological functions that determine our thoughts and our moods.

While 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 the consumption of certain substances, or be the product of all this at the same time.

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 no single cause of agoraphobia, but several, as it happens in practically any psychological phenomenon, pathological or not.

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

Treatment

Once diagnosed, agoraphobia can be treated both from psychological intervention and through drugs . We will now talk about these two types of treatment for agoraphobia, but it is important to emphasize that only a mental health professional is authorized to carry out effective therapy.

1. Drug treatment

In pharmacological treatment, both antidepressants (SSRI) as anxiolytics (clonazepam and diazepam). 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 their symptoms.

It is also important to bear in mind that, as always happens with drugs, they can produce important side effects and adverse effects, such as the appearance of serotonin syndrome.

2. Psychological therapy

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

The advantages of this option is that its benefits tend to last longer in time than the effects of the drugs after the last doses, it is a brief intervention and has no side effects by not acting directly on the regulation of hormones and neurotransmitters.

Among its drawbacks compared to pharmacological treatment are the relative slowness with which progress appears and the need for the person with agoraphobia to be willing to collaborate and achieve the objectives proposed in therapy. This is important, because progress with this type of interventions supposes to strive and face unpleasant situations to generate more resistance to what is feared, with professional supervision and in a controlled environment.

From the Cognitive-Condutual perspective, we will work on the beliefs that the person has about their disorder as well as 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 at the same time 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 himself more and more to the feared situations and to manage the sensation of nervousness.

Bibliographic references:

• Badós, A. (2006). Treating panic and agoraphobia. Madrid: Pyramid.
• Hersen, M. and Last, C. (1985/1993). Behavioral therapy case manual. Bilbao: Desclée de Brouwer.
• Luciano, M.C. (nineteen ninety six). Manual of clinical psychology. Childhood and adolescence Valencia: Promolibro.

SYMPTOMS OF AGORAPHOBIA (March 2024).