The term agoraphobia is derived from the Greek word agora, meaning place; in fact, the earliest uses of the word in psychology and psychiatry were for people who were afraid of being in crowded places.

In fact, patients with symptoms of agoraphobia fear situations where it is difficult to escape or get help. Consequently, they avoid such places in order to control the anxiety associated with the anticipation of a new panic crisis.

Agoraphobia is an anxiety disorder characterized by intense fear and anxiety triggered by actual or anticipated exposure to a variety of situations.

The fear and/or anxiety is caused by being alone in places or situations from which it would be difficult or embarrassing to escape. Or where help may not be readily available.

People with agoraphobia experience thoughts related to the fact that something terrible might happen to them. For example, “I can’t escape/run away/get out” and/or “There’s no one to help me.

Characteristics and signs of agoraphobia

In most cases, agoraphobia is a problem that emerges secondary to the onset of panic attacks or minor anxiety crises.

It is diagnosed when the agoraphobic person begins to systematically avoid all places, situations, and contexts where there may be obstacles to getting help.

Agoraphobic avoidance and protective behavior

Situations most commonly avoided by those who exhibit symptoms of agoraphobia include:

  • Going out alone or staying home alone
  • Driving or traveling by car
  • Going to crowded places such as markets or concerts
  • Riding the bus or airplane
  • Being on a bridge or in an elevator

When these avoidances begin to interfere with the person’s daily activities and social functioning, it is called agoraphobia.

Sometimes the problem is more difficult to recognize because the person does not avoid certain feared situations, but becomes unable to cope with them without the assistance of a trusted person.

In this regard, it is possible that instead of avoidance, the agoraphobic person uses protective behaviors to prepare for a particular feared situation.

Although avoidance and protective behaviors may be useful for the individual in the short term, in the long term they do not allow him or her to cope with the problem and are powerful factors in maintaining the disorder itself.

Agoraphobia and panic attack disorder

Agoraphobia can be diagnosed within panic disorder with agoraphobia or as agoraphobia without a history of panic disorder.

In the latter case, the crises that the patient avoids are characterized by panic-like anxiety symptoms, but without all the features of the actual panic attack.

Symptoms of agoraphobia

Agoraphobia is characterized by symptoms such as

  • Fear of being in places where it would be difficult to get away, escape, or seek and receive help should a panic attack or anxiety crisis occur.
  • The feared situations are avoided or managed with great difficulty or with the support of a companion.
  • Anxiety and avoidance limit the person’s social and occupational functioning and do not result from other types of fears or phobias. For example, avoidance of elevators in claustrophobia, avoidance of social situations in social phobia, avoidance of stimuli reminiscent of a traumatic event in post-traumatic stress disorder.
  • There may also be symptoms such as increased heart rate, excessive sweating, increased breathing rate, dizziness, and fear of losing control or dying. This is because people with agoraphobia often experience the physical and psychological symptoms typical of a panic attack.
  • One may experience the presence of brooding, which is the constant thinking and rethinking of negative events that might happen, with the goal of anticipating, preventing, and preparing for them.

Agoraphobia therapy

Cognitive behavioral therapy

Standard cognitive-behavioral therapy for the treatment of agoraphobia includes behavioral interventions based on situational exposure, as well as initial psychoeducation and cognitive interventions.

Within cognitive-behavioral psychotherapy, exposure techniques have proven useful in reducing behaviors that fuel agoraphobic anxiety.

More recently, strategies have been implemented to increase the ability of individuals to remain in contact with anxious activation without fear of its catastrophic consequences. Promote acceptance and reduce the need to control anxiety symptoms.

In certain cases, it is appropriate for the psychotherapist to work in a multidisciplinary setting with a psychiatrist to consider pharmacological help in treating the disorder.

Pharmacological therapy

In general, psychotherapy is essential for the treatment of agoraphobia.

Psychotropic drugs may help in the short term by reducing anxiety and panic attacks, but in the long term they create a strong psychological dependency.

In addition, the symptoms of agoraphobia often return when the medication is discontinued.

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