Agoraphobia: Causes, Symptoms, Treatment and Prevention

Agoraphobia is an anxiety disorder

It is characterized by intense fear associated with situations that may be difficult to get out of (for example, being on a bus or train), or where help may not be available in the event of a panic attack. Panic is defined as extreme and unreasonable fear and anxiety.

According to a guide used by mental health professionals to diagnose mental disorders, patients with agoraphobia tend to fear symptoms such as dizziness, diarrhea, fainting, or a feeling that the person is “going crazy”.

Anxiety associated with agoraphobia makes people avoid situations of being alone outside the home, in a crowd, on a bridge, traveling by car, or on public transport. Agoraphobia can worsen to the point that it makes it difficult for a person to find work outside the home or to carry out routine activities such as shopping for groceries or going to the movies.

The reasons


Currently, the causes of agoraphobia are complex and not fully understood. Research shows that there are several factors that can influence this condition.

Genetics

It has been known for several years that anxiety disorders tend to be inherited. Recent studies have confirmed previous hypotheses about the presence of a genetic component of agoraphobia. The researchers concluded that agoraphobia and Parkinson’s disease are common; both are hereditary anxiety disorders that share common genetic susceptibility loci at some, but not all, genetic loci.

Inner temperament

A number of researchers have pointed to congenital temperament as a broad factor of vulnerability in the development of anxiety and mood disorders. In other words, a person’s natural character can be a factor in the development of a number of mood or anxiety disorders. Some people seem to be more sensitive to events throughout their lives, but upbringing and life experience are also important factors in determining who will develop these disorders.

Children who develop so-called “behavioral inhibition” (a group of behaviors that occurs when a child is confronted with a new situation or with strangers) in early infancy are at increased risk of developing more than one anxiety disorder in adulthood, especially if the inhibition persists with time. These behaviors include movement, crying, and general irritability, followed by pulling away, seeking comfort from someone you know, and stopping what you are doing when you notice a new person or situation. Children from depressed or anxious parents are more prone to behavioral inhibition.

Physiological response to illness

Another factor in the development of Parkinson’s disease and agoraphobia is a history of respiratory disease. Some researchers have hypothesized that repeated episodes of respiratory illness may predispose a child to Parkinson’s disease by making it difficult to breathe and lowering the choking threshold. It is also possible that respiratory illness can trigger dangerous beliefs in a child that will cause him or her to exaggerate the significance of the respiratory symptoms.

Symptoms


Symptoms of an episode of agoraphobia can include any or all of the following:

  • shiver;

  • sweating;

  • cardiopalmus;

  • paresthesia (tingling or feeling of needles in the hands or feet);

  • nausea;

  • fatigue;

  • rapid heart rate or breathing rate;

  • a sense of impending doom.

In most cases, a person with agoraphobia will experience some relief from their symptoms after he or she has left a dangerous situation or returned home.

Diagnostics


The patient’s symptoms should not be associated with substance abuse, and if they are associated with a general illness, they should have the excessive symptoms usually associated with the condition. For example, a person with Crohn’s disease has a serious fear of an attack of diarrhea in a public place and should not be diagnosed with agoraphobia unless the fear of losing gut control is clearly exaggerated.

In contrast, the European diagnostic guidelines primarily distinguish between agoraphobia and delusional or obsessive-compulsive disorder and depressive episodes. In addition, ICD-10 specifies that patient anxiety should be limited or occur mainly in two of four specific situations: in a crowd, in public places, while traveling alone, or while traveling away from home. The main area of ​​agreement between American and European diagnostic guidelines is that avoidance of a hazardous situation is specified as a diagnostic criterion in both guidelines.

The diagnosis of agoraphobia is usually made by a physician after carefully ruling out other mental disorders and physical conditions or illnesses that may be related to the patient’s fears. Head injury, pneumonia, and not taking certain medications can cause some of the symptoms of panic attack. In addition, the doctor may ask about caffeine intake as a possible dietary factor. There are currently no laboratory tests or diagnostic imaging tests that can be used to diagnose agoraphobia.

In addition, there are no widely used diagnostic screening tools specifically for agoraphobia. Dutch researchers have developed a self-report questionnaire that promises to be useful for doctors treating people with agoraphobia. The test is called the agoraphobia questionnaire and is designed to assess the thought processes in patients with agoraphobia as opposed to their emotional responses.

Treatment


Treatment for agoraphobia usually consists of medication and cognitive behavioral therapy (CBT). A doctor may also recommend an alternative form of treatment for anxiety symptoms associated with agoraphobia. Some patients may be advised to cut back or stop their coffee or tea intake, as the caffeine in these drinks can contribute to their panic symptoms.

Medicines

Medications that have been used in patients diagnosed with agoraphobia include benzodiazosine pine tranquilizers, MAO inhibitors (MAOIs), tricyclic antidepressants (TCAs), and selective serotonin uptake inhibitors or SSRIs. In the past few years, SSRIs have come to be seen as the first choice because they have fewer side effects.

Prophylaxis


The genetic factors that are involved in the development of agoraphobia cannot be prevented. On the other hand, recent recognition of the link between parent anxiety and mood disorders and their children’s vulnerability to phobic disorders may help identify children at risk and develop appropriate prevention strategies for them.

Photo from psylib.org

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