Anxiety Disorders

Agoraphobia

Agoraphobia is an anxiety disorder and a subset of panic disorder. With agoraphobia the individual feels unsafe in environments and social situations where they feel they have no control. Examples could include going to the mall, where who one will meet and what sorts of social situations will materialize are unknown. In some instances, the fear can become so bad that the individual may begin to have a panic attack. In the worst case scenario, this can keep the individual from leaving their homes.

Signs

Women are twice as likely to suffer from agoraphobia than men. It has not yet been discovered why this is the case however, there are some theories. The most popular surrounds gender roles. Historically, women have been placed, by society, into helpless and dependent roles. Roles that largely avoid using coping strategies. This, in turn, results in fear and panic. Again, this is only a theory.

Physical signs of agoraphobia include: dizziness, lightheadedness, flushing (the face turns red and heated), nausea, chest pain, trouble swallowing, feeling a loss of control, trouble breathing, upset stomach and diarrhea. Most of the individuals will suffer these symptoms while they are in the environment, or social situation that causes them stress. However, some individuals will exhibit these signs prior to, merely in anticipation of these would-be events and/or situations.

Causes

The cause of agoraphobia is still unknown. It is hypothesized that one cause could be substance abuse. The use of sleeping pills, like benzodiazepines, and tranquilizers have shown links to the onset of agoraphobia. Some other believed causes are anxiety disorders and stressful environments. Agoraphobia seems to co-occur with other anxiety disorders. That is why this link is made.

There have been some connections made to trouble with spatial orientation. It is part of a theory called attachment theory. This has to do with the actual physical functioning of the brain. Individuals become physically disoriented and can even lose their balance due to the part of the brain which controls spatial orientation not working properly.

An evolutionary psychologist would tell you that agoraphobia comes from our evolution as a species. We developed an instinct to avoid open, unconcealed spaces to avoid being nabbed by predators or killed by perceived enemies. It persists even though the likelihood of being attacked by a saber tooth tiger while in line at the frozen yoghurt place in the food court is unlikely.

Management

In order to manage one’s agoraphobia, therapy and medications are advised. It is believed that using both therapy and medication actually increases your chance of getting better.

Therapy such as cognitive behavioral treatments have been seen to have good results. Cognitive restructuring is one type of cognitive behavioral treatment that works well. The therapist replaces counterproductive, irrational beliefs with beneficial, rational ones. Systematic desensitization is another way of helping that falls under cognitive behavioral treatments. This involves having a close friend of the patient with them during their anxiety or panic attacks. This comforts them and lessens the severity of the attack.

Selective serotonin reuptake inhibitors (ex. paroxetine, sertraline, and fluoxetine), MAO inhibitors, tricyclic antidepressants and benzodiazepine tranquilizers are the most useful in the fight against agoraphobia. You may wonder why antidepressants work. It is because many of them have antipanic effects.

Prognosis

The prognosis for agoraphobia is not great. If left untreated, impairment can become worse and worse, resulting in the individual being held captive in their own homes by the illness. Individuals can get better if treated with therapy and medications. 90% of individuals suffering from agoraphobia will see improvement with a combination of the two.