Under an agoraphobia, the medical profession understands a psychological disorder or phobia. The affected person fears not being able to escape from an everyday situation (for example, in the suburban train or at the hairdresser). This fearful situation then usually results in a panic attack.
What is agoraphobia?
Agoraphobia sufferers fear not being able to escape from an everyday situation (for example, in the suburban train or at the hairdresser). This anxiety situation then usually results in a panic attack. Every living being is familiar with states of anxiety. In the animal world and also in humans, this feeling protects us when a threatening situation or danger approaches. Anxiety is usually a natural warning signal. People who suffer from agoraphobia transfer their anxiety into normal life situations. However, they overestimate the danger of a situation and are therefore afraid to go to certain places with a
gathering of people. Ultimately, this exaggerated sense of fear can lead them to avoid leaving their own homes.
Causes
In many cases, a severe traumatic experience triggered agoraphobia. However, the cause can also be very stressful life events that last for several weeks or months. The death of a very close person, conflicts in a partnership, divorce from the spouse, bullying at work, professional overload or a dismissal can be triggering circumstances to an agoraphobia. The fact that every person reacts differently to stress or stressful life situations is partly due to genetics, but on the other hand it is also a consequence of behavioral patterns learned in childhood. Each person has his or her personal vulnerabilities and reacts differently in the face of emotional injuries, wounding or stress.
Symptoms, complaints and signs
Agoraphobia involves anxiety that can progress to panic attacks. Sufferers are afraid of large places, of unclear expanses or even of a gathering of people and crowds. The fear first becomes noticeable only insidiously and begins with a strong uneasiness in the situation concerned. Only with time do the fears manifest themselves more and more until the person affected can name them directly. At this point, medical help should be sought. If agoraphobia is not treated, it can lead to a significant reduction in quality of life and free movement. Sufferers try to help themselves and usually resort to so-called avoidance strategies. If the fear occurs mainly in large places, large squares are avoided or no longer crossed, but circumvented in a roundabout way. In most cases, however, this does not result in an improvement, but rather in a worsening of the situation. The circumstances that create the fear widen, so that new additional avoidance strategies become necessary. In the worst case, this can lead to affected persons even being afraid to leave the apartment or house at all. In the long term, it may be possible that they can no longer participate in public life.
Diagnosis and progression
In agoraphobia, psychological and physical reactions show up in the sufferer. Many fears determine his thinking, feeling and behaviors. This is expressed in the fact that he constantly fears that something bad could happen to him or that he could be alone and helpless or even in mortal danger. Will I get out of this alive? What if I have a heart attack? I can’t do that on my own! I can’t take it anymore! What if I can’t breathe or I faint? – Fainting feelings of this kind lead to high blood pressure and the muscles in the body tense up. This leads to physical reactions, which in turn trigger anxiety again. Sweating, a dry mouth, trembling, strong palpitations or a fast and irregular heartbeat, shortness of breath, nausea and vomiting, urination and bowel movements, dizziness and lightheadedness are some possible physical symptoms of agoraphobia. Because the sufferer is afraid of these physical reactions, he begins to avoid certain situations or places. He stops going to public places, department stores, supermarkets, inns or hotels, movie theaters or theater events. He avoids taking public transportation or long-distance travel by plane or train.Those who suffer from agoraphobia initially experience their symptoms in phases. Increasingly, however, he becomes more insecure and believes that he is actually affected by
of a serious organic disease. If agoraphobia remains untreated, the further psychological course is unfavorable.
Complications
Agoraphobia can severely limit life. In a severe manifestation of the anxiety disorder, affected persons sometimes no longer leave their homes or only dare to go outside when accompanied by a trusted person. As a result, everyday tasks often become insurmountable obstacles. Professional and family complications are almost inevitable with severe agoraphobia. Friendships and other social contacts also often suffer from agoraphobia. This isolation in turn fosters other psychological problems, for example, obsessive-compulsive disorder or depression. A depressive episode may also occur despite treatment, or may be triggered by treatment in the first place – when the sufferer realizes that (often for many years) he has subjected his life to a treatable disorder. Agoraphobia may occur with or without panic attacks. Because panic attacks can resemble a heart attack or other medical complications, careful evaluation is necessary (especially at the onset of the anxiety disorder). In addition, anxiety disorder often occurs together with personality disorders. Dependent personality disorder and anxious avoidant personality disorder are the most common. Furthermore, another anxiety disorder may occur in addition to agoraphobia. Specific phobias, generalized anxiety disorder, and social phobia come into consideration. Harmful use of medications or alcohol may represent a form of self-medication.
When should you see a doctor?
A phobia such as agoraphobia can potentially develop at any time in life. In most cases, latent fears of places where sufferers feel defenseless have been present for a long time. They avoid crowds in public places or travel to unfamiliar places. Often agoraphobia occurs as a result of unprocessed trauma or as a result of life crises. It is necessary to confidently go to the family doctor with such complaints, so that the symptoms do not worsen. Increasing social withdrawal has far-reaching consequences. These can mean the loss of the job and the usual ability to act. In most cases, those affected cannot free themselves from their fears on their own. Often, even going to the family doctor is problematic. The fears can be accompanied by shame. The family doctor refers the affected person to an exposure or behavioral therapy or another psychotherapeutic measure. He or she may also prescribe anti-anxiety medications to restore some normalcy to the patient. Since this may be a combination of anxiety disorders with or without panic attacks, further measures may be necessary. The anxiety disorder may already be generalized, as it has often been present for a long time. However, the patient may learn through therapy that anxiety can be unlearned over time.
Treatment and therapy
Once the psychotherapist has ruled out other conditions, such as psychosis or organic disease, and diagnosed agoraphobia, he or she will use examples from the patient’s own medical history to illustrate the connection between his or her anxiety and avoidance behavior. If addictive behavior related to alcohol or medication has developed in the affected person in order to endure anxiety situations, this must also be treated therapeutically. For the therapeutic treatment of agoraphobia, there are practically two ways:
In systematic desensitization, the therapist tries to help the sufferer step by step. First, individual coping strategies are worked out during talk therapy. In the process, it can be helpful to learn a relaxation procedure, which is subsequently practiced in a supportive manner during the practical confrontation exercises or desensitization therapy. In addition, imagination therapy could prepare the affected person individually. Furthermore, strong blockades could be solved by hypnosis therapy.The affected person should then face the specific fear situation step by step together with his therapist until he has learned that it is unrealistic to have this fear or that he has learned how to deal with
deal with this fear in a positive way in this situation. The other option for treatment is called “flooding.” In this, the sufferer voluntarily dares to face his most difficult fear situation first, while the therapist remains observing in the background.
Outlook and prognosis
Many patients suffering from more or less pronounced agoraphobia worry, in addition to their anxiety symptoms, about whether these unpleasant attacks will remain or disappear spontaneously or with appropriate therapy. In general, agoraphobia has a favorable prognosis, but this depends on two factors in particular. First, the success of treatment is often better if the patient seeks treatment as early as possible in more severe cases. A rapid start to treatment often prevents the clinical picture from becoming chronic in advance. This means that undesirable side effects and complications such as the development of a strong anticipatory anxiety before the next attack of panic or a strong avoidance behavior in relation to anxiety-provoking situations can often be avoided by early therapy. On the other hand, the cooperation and motivation of the patient (the so-called compliance) is also an important factor for the success of a therapy and thus the prognosis of the disease. In agoraphobia, the most important thing is to expose oneself to fearful situations and to learn that these situations are harmless. In mild cases, a motivated patient may well manage to perform these exposures successfully on his or her own. In persistent cases, the responsible therapist guides, but also depends on the participation of the affected person for the success of the treatment.
Prevention
The learned relaxation procedures and behavioral strategies with individual positive affirmations also help the sufferer to prevent acute anxiety states of agoraphobia.
Aftercare
Agoraphobia is one of the anxiety disorders that generally requires careful aftercare, as it can easily flare up again. On the one hand, this can be done by the treating psychologist or psychotherapist, who offers regular sessions for stabilization. However, this can also be done on one’s own, since those affected are sensitized to the thought patterns that trigger or promote agoraphobia through therapy. Self-monitoring is an important part of follow-up care. If a patient notices that it is becoming increasingly difficult for him or her to be in crowds and open spaces, it is important to consciously seek out these situations again. What has been learned from confrontation therapy can be applied here in a targeted manner. Remembering that perceived dangers in these situations are not real is important for aftercare and stabilizes health in relation to the anxiety disorder. Support groups can also significantly support aftercare. The community of former and current anxiety sufferers provides support during periods of weakness, and sharing experiences expands the action strategies available when agoraphobia occurs. Activity and relaxation forms can also contribute to aftercare. Physical activity helps build confidence in one’s body and reduces adrenaline. Relaxation techniques promote the ability to become calmer and more relaxed. Autogenic training, progressive muscle relaxation and yoga are important here.
Here’s what you can do yourself
What self-help measures are appropriate in everyday life can vary greatly, as agoraphobia also varies from person to person. In the treatment of agoraphobia, confrontation takes an important position. Affected people can therefore repeatedly set themselves small challenges in everyday life, instead of avoiding fearful situations. In the beginning, it is often useful to have the support or guidance of a psychotherapist. Professional support ensures that the anxiety is not avoided, but actually subsides on its own. In addition, therapeutic guidance can provide a sense of security. Especially in behavioral therapy, it is important that patients do their “homework”.Actively helping to shape one’s own therapy makes it possible to make the best possible use of the therapeutic sessions. In addition, such homework can help to implement what has been learned in therapy in everyday life. Some people who suffer from agoraphobia are helped by learning to understand the fear better. Suitable literature can be found, for example, on the Internet and in books. However, the quality of such publications varies greatly. It is an advantage if authors have a scientific background or are therapists. Agoraphobia can be accompanied by other mental disorders. These should not be left untreated, but should be included in therapy as well as in everyday life.
