Presenting – Agoraphobia
A person with agoraphobia fears being in places where there is a chance of having a panic attack that people may witness, and getting away rapidly may be difficult. Because of these fears the sufferer will deliberately avoid such places – which may include crowded areas, special events, queues (standing in line), buses and trains, shops and shopping centers, and airplanes.
A person with agoraphobia may find it hard to feel safe in any type of public place, especially where large numbers of people gather. Some people may have it so severely that the only place they feel really safe in is their home, and rarely ever go outside.
Agoraphobia is not the opposite of claustrophobia (fear of closed spaces, such as elevators) – it is not simply a fear of open spaces. Agoraphobia may result in a fear of being outdoors, a kind of open space – but it is not a fear of there being too much openness and no walls, ceilings or boundaries, etc. The fear of going outdoors results from a dread of becoming embarrassed, trapped and helpless somewhere while having a panic attack – this never happens inside one’s own home.
According to the National Institute of Mental Health (NIMH), USA, about 3.2 million American adults are living with agoraphobia. The median age of onset of agoraphobia is 20 years.
Physical symptoms of agoraphobia
Sufferers will usually only experience the symptoms when they find themselves in a situation or environment that causes them anxiety. Physical symptoms are rare because most people with agoraphobia avoid situations that they believe will trigger panic. When symptoms do occur, they may include:
* Accelerated heart beat.
* Rapid and shallow breathing (hyperventilating).
* Feeling hot, flushing.
* Stomach upset.
* Diarrhea.
* Trouble swallowing.
* Breaking out in a sweat.
* Nausea.
* Trembling.
* Dizziness.
* Feeling light headed, as if one were about to faint.
* Ringing in the ears.
Psychological symptoms of agoraphobia
* Fear that people will notice a panic attack, causing humiliation and embarrassment.
* Fear that during a panic attack their heart might stop, or they won’t be able to breathe, and may die.
* Fear that the sufferer himself/herself is going crazy.
The following psychological symptoms are also possible:
* Low self-confidence and self-esteem.
* Feeling a loss of control.
* Depression.
* General feeling of dread and anxiety.
* Thinking that without the help of others the sufferer himself/herself would never be able to function or survive.
* Dread of being left alone.
Behavioral symptoms of agoraphobia
* Avoidance – avoiding environments and situations that may trigger anxiety. In some cases this may be mild, where the sufferer avoids going in a crowded train. In extreme cases the person finds it very hard to leave the house.
* Reassurance – the sufferer needs to be reassured by another person. Going out to the shops may only be possible if a friend comes along too. In extreme cases the sufferer finds being alone unbearable.
* Safety behavior – needing to have or to take something in order to confront situations or places that trigger anxiety. Some sufferers have to have an alcoholic drink before going into a crowded place, while others cannot go outside unless they are sure they have their tablets with them.
* Escape – leaving a stressful place or situation straight away and going back home.
What are the causes of agoraphobia?
Experts are not completely sure what the exact causes of agoraphobia are. Most believe that they are a result of physical and/or psychological factors.
* A complication of a panic disorder
Agoraphobia is thought to be a complication of a panic disorder – a disorder characterized by regular episodes of panic attacks (intense fear) which trigger severe physical reactions for no apparent reason. Panic attacks can be extremely frightening – causing people to think they are losing control, or even dying.
Some people may link their panic attacks to one or two situations in which they occurred. By avoiding those places or situations the sufferer believes he/she may be preventing future recurrences of panic attacks. If a situation or place has people – perceived as potential witnesses to a panic attack by the sufferer – they are more likely to avoid it.
Agoraphobia very rarely develops without an accompanying panic disorder. When it does, nobody knows what caused it.
* Some medications and substances
Long-term use of tranquilizers and sleeping medications, such as benzodiazepines, have been linked to agoraphobia. Health care professionals report that when benzodiazepine dependence is treated agoraphobia symptoms eventually improve.
* Difficulties with spatial orientation
Some studies have found a link between agoraphobia and problems with spatial orientation. Most people without agoraphobia can maintain balance by combining data from their vestibular (components in the inner ear) and visual systems, as well as their proprioceptive sense (the sense of the relative position of neighboring parts of one’s own body). A higher percentage of people with agoraphobia have weak vestibular function, compared to the rest of the population, and consequently rely more on tactile and visual signals. When visual signals are overwhelming, as may be the case in a crowded place, the sufferer is more likely to become disoriented.
* Some other factors
o A history of alcohol abuse.
o A history of drug abuse.
o A traumatic childhood experience.
o A very stressful event, such as bereavement, loss of a job, an explosion, war, or devastating earthquake.
o A history of mental illness, such as an eating disorder or depression.
How is agoraphobia diagnosed?
A GP (general practitioner, primary care physician) who identifies psychological symptoms of agoraphobia will most likely refer the patient to a psychiatrist – a doctor who specializes in the diagnosis, prevention and treatment of mental illness. The GP may also examine the patient if there are physical symptoms to find out where there are any underlying physical causes.
The psychiatrist will ask the patient about his/her feelings, symptoms and general background. The specialist will also try to find out whether the agoraphobia is being caused by another mental health condition. If this is the case, it must be addressed first before being able to successfully treat the agoraphobia. For example, a person who avoids crowds because he/she has a fear of catching other people’s germs most likely has OCD (obsessive-compulsive disorder).
According to the DSM-IV Diagnostic Criteria for Agoraphobia, a patient suffers from agoraphobia if:
* The person is anxious about being in a place or situation where escape or help may be difficult in the event of a panic attack, or panic like symptoms. Examples are being in a crowd or travelling on a bus.
* The person avoids these places (described above).
* The person endures these places (described above) with extreme anxiety.
* The person endures these places (described above) only with the help of a friend or companion.
* There is no other underlying condition that may explain the person’s symptoms.
Some experts criticize this classification system because it does not include people with agoraphobia who do not have other symptoms of panic disorder, including patients who have never had a history of panic attacks, or those whose agoraphobia is triggered by other fears not linked to panic attacks. Even so, panic attacks do not necessarily have to be present for a diagnosis of agoraphobia to be confirmed.
What are the treatment options for agoraphobia?
Treatment for agoraphobia usually involves a combination of medication and psychotherapy. In the majority of cases treatment is effective and the patient is either cured or learns to keep it under control.
Medications for agoraphobia
Anti-anxiety drugs and antidepressants are generally prescribed for patients with agoraphobia and panic symptoms. In some cases the patient may have to try out some different medications before hitting on the best one.
* SSRIs (selective serotonin reuptake inhibitors) – these antidepressant drugs include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) or sertraline (Zoloft).
Side effects may include:
o Headaches
o Insomnia
o Nausea
o Sexual dysfunction
* Tricyclic antidepressants or monoamine oxidase inhibitors – these antidepressant drugs may also be used to treat agoraphobia. However, they tend to have more side effects.
* Anti-anxiety medications (benzodiazepines) – examples are alprazolam (Xanax) and clonazepam (Klonopin). They are used to treat anxiety and can also help control the symptoms of a panic attack. If taken in doses larger than those prescribed, or for too long, they can cause dependence.
Side effects may include:
o Confusion
o Drowsiness
o Light-headedness
o Loss of balance
o Memory loss
Patients usually start off on small and gradually increasing dosages. At the end of treatment the doctor will probably gradually lower the dosage.
Psychotherapy for agoraphobia
Psychotherapy is treatment by psychological means. Psychotherapy may utilize persuasion, suggestion, reassurance, insight (perceptiveness, self-awareness), and instruction so that the person can see himself/herself and their problems in a more realistic way and wish to overcome and/or cope with them effectively. There are many types of psychotherapy, including cognitive therapy, interpersonal therapy, psychodynamic therapy, and family therapy.
Cognitive behavioral therapy (CBT) – this type of therapy has two parts. The cognitive part focuses on learning more about agoraphobia and panic attacks and how to manage them. The patient learns what the panic attack or panic-like symptom triggers are, and what makes them worse. Coping techniques, such as breathing and relaxation exercises are taught and practiced.
The behavioral part involves altering unhealthy or undesirable behaviors. This may be done through desensitization or exposure therapy, also known as cognitive delivered exposure (CDE). The patient safely confronts the situations or places that cause problems, often in the company of the therapist. With practice and guided exposure the patient learns that what he/she feared might happen does not occur, resulting in a gradual decline of anxiety.
Sometimes the therapist may start sessions off in the patient’s home if venturing outside is too difficult. The first few appointment may also take place in a ‘safe zone’ if getting to the therapist’s office is perceived as having too many anxiety triggers. A good agoraphobia therapist should be aware of these problems and have practical options for the patient. Another possibility is to have the first few sessions over the phone.
What are the complications of agoraphobia?
Complications of agoraphobia may occur if the patient does not receive treatment.
An agoraphobia sufferer may eventually have a very restricted lifestyle. In severe cases the person will never leave the house and is dependent on other people. Being housebound usually means the patient’s job prospects are severely limited. His/her social life, opportunities for education and learning new skills, walking the dog, running errands, or taking part in various daily activities are affected.
People with untreated agoraphobia have a much higher risk of developing depression, further anxiety disorders, and turning to alcohol or other substances.
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January 9th, 2010 at 9:51 pm
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January 10th, 2010 at 1:16 am
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Hello everyone … while I was researching the HCG Diet Protocol I came across this page of other HCG dieters and really appreciated reading the thoughts, concerns and encouragement of others on the diet. I too am beginning this diet and injection tomorrow, Monday, May 19. I have been under a doctors care for a little over two months … have gone through a 28 day detox where I only lost 3 pounds and then keep on the detox way of eating (which is most often my normal way of eating) and remain stuck at the weight I am. I am 5’7″ and cannot seem to get below 170 pounds. Although to some this weight may be okay, it is horrendous for me. I can walk 30 miles a week and I still am stuck, I am taking thyroid pills and still am stuck, I have struggled with chronic constipation for 20+ years and the doctor believes this is some of the problem, I have also struggled with bulemia for 20+ years but in the last 5 or so is 85% better. I didn’t know if some of those on the HCG diet have a background like mine. Anyway, all this to say that after trying just about everything my doctor feels it is a good time to do the HCG injections and is adament about not deviating off the 500 calorie diet. He said it is critical to do exactly what they say; he has only, on occasion, had a patient increase their protein when they struggled with energy levels. I am anxious to get started and excited to see the results! I have never been able to accept myself as a chubby person and have kept myself out of social activities because of my weight. I just want to be normal again after being told by many doctors that I am not the typical because nothing seems to work for me; I have always told them my body does not process my food and it stays in my stomach for hours and hours … I could throw up meat 6 hours after eating it and salad 4 hours after eating it … this is not normal. Can someone who has been on the program tell me the benefit of binging for the first two days when you start the injections; it seems like such a set up for failure and always seems to make a person even more hungry the following days. I will follow whatever I am instructed to do because I am desperate to get my 30-35 pounds off and not just the weight but the fat that just seems to sit there and never go away. I would love to have a connecting to others on the protocol to hold each other accountable and also to receive the support myself. Sorry for the long novel … I really do try to keep things short.
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Wow! Thank you! I always wanted to write in my site something like that. Can I take part of your post to my blog?
November 4th, 2010 at 1:40 pm
A subject near to my heart thanks, You must have a Facebook group for your site?
November 4th, 2010 at 3:44 pm
I agree, tyvm for sharing this..
November 5th, 2010 at 12:52 am
Keep working, nice post! Just the info I needed.
November 5th, 2010 at 1:27 am
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November 5th, 2010 at 6:30 am
Hey – nice blog, just looking around some blogs, seems a pretty nice platform you are using. I’m currently using WordPress for a few of my sites but looking to change one of them over to a platform similar to yours as a trial run. Anything in particular you would recommend about it?
November 5th, 2010 at 11:18 am
God has made everything so mysterious that we humans can’t even think of that. Talking fishes might be possible but for those who have not seen is still a mystery.
November 5th, 2010 at 2:09 pm
Amazing! I have already been looking yahoo and google for hours for this and i also ultimately think it is here!
November 6th, 2010 at 1:55 pm
Thought I would comment and say cool theme, did you code it on your own? It’s really great!
November 6th, 2010 at 5:31 pm
I just book marked your blog on Digg and StumbleUpon.I enjoy reading your commentaries.
November 6th, 2010 at 5:32 pm
I just sent this post to a bunch of my friends as I agree with most of what you’re saying here and the way you’ve presented it is awesome.
November 6th, 2010 at 6:48 pm
Hi, I need to ask you a question, how can I ge ta hold of you_
November 7th, 2010 at 4:46 am
Hello, thank you for taking the time and effort to write this post. I feel a bit more enlightened after going through the article. Again, I really appreciate it and hope you have a wonderful day. Take care – J
November 7th, 2010 at 5:58 pm
bit offtopic – I experience Ones website into google and also I’m wondering Techniques to long went it get web site To get To the top 10 ranking? I have a in truth niche category by low competition. My web site is optimized using over 250 resources, good keyword density, optimized title and also description tags, etc. Here’s how endless will it take my website how to zero in on the great ten listing by use of yahoo or google?
November 8th, 2010 at 2:31 pm
Social networking is good and bad. It’s nice to say you got 10,000 friends, but it’s bad when you never met any of them and probably never will.
November 8th, 2010 at 10:27 pm
I would not assume I’ve ever noticed a web site using this type of many reviews in it!
November 9th, 2010 at 2:34 am
What a waste of time. You’re poor english made this article hard to read. Learn to write.
November 9th, 2010 at 8:54 am
Hmm i found a similar entry on a secound page and didn’t quite get it, but your story helped me understand it better. A lot thanks publisher!
November 9th, 2010 at 11:11 am
Its funny, There was never so much consumtion of music than today! But still, the industry is dead!
November 9th, 2010 at 1:59 pm
What did people do before Twitter? Suffer? Presumably, they suffered.