In the nineties one of the first films appeared in which described in detail a case of agoraphobia . The psychologist who stars in this piece of fiction is anxious about leaving her apartment for a few seconds to reach the newspaper.

Of course, and no matter how striking the scene may seem, it is still a resource to introduce one of the main characters . It doesn’t serve to understand what this anxiety disorder consists of, but rather it confronts us with an extreme case of agoraphobia so that we can see to what extent it can put a person’s quality of life on the edge and understand that person’s behavior. At the same time, it highlights the fact that the anxiety crises produced by this disorder can be very shocking and present in many of the spheres of a human being’s life.

But while agoraphobia is so shocking and its consequences may be so palpable, it is not easy to understand what it is. Reading the following may help you to form a more detailed picture of this type of phobia , and 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 squares ( agoras , a word from the Greek), and it is easy to take as agoraphobia certain cases of people who simply do not like to leave home or with problems related to social isolation.

However, it is not entirely true that agoraphobia is equivalent to fear of open or public spaces . It is a way of feeling fear and anguish whose origin is somewhat more abstract than the simple visualization of this type of environment.

The fact of perceiving open or very crowded spaces plays a role in triggering panic attacks in people with agoraphobia, but the fear is not produced by these spaces per se, but by 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 consists of defining it as an anxiety disorder that is expressed by noticing that one is not in a safe context in which it is possible to receive help in the face of a crisis . In other words, its symptoms are based on a strong distress produced by situations in which the person who suffers it feels unprotected and vulnerable to anxiety crises that are beyond his control. The root of the problem is something like a fear of fear. And this means that once you have entered into the dynamic of fearing the symptoms of agoraphobia, it favors its appearance. It is a disorder that is often based on self-fulfilling prophecy, or a fish-eater that is linked to fear and anxiety.

The distressing fear experienced by someone with this anxiety disorder is basically based on the anticipation of panic attacks . Therefore, where there is agoraphobia there is also a fear-based loop. A vicious circle of recurring thoughts from which it is difficult to escape.

Somehow, agoraphobia feeds itself by anticipating both the unpleasant feelings 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: one fears not the open space, but the possibility of suffering a panic attack or an anxiety crisis because of being there, and at the same time the consequences of being in that place when that happens.

In short, agoraphobia consists of the fear of losing control over one’s physiological activation and the results this can lead to, in addition to the fear of the subjective feelings of discomfort this would produce in real time. This is what explains why anxiety attacks can appear not only in large spaces, but also in an elevator or any place other than one’s own home. Agoraphobia often expresses itself in any place that is perceived as particularly unsafe, that is, where we have less control over things.

The myth of agoraphobia as a watertight compartment

From the above we can come to a conclusion: the symptoms of agoraphobia are not always the same, and its triggers can have very different forms . The situations and places that can produce anguish or anxiety are neither stereotypical nor the same in all the people diagnosed with this disorder, as it would be expected if agoraphobia was expressed in a similar way as the fear of vampires of crucifixes is expressed in popular culture. In fact, it sometimes happens that anxiety attacks occur even when the person is in a “safe” place, due to internal causes unrelated to how the environment is perceived.

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

Diagnosis and symptoms

Broadly speaking, some of the characteristics presented by people with agoraphobia are

  • Being exposed to open places , very crowded or unfamiliar produces a strong feeling of anguish.
  • This feeling of anguish is intense enough for the person to adopt the strategy of living avoiding this type of place, despite the fact that this has a negative impact on their quality of life.
  • These outbreaks of anxiety and distress cannot be explained by other disorders already diagnosed.
  • The possibility of attracting the attention of strangers or of making a fool of oneself 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 on a case-by-case basis when there is a case of agoraphobia and when there is not .

When diagnosing this type of disorder, it is essential to consider whether the person perceives what is happening to him or her as something that limits his or her quality of life and is therefore disabling. In other words, the existence or not of agoraphobia does not depend only on the symptoms, but also on the context in which they occur, both subjectively (does the patient think he is problematic?) and objectively (do the symptoms appear when the anxiety is unjustified?).

That’s why you have to consider 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, but it is quite another to talk about its causes. On this point, it is common to believe that phobias in general, including agoraphobia, appear simply because of a stressful lifestyle, or that they are the expression of some kind of trauma or internal conflict that is expressed symbolically through fear of open spaces.

However, at present this type of explanation is not very useful (and in the case of the second one it cannot even be demonstrated because of the epistemological foundations of this approach), among other things because it ignores possible organic causes. That is, those that have to do with the biological functions that determine our thoughts and our states of mind.

While it is not known exactly what causes agoraphobia , a link has been found between agoraphobia and abnormally low serotonin levels in certain parts of the brain. These low serotonin levels may be the result of a genetic mutation, but they may also be due to a chemical imbalance caused by certain experiences or by the use of certain substances, or they may be a product of all of these.

Regardless of whether or not this finding ends up being accurate in explaining the mechanisms behind this disorder, what is clear is that there is not just one cause of agoraphobia, but several, as occurs in practically any psychological phenomenon, pathological or otherwise.

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

Treatment

Once diagnosed, agoraphobia can be treated both through psychological intervention and through medication . Below we will see what these two types of treatment for agoraphobia are, but it is important to emphasize that only a mental health professional is authorized to carry out effective therapy.

1. Treatment with drugs

Both antidepressants (SSRIs) and anxiolytics (clonazepam and diazepam) are commonly used in drug treatment. However, these medications should only be taken under strict medical supervision and only with a prescription, and in any case are not used to cure the disorder, but to cope with its symptoms.

It is also important to note that, as is always the case with drugs, they can produce significant side effects and adverse effects, such as the development of serotonin syndrome. This occurs because, as with all drugs in general, those used to combat the symptoms of phobias not only act on the parts of the brain involved in maintaining a high level of anxiety, but also impact on the whole body in general, and this can produce a maladjustment depending on the genetic and biological predispositions of the individual .

Thus, there is always some risk in using these substances for either agoraphobia or any other psychological disorder, and it is up to mental health professionals to determine whether the danger is low enough to use a certain dose, and how it should be used.

2. Psychological therapy

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

The advantages of this option are that its benefits tend to last longer than the effects of the drugs after the last doses, it is a short intervention and has no side effects as it does not act directly on the regulation of hormones and neurotransmitters.

Among its disadvantages in comparison to pharmacological treatment are the relative slowness with which progress appears and the need for the person with agoraphobia to be able to collaborate and achieve the proposed goals of therapy. This is important, because progressing with this type of intervention involves making an effort and facing up to unpleasant situations in order to generate greater resistance to what is feared, with professional supervision and in a controlled environment.

From the Cognitive-Conditional perspective, we will work on the beliefs that the person has about his disorder as well as on his habits and daily actions, so that the changes carried out in both dimensions, the mental and the behavioural, 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 both pharmacological and psychological intervention , to alleviate the immediate effects of this anxiety disorder and at the same time to train the patient to be able to expose himself more and more to the feared situations and to manage the sensation of nervousness. However, this will only happen if it is considered strictly necessary, and drugs should only be taken under medical indication.

Bibliographic references:

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