Agoraphobia

Source: Wikipedia, the free encyclopedia.
Not to be confused with Acrophobia.

Agoraphobia
Separation anxiety, post-traumatic stress disorder, major depressive disorder[1]
TreatmentCognitive behavioral therapy[3]
PrognosisResolution in half with treatment[4]
Frequency1.9% of adults[1]

Agoraphobia

behavioral disorder,[5] specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape.[1] These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own.[1] Being in these situations may result in a panic attack.[2] Those affected will go to great lengths to avoid these situations.[1] In severe cases, people may become completely unable to leave their homes.[2]

Agoraphobia is believed to be due to a combination of

post-traumatic stress disorder, and major depressive disorder.[1] The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicide ideation.[6][7]
Without treatment, it is uncommon for agoraphobia to resolve.
counselling called cognitive behavioral therapy (CBT).[3][8] CBT results in resolution for about half of people.[4] In some instances, those with a diagnosis of agoraphobia have reported taking benzodiazepines and antipsychotics.[6] Agoraphobia affects about 1.7% of adults.[1] Women are affected about twice as often as men.[1] The condition is rare in children, often begins in adolescence or early adulthood, and becomes less common in old age.[1]

Etymology

The term agoraphobia was coined in German in 1871 by pioneering German psychologist Karl Friedrich Otto Westphal (1833–1890), in his article "Die Agoraphobie, eine neuropathische Erscheinung." Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1871–72; 3: 138–161. It is derived from Greek ἀγορά (agorā́), meaning 'place of assembly' or 'market-place' and -φοβία (-phobía), meaning 'fear'.[9][10]

Signs and symptoms

Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of a known, controllable space, usually their home.[1]

Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks".[11] In these cases, the patient is fearful of a particular place because they have previously experienced a panic attack at the same location. Fearing the onset of another panic attack, the patient is fearful or avoids a location. Some refuse to leave their homes in medical emergencies because the fear of being outside of their comfort areas is too great.[12]

The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making a diagnosis of panic disorder. Other syndromes like obsessive–compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome.[13]

People with agoraphobia may experience temporary separation anxiety disorder when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends.[14][15]

People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia".[16]

Panic attacks

Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack,

fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.[17] Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report a fear of dying, fear of losing control of emotions, or fear of losing control of behaviors.[17]

Causes

Agoraphobia is believed to be due to a combination of genetic and environmental factors.[1] The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.[1]

Research has uncovered a link between agoraphobia and difficulties with spatial orientation.

proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds).[20] Likewise, they may be confused by sloping or irregular surfaces.[20] In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with subjects without agoraphobia.[21]

Substance-induced

Chronic use of

long-term effects of alcohol consumption causing a distortion in brain chemistry.[24] Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.[25]

Attachment theory

Main article: Attachment theory

Some scholars[26][27] have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.[28] Recent empirical research has also linked attachment and spatial theories of agoraphobia.[29]

Spatial theory

In the social sciences, a perceived clinical bias[30] exists in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.[31] Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating a conflict in the mind of agoraphobic individuals.

Evolutionary psychology

An evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred.[32][33]

Diagnosis

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.[34] Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.[35] Early treatment of panic disorder can often prevent agoraphobia.[36] Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other anxiety disorders such as depression.[37]

Agoraphobia without history of panic disorder

Agoraphobia without a history of panic disorder (also called primary agoraphobia) is an

social phobia. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic".[38]
In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.

According to the

DSM-IV-TR, a widely-used manual for diagnosing mental disorders, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence.[39] The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be diagnosed together.[40]

Treatments

Therapy

Systematic desensitization can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.[41] Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely.[42][43] In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until the symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise.[43]

A related exposure treatment is in vivo exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects.[44] This treatment was largely effective with an effect size from d = 0.78 to d = 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment).[44]

Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals.[44] Further research showed there was no significant effect between using group CBT versus individual CBT.[44]

Cognitive restructuring has also proved useful in treating agoraphobia.[citation needed] This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.

Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.[45]

Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method.[46] Similar to traditional face-to-face interventions, VCP can be used to administer CBT.[47]

Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).[48]

Medications

Antidepressant medications most commonly used to treat anxiety disorders are mainly

tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia.[49] Antidepressants are important because some have anxiolytic effects.[43] Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy.[43] A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.[43]

Benzodiazepines and other anxiolytic medications such as alprazolam and clonazepam are used to treat anxiety and can also help control the symptoms of a panic attack.[citation needed]

Alternative medicine

Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.[50] As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.[51]

Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.[52]

Epidemiology

Agoraphobia occurs about twice as commonly among women as it does in men. It can develop at any age but is much more common in adolescence and early adulthood and occurs more often in people of above average intelligence.[53]

Panic disorder with or without agoraphobia affects roughly 5.1% of Americans,[44] and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting panic disorders as well.[44]

Society and culture

Notable cases

See also

References

Public Domain This article incorporates public domain material from websites or documents of the National Institute of Mental Health.

  1. ^
    ISBN 978-0-89042-555-8
  2. ^ a b c "Agoraphobia". PubMed Health. Retrieved 11 August 2016.
  3. ^
    ISBN 978-1-58562-687-8. Archived
    from the original on 21 August 2016.
  4. ^
    S2CID 208789585
    .
  5. ^ Drs; Sartorius N, Henderson A, Strotzka H, Lipowski Z, Yu-cun S, You-xin X, et al. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). www.who.int World Health Organization. Microsoft Word. bluebook.doc. pp. 110, 112–3. Archived (PDF) from the original on 17 October 2004. Retrieved 23 June 2021 – via Microsoft Bing.
  6. ^
    PMID 32791758
    .
  7. PMID 30249220
    .
  8. PMID 27071857
    .
  9. ^ "Collins dictionary". Retrieved 17 September 2020.
  10. ISBN 978-0-307-56097-1. Archived
    from the original on 21 August 2016.
  11. ^ "Agoraphobia – Dictionary of Psychotherapy". Archived from the original on 3 April 2016. Retrieved 23 March 2016.
  12. ^ "Agoraphobia". betterhealth.vic.gov.au. Archived from the original on 22 March 2017. Retrieved 21 March 2017.
  13. ^ "Agoraphobia Symptoms". Psych Central.com. 17 May 2016.
  14. ^ "Agoraphobia – Symptoms and causes". Mayo Clinic. Retrieved 1 July 2019.
  15. ^ "What Are Anxiety Disorders?". www.psychiatry.org. Retrieved 1 July 2019.
  16. ISBN 978-1-4381-2098-0
    .
  17. ^ a b David Satcher, et al. (1999). "Chapter 4.2". Mental Health: A Report of the Surgeon General. Archived from the original on 27 April 2006. Retrieved 7 March 2006.
  18. PMID 7755529
    .
  19. PMID 8599398
    .
  20. ^
    S2CID 9789982
    .
  21. S2CID 6932961
    .
  22. ISBN 978-0-8039-7477-7
    .
  23. PMID 2886145
    .
  24. PMID 17592911
    .
  25. PMID 19961810
    .
  26. ^ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
  27. ^ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
  28. doi:10.5840/intstudphil2004362165
    .
  29. doi:10.1111/j.1475-4762.2008.00820.x
    .
  30. ^ J. Davidson, (2003). Phobic Geographies
  31. doi:10.5334/opt.010606 (inactive 31 January 2024). Archived from the original on 3 March 2016.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link
    )
  32. PMID 16563589
    .
  33. ^ Raffaello S, Alessandra SM, Alessandra S (2011). "[Primary agoraphobia specific symptoms: from natural information to mental representations]" (PDF). Italian Journal of Psychopathology (in Italian). 17 (3): 265–276. Archived from the original (PDF) on 26 April 2012.
  34. ^ American Psychiatric Association, 1998
  35. ^ Barlow DH (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press.
  36. ^ pmhdev. "Agoraphobia – National Library of Medicine". Archived from the original on 30 March 2014. Retrieved 25 January 2017.
  37. ^ Kenny T, Lawson E. "Agoraphobia". Patient.info. Archived from the original on 7 June 2015. Retrieved 8 December 2014.
  38. ^ Barlow, D. H. & Waddell, M. T. (1985) Agoraphobia. Ch 1 in Barlow, D. H. (Ed) Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford.
  39. ISBN 0-89042-025-4. Archived from the original
    on 28 August 2021. Retrieved 28 June 2007.
  40. ^ Administration SA (June 2016). "Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5". www.ncbi.nlm.nih.gov. Retrieved 4 November 2023.
  41. S2CID 5652068
    .
  42. ^ "Agoraphobia – Diagnosis & Treatment". Mayo Clinic. 18 November 2017. Retrieved 15 May 2020.
  43. ^
    ISBN 978-0-19-852863-0
    .
  44. ^
    PMID 19775792
    .
  45. ^ "Agoraphobia – Diagnosis and treatment – Mayo Clinic". www.mayoclinic.org. Retrieved 1 July 2019.
  46. PMID 33679513
    .
  47. PMID 32973638
    .
  48. S2CID 260053713
    .
  49. PMID 2960710
    .
  50. ^ Goldstein, Alan J., de Beurs, Edwin, Chambless, Dianne L., Wilson, Kimberly A. (2000). "EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions". Journal of Consulting and Clinical Psychology. 68 (6): 947–957.
    PMID 11142547
    .
  51. ^ Agoraphobia Resource Center. "Agoraphobia treatments—Eye movement desensitization and reprogramming". Archived from the original on 5 April 2008. Retrieved 18 April 2008.
  52. ^ National Institute of Mental Health. "How to get help for anxiety disorders". Archived from the original on 4 July 2008. Retrieved 18 April 2008.
  53. PMID 8629891
    .
  54. ^ Peter Biskind (10 October 2006). "Reconstructing Woody". Vanity Fair. No. December. Archived from the original on 17 October 2012.
  55. ISBN 978-1-55970-693-3. Archived
    from the original on 16 October 2015. Retrieved 11 September 2015.
  56. ^ Murray J (15 August 1991). "Campbell Breaks Free Again". Los Angeles Times. Retrieved 6 January 2023.
  57. ^ "CNN.com – Transcripts". CNN. 27 May 2004. Archived from the original on 20 July 2009. Retrieved 7 August 2009.
  58. ^ Julia Moskin (28 February 2007). "From Phobia To Fame: A Southern Cook's Memoir". The New York Times. Archived from the original on 1 February 2017.
  59. ^ Erik Gregerson (2011). "Horace L. Gold". Britannica. Retrieved 6 January 2023.
  60. IMDb
    . Retrieved 28 November 2007.
  61. ^ Ellis-Petersen H (26 May 2017). "Miranda Hart: 'I used to think fame would justify my whole existence". The Guardian. Retrieved 14 September 2023.
  62. ^ "Psychological Autopsy can help understand controversial deaths—The Crime Library on truTV.com". Archived from the original on 14 February 2015. Retrieved 25 January 2017.
  63. ^ Olivia Hussey—People Magazine—March 16, 1992 Archived March 18, 2012, at the Wayback Machine
  64. IMDb
  65. ^ Churchwell S (10 February 2017). "Shirley Jackson: A Rather Haunted Life by Ruth Franklin review – beyond spooky". The Guardian. Retrieved 9 March 2021.
  66. ^ [1] essay by Jonathan Lethem Archived April 29, 2012, at the Wayback Machine
  67. ^ Mike Conklin. (10 December 2004). "Where is Elfriede Jelinek?". Chicago Tribune. Archived from the original on 17 June 2013. Retrieved 8 May 2013.
  68. ^ Hatfield A (19 July 2022). "Mike Patton discusses agoraphobia diagnosis, canceling Faith No More shows in new interview". Brooklyn Vegan. Retrieved 21 July 2022.
  69. ^ Stanisław Fita, ed., Wspomnienia o Bolesławie Prusie (Reminiscences about Bolesław Prus), Warsaw, Państwowy Instytut Wydawniczy (State Publishing Institute), 1962, p. 113.
  70. ^ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.
  71. ^ V J (21 November 2014). "Famous People With Agoraphobia". Morningside Recovery. Retrieved 26 July 2023.
  72. ^ McNair J (3 September 2007). "Brian Wilson: Here Comes the Sun". The Independent. Archived from the original on 20 January 2009.
  73. ^ "Ben Weasel featured on Carson Daly". www.punknews.org. 14 October 2010.

Further reading

External links

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