Agoraphobia is a complex phobia that manifests itself in the form of fear of open spaces, large crowds of people, crossing wide streets and squares, staying in places that cannot be left quickly and unnoticed by others, etc. It occurs as a result of fears related to people and emotional traumas received in the process of personal or social contacts. It can manifest itself as a sharp weakness, loss of orientation, a feeling of instability, palpitations, sweating, trembling, increased breathing and fear of death. The main method of treating agoraphobia is cognitive behavioral therapy, sometimes against the background of drug support. In some cases, long-term psychotherapy is required.
ICD 10
F40.0 Agoraphobia
General information
Agoraphobia is a persistent unexplained fear of being in a crowd, in an open space and in other places that cannot be left unnoticed with the development of a panic attack, a manifestation of helplessness or “loss of face”, allegedly confirming the inexcusable weakness of the patient or his non-compliance with the standards of behavior in public. It can be observed in panic attacks, panic disorder, generalized anxiety disorder, social phobia, other mental illnesses, neurotic and borderline disorders.
Patients suffering from agoraphobia cannot use public transport, cannot get to work, and in severe cases cannot leave the house at all. This seriously limits their professional and social opportunities, as well as their personal relationships with other people. Agoraphobia is one of the most severe phobias and often leads to disability. Treatment of agoraphobia is carried out by specialists in the field of psychology, psychotherapy and psychiatry.
Causes of agoraphobia
From the point of view of patients, their fears are inexplicable, a direct link between agoraphobia and acute or chronic emotional trauma is often not traced. Some patients note that for the first time fear appeared in circumstances associated with poor health or an unfavorable psychological state, for example, with fatigue, acute respiratory illness, a decrease in blood pressure, in heat and stuffiness, with excitement before an exam or a difficult personal conversation, etc.
In fact, the development of agoraphobia is due to a combination of several physical and psychological factors, the significance of which may vary significantly. Usually it is based on a low level of basic security (a sense of the level of security of the world, which is laid in childhood and has an impact on the entire subsequent life of a person). For some reason, in childhood, patients formed a stable image of themselves as vulnerable, defenseless, helpless, unable to cope with circumstances, and an image of the world as a deliberately dangerous, threatening space that does not forgive weaknesses and mistakes.
Along with the peculiarities of upbringing, the peculiarities of the character of patients are important. Agoraphobia often develops in sensitive, impressionable, anxious patients who tend to hide their experiences, “accumulate” negative emotions. Sometimes agoraphobia occurs after acute traumatic events: serious illness, physical or sexual violence, death of a loved one, natural disaster, loss of work or stay in the territory of military operations.
According to research, in some patients with agoraphobia, the connection of the vestibular apparatus with the proprioceptive and visual perception systems is disrupted. Usually, people easily maintain balance by focusing on three types of signals: proprioceptive, tactile and visual. If the balance is maintained only or mainly due to visual and tactile signals, disorientation is possible when staying in a moving crowd, hitting inclined surfaces and large open spaces with a minimum of landmarks.
There is a connection between agoraphobia and a hereditary change in the level of certain hormones in the brain. Vegetative-vascular dystonia and neurocirculatory dystonia are often observed in patients with agoraphobia. Experts also note that in the presence of an appropriate premorbid background, agoraphobia can develop as a result of the abuse of alcoholic beverages, stimulants (including caffeine), benzodiazepines and narcotic drugs.
Symptoms of agoraphobia
Agoraphobia is traditionally called the fear of open spaces, but nowadays the interpretation of this term has significantly expanded. Agoraphobia is understood as the fear of situations located outside the patient’s comfort zone. Patients with agoraphobia may experience fear when traveling outside the house, staying in open spaces, in crowded public places and in places that cannot be left unnoticed (public transport while driving, a barber’s chair during a haircut). The cause of anxiety is the fear of publicly demonstrating their helplessness, embarrassing themselves in front of others with loss of control and the development of a panic attack.
Usually, the level of anxiety decreases if there is a person nearby whom the patient trusts. The severity of the symptoms of agoraphobia and the list of disturbing situations can vary greatly. Some have anxiety only when staying in squares or on public transport, others cannot walk without an escort, but move freely by car, others do not leave the house at all, and sometimes they cannot even stay alone at home. A characteristic feature of agoraphobia is the avoidance of unsafe situations. Patients organize their lives so as not to find themselves in an environment or circumstances that cause anxiety.
If you get into disturbing circumstances, tachycardia, rapid shallow breathing, increased sweating, dizziness, fainting, trembling, nausea, unpleasant sensations in the stomach and intestines and difficulty swallowing are possible. Physical symptoms are accompanied by the fear of discovering your panic in front of others, going crazy or dying. Outside of disturbing circumstances, there is usually a fear of waiting (the patient begins to worry in advance, knowing that after a while he will have to leave the comfort zone).
Patients with agoraphobia suffer from self-doubt and low self-esteem. They feel helpless, they are afraid that they will not be able to survive without the help of other people, they feel that they are losing control of their lives. Patients with agoraphobia often develop depression. There may be a certain cyclical nature of the disease, in which the patient either “wins” some space from the disease and expands the safety zone, or loses it (usually losses occur when some additional traumatic circumstances occur).
Treatment of agoraphobia
The most effective method of treating agoraphobia is cognitive behavioral therapy. This is short-term psychotherapy, in which the doctor together with the patient identify thoughts and beliefs that provoke the development of anxiety when visiting unsafe places. Then the patient begins to gradually plunge into frightening situations, first with the support of a specialist, and then independently. Psychological desensitization occurs, the patient gets used to frightening situations, and his anxiety level decreases.
In the presence of concomitant depression, panic disorder and other similar diseases, psychotherapeutic treatment is carried out against the background of drug therapy using antidepressants and tranquilizers. It should be borne in mind that substances that depress the central nervous system can interfere with cognitive behavioral therapy, therefore, alcohol consumption should be excluded during treatment, and tranquilizers should be taken strictly as prescribed by a doctor (usually these drugs are prescribed for a short time to alleviate the patient’s condition before the onset of antidepressants).
In the presence of severe psychological trauma and internal conflicts, long-term psychotherapy using gestalt therapy, psychoanalytic therapy, psychodrama, existential therapy and other methods may be required. All of these methods aim not to get rid of agoraphobia, but to eliminate psychological attitudes, self-perceptions and perception features that contribute to the emergence and preservation of fears – without working with these psychological mechanisms after cognitive behavioral therapy, agoraphobia may return or transform into another phobia after a while.
Forecast
The prognosis for agoraphobia depends on the depth and severity of psychological problems that cause the development of the disease, the characteristics of the patient’s personality, the presence of concomitant mental and somatic pathology. The chances of a cure increase if there is a clear motivation, conscious cooperation with a psychologist, psychotherapist or psychiatrist and the exact implementation of all the recommendations of a specialist.
