What is Agoraphobia?
Agoraphobia (synonymous with topophobia, from Greek agore – the market square, phobos – fear) is a kind of obsessive fears, expressed in the fear of empty spaces that occurs when crossing wide open spaces, areas also close to them, such as the presence of a crowd and the impossibility immediately back to safety. Thus, agoraphobia includes a whole set of interrelated and usually partially coincident phobias, covering fears of leaving the house: go into shops, crowds or public places, or travel alone in trains, buses or airplanes. Despite the fact that the intensity of anxiety and the severity of avoiding behavior may be different, this is the most disadaptive of phobic disorders, and some patients become completely housebound.
Causes of Agoraphobia
It occurs psychogenically in people with a sufficiently developed imagination, more often in women. Demonstration may be preceded by depressive episodes. Fear has the features of obsession, after leaving the state there is often a fear of fear (phobophobia). In an analytical sense, fear is associated with fear of aggression or accusation.
Pathogenesis during Agoraphobia
The onset of the disorder usually occurs in early adulthood. Starting as a fear of open spaces, the symptoms are enriched by the fear of the crowd, the inability to immediately return to a safe place (home), the fear of traveling alone in transport. As a result, patients are maladjusted and become housebound. Lack of immediate access to the exit dramatically increases fear. The flow is wavy, tends to chronic. In the absence of an effective treatment, agoraphobia often becomes chronic, although it usually flows in waves.
Symptoms of Agoraphobia
Fear of open spaces, crowds and the inability to return to a safe place, fear of losing consciousness in a crowded place, the lack of immediate access to the exit.
Starting as a fear of open spaces, the symptoms are enriched by the fear of the crowd, the inability to immediately return to a safe place (home), the fear of traveling alone in transport. As a result, patients are maladjusted and become housebound. Lack of immediate access to the exit dramatically increases fear. The flow is wavy, tends to chronic. Accompanied by a vegetative response. This can lead to problems in relationships with others, because the patient’s avoidance extends to people who are associated with open space.
If there is an attempt to abruptly leave the place of the origin of fear, a diagnosis of agoraphobia with panic disorder is made.
Diagnosis of Agoraphobia
- Anxiety or fear should be limited only (or predominantly) to two of the following situations: (a) a crowd or public place, movement outside the home, (b) traveling alone.
- Phobic situations are avoided, and psychological or vegetative symptoms should be the primary expression of anxiety, and not be secondary to other symptoms, such as delirium or obsessive thoughts.
- Avoiding phobic situations is or was a pronounced symptom.
According to the presence or absence of panic disorder (attempts to abruptly leave the place where the fear originated), in most cases, falling into the agoraphobic situation shares agoraphobia without panic disorder and agoraphobia with panic disorder
Differential diagnosis. It should be differentiated from a depressive episode if there was a distinct depression at the time of the appearance of the phobia, as well as an organic anxiety-phobic disorder. In a depressive episode, the remaining criteria for depression are present, and organic matter can be excluded by additional methods of investigation. Symptoms of agoraphobia can also be secondary to delusions or obsessive-compulsive disorder.
Desensitization and other behavioral therapies, hypnotherapy, auto-training, meditative training and psychoanalysis. Tricyclic antidepressants, monoamine oxidase inhibitors, alprazolam, and fluoxetine are used.