Agoraphobia: how does it manifest itself?

Agoraphobia is the disorder that indicates the fear of open spaces and crowded places: those affected feel in danger in the crowd and feel the desire to escape.

From the Greek etymology “agora” (square) and “phobia” (fear), the term agoraphobia literally means “fear of the square”, but it is a much more complex and profound phenomenon.

One of the most recurring thoughts that the person feels is the fear of not receiving help and not finding an escape route, so when he enters a closed place he always looks for an emergency exit to reach a safer place.

Those suffering from agoraphobia avoid getting on public transport (plane, train or tram) for fear of losing control and do not attend meeting places such as cinemas, theaters, supermarkets, restaurants and shopping centers, where the feeling of claustrophobia could trigger panic attacks.

The feeling you feel during a panic attack can be explained by resorting to the world of Greek mythology and the story of the god Pan (hence “panic”), a deity much feared because it is linked to primordial pleasures and instincts. Every time it manifested itself suddenly in front of the Nymphs, they felt terror, up to trigger the so-called psychic short circuit, a phenomenon in which the more you are frightened and the more you feel bad, and the more you feel bad the more you are frightened, characteristic behavior of attacks.

These episodes report somatic symptoms that are very unpleasant and difficult to control:

  • tachycardia
  • Palpitations
  • chest pain
  • Tremors
  • dizziness
  • perspiration
  • choking sensation and lump in the throat
  • nausea
  • difficulty breathing
  • derealization (feeling that the world around you becomes foreign and unreal)
  • depersonalization (feeling detached from oneself)
  • fear of fainting or dying.

“After experiencing the panic attack – explains Laura Brutti, psychologist and psychoanalyst of the Spazio Salute San Decenzio in Pesaro – anticipatory anxiety is established: fearing that such a strong event may happen again, terror and fear of going out arises, and avoidance follows, or the subject begins to escape from all the places where he can feel at risk and elects in this scheme a reference person to call every time he feels bad.” This means always having medication with you and never going out alone for fear of feeling lost in the middle of a queue or in a very large space.

Diagnosis and epidemiology of agoraphobia

Panic attacks are common to different pathologies: through psychotherapy sessions a differential diagnosis can be made between agoraphobia and other disorders that have traits in common.

The specialist analyzes with the patient the true origin of his phobia, evaluating the following diseases with similar symptomatology:

Pathology Features
Social phobia The subject fears situations in public embarrassing or social episodes in which he could be judged negatively
Specific phobias The person feels an irrational fear of an object or a detailed situation. They can be animals, blood, dolls and clowns, but also actions such as flying or driving, to whose only thought Panic can be triggered
Obsessive-compulsive disorder The patient who suffers from it proves obsessions or compulsions disabling agents that can interfere with daily activities and Working
Post-traumatic stress disorder Fear is caused by the memory of a traumatic event that can be been lived. This makes irritable the subject who will tend to avoidance and will feel discomfort
Behavioral disorders They include a wide range of attitudes different from the norm and distinguish subjects who are often aggressive or asocial.
Mental disorders They are usually identified as neurosis or psychosis and they are mental illnesses that can lead to hallucinations, inexpressiveness or, on the contrary, to decontextualized emotions
Personality disorders The person is unstable in behaviors and relationships, quickly changes mood and acts impulsively.

As for epidemiology, studies by the WHO (World Health Organization) show that between 1.5% and 3.5% of the world population suffers from it, with a greater predisposition in women, while there is no statistical data on the age of onset of the disorder (which can occur already during adolescence up to 35 years).

What are the causes of agoraphobia?

“They usually happen for great traumas that can happen (a bereavement, a post-traumatic stress disorder, experiences close to death or accidents) or – continues the specialist – there is a very rigid and severe part of us that, following a change in our lives that raises the weight of responsibilities, such as the birth of a child or a promotion at work, It causes the person to let go and ask for help.”

If this new balance of energies is repressed or underestimated, it will be vented as a symptom, in this case agoraphobia, which can affect anyone, from the young mother to the manager accustomed to keeping everything under control and having very rigid mental schemes.

In addition, this condition of discomfort can be the consequence of pathologies (anorexiadepression and hypochondria) and can often depend on environmental and character factors, such as a vulnerable and sensitive temperament with a tendency to pessimism and negativity. Anxiety, worry and stress also certainly influence, and genetic predisposition and familiarity cannot be excluded.

How can we help those who suffer from it?

Being a chronic condition, you can support those who suffer from it by evaluating a path of cognitive-behavioral therapy, learning to apply strategies for managing emotions and relaxation of the mind, such as hypnosis or autogenic training.

One of the most used techniques is that of exposure, which can take place in three ways:

  • in imagination, during which the situation that transmits anxiety is visualized and analyzed, starting from the least invasive scene to that of greatest disturbance
  • simulated in the studio, i.e. the mode that generates panic is recreated
  • In vivo, you return to the place you avoid to apply self-corrective techniques and dissociate the brain from activating a stress response.

During the sessions you learn to enter the autogenic state as quickly as possible and have control of your emotions, and then apply the technique during the acute phase thus avoiding the panic attack. By managing stress within a few seconds, the person suffering from agoraphobia becomes stronger and more tolerant even in situations of greater discomfort and learns to prevent any relapses: this requires an active effort with constancy and patience, weekly sessions and exercises to be practiced regularly at home.

The approach of psychoanalysis is different: «In relational psychoanalysis we do not work on the symptom but on the person, who is automatically led to acceptance and to solve the problem in an active way thanks to the new tools that are indicated to the patient, adding something new to one’s way of being every time – explains Laura Brutti. Once he understands the origin of the problem, he must learn to accept it and understand its meaning. Thanks to the tools that will be indicated to him, he is able to know himself better and to listen to the problem without immediately running for help, but working on it and putting new techniques into practice».

This does not exclude that a state of anxiety will not return in the course of his life, but he will have different tools to face it with more awareness and maturity: once the origin of the problem is unmasked, this will be less scary. And in fact, to understand the most real and profound dynamics that push the subject to panic, we often work on dreams, where the most authentic part is discovered and the innermost world of each individual rises to the surface.

At the same time, the role of a pharmacological therapy prescribed by the specialist doctor is important, which usually involves the use of anxiolytics: those of first choice are SSRI antidepressants (selective serotonin reuptake inhibitors). By inhibiting the re-uptake of this hormone, these medicines act by improving mood and are among the preferred drugs for long-term therapies as they are well tolerated and do not create sedation.

An alternative is represented by benzodiazepines, antipsychotics particularly indicated in states of anxiety, but suitable for short-term intake. In fact, they can induce sleep, abuse and dependence: if interrupted abruptly, for example, the subject can enter into withdrawal.

Support can also come from natural therapies. «Different types of mother tinctures can be taken daily – advises Alessandra D’Emilio, pharmacist and biologist expert in phytotherapy and homeopathy – such as passionflower with a calming action, oats, relaxing and mood-rebalancing and hawthorn, useful for the control of tachycardia». The dose may vary depending on whether the purpose is preventive or whether the patient needs to prepare for a risky situation. “A further aid – explains the specialist – is represented by gemmoderivatives such as linden and maple, specific for anxiety or panic attacks. It is also very useful to always have with you the association in drops or sprays of the five flowers that Dr. Bach considered useful in emergency situations».

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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