Definition It is an anxiety disorder, which consists of being afraid to suffer from a panic attack in places where help cannot be received and usually generates fear of open spaces, manifesting itself as an irrational fear in spaces such as large avenues, parks, natural environments, etc. As the etymology of the word indicates, "phobia" means fear and "agora" means square, according to Greek. However, it does not necessarily amount to fear of open or public spaces. Perceiving open and/or crowded spaces plays a key role in triggering the panic attack that occurs in people with agoraphobia, but fear is not produced by the open space itself, but by being exposed to that place. It's the crucial aspect of panic attack, often overlooked. Agoraphobia can then be defined as the anxiety that occurs when you feel that you are not in a safe context and where it is difficult to receive help in the face of a panic crisis. It is also known as "fear of fear", that is, its symptoms are based on a strong anguish that occurs in situations where the person who suffers it, feels unprotected and vulnerable to an anxiety crisis that escapes its control. In agoraphobia there is a vicious cycle, which once started is difficult to stop: it is feared to present symptoms of anxiety and a panic attack, but anxiety and panic attack is generated due to that fear, which favors its appearance. It is a disorder that is based on "self-fulfilling prophecy" (false belief that, directly or indirectly, leads to its own fulfillment), that is, it is based on anticipation of the symptoms of a panic attack (anticipatory anxiety). Therefore, in agoraphobia there is a loop based on fear (a vicious circle and recurring thoughts, from which it is difficult to escape). In this sense, agoraphobia feeds itself, through anticipation of the unpleasant sensations associated with this crisis and the dangers of losing control over the acts themselves. The way in which anguish manifests itself reproduces the loop structure: it is not afraid of open space, but of the possibility of suffering a panic attack or an anxiety crisis from being there, as well as at the same time, the consequences of being in that place when that happens. In conclusion, theagoraphobia consists of the fear of losing control over one's own physiological activation and the result that this can lead to, as well as the fear of subjective sensations of discomfort. This explains why agoraphobia is presented, in addition to open spaces, in an elevator for example or anywhere other than the house itself. Agoraphobia manifests itself anywhere perceived as insecure or what is the same, where we have less control over things. It is important to add that the symptoms of agoraphobia are not always the same and various situations can trigger the panic attack can. The disorder is so subjective that the stimuli that cause it (situations and/or sites) may be different for the home person. It is common for a person with agoraphobia to also be diagnosed with a panic disorder (characterized by anxiety attacks due to internal causes, not related to how the environment is perceived, which occur even when the person is in a "safe" place) or post-traumatic stress (anxiety experienced after suffering a traumatic event), while several of their symptoms overlap. Causes For sure, it is not known exactly what causes agoraphobia. However, a link between this disorder and an abnormality in Serotonin levels (low levels of this neurotransmitter) has been detected in certain parts of the brain. Low Serotonin levels can be caused by a genetic mutation, but also by a chemical decompensation caused by certain experiences, by the consumption of certain substances or by being the product of all this at once. It should be noted that there is not a single cause of agoraphobia, but there are many. Agoraphobia appears and is expressed through biological and genetic factors, but equally, by cultural factors and based on the learnings (and associations) that each person has had, which constitute his memories. It often happens, when a person has had a panic attack and begins to be afraid of situations that could lead to another attack. Characteristics of agoraphobia
It occurs when exposed to open places, very crowded or uns familiar, producing a strong feeling of anguish.
The feeling of anguish is so intense that the person adopts the strategy of living avoiding such places, causing a great negative impact on their quality of life.
Outbreaks of anxiety and distress cannot be explained by other disorders.
The fear of attracting the attention of strangers or making a fool of themselves because of the anxiety crisis plays a key role in the disorder.
To diagnose the disorder, it is important to consider whether the person perceives what is happening to them, such as something that limits their quality of life (that is, that represents a clinically significant discomfort for the person and that is disabling). The existence of an agoraphobia disorder depends on the symptoms, but also on the context in which they occur, both subjectively (does the patient think it is problematic?), and the objective (do symptoms appear when anxiety is unwarranted?). Symptoms
Physical:
Choking or shortness of breath (dyspnoea)
Tachycardia
Discomfort, chest pain or chest pressure
Dizziness and/or fainting
Feeling instability, numbness or tingling
Nausea or upset stomach
Sudden chills or redness
Stomach upset
Feeling loss of control
Excessive sweating
Tremor
Fear of dying
Psychological:
Afraid of being left alone.
Fear of being in places where escape could be difficult.
Be afraid of losing control in a public place.
Have dependence on others.
Feelings of separation or estating from others.
Feelings of hopelessness.
Feeling that the body and/or environment is unreal.
Treatment With drugs Antidepressants (SSRS) and anxiolytics (clonazepam and diazepam) are often used. However, these medications should only be taken under strict medical and prescription supervision. They are not used to cure the disorder, but to cope with your symptoms. It should be noted that side effects and side effects may occur. With psychological therapy The most prominent therapy to intervene in this type of disorder is that known as Cognitive Behavioral Therapy,which hasscientifically proven benefits. Its benefits tend to last longer than the benefits of drugs after the last dose. It is a brief intervention and has no side effects. Its disadvantage compared to drug treatment is that progress is perceived more slowly and involves effort on the part of the patient, as well as requires that it face unpleasant situations to generate greater resistance to what is feared, with professional supervision and in a controlled environment. With this psychological approach, irrational beliefs about the disorder, as well as its daily habits and actions, are worked out so that changes at the mental and behavioral level reinforce each other. It is also common to resort to relaxation techniques to train the ability to manage anxiety. In these cases, both pharmacological and psychological intervention is recommended to decrease the immediate effects of the disorder and train the patient to be able to expose himself to feared situations and to manage anxiety.
References:
Bados, A. (2005). Agorafobia y pánico. Universidat de Barcelona: http://diposit.ub.edu/dspace/bitstream/2445/358/1/115.pdf
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