Anxiety Disorder: Agoraphobia

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Agoraphobia among the anxiety disorders and describes it as anxiety, or avoidance of places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack or panic-like symptoms. The greek work “agora” means, “assembly or market place” (Wittchen, H., Gloster, A. T., Beesdo-Baum, K., Fava, G. A., & Craske, M. G., 2010). Agoraphobic fears typically involve characteristic clusters of situations that include being outside the comfort and safety of their own home, although others are able to venture outside there homes. Furthermore, they fear traveling on a bus, train, or car. Walking on a bridges, standing on a large field or meeting with friends; being among many people, and waiting in a line. Additionally, they may also fear certain weather conditions. Agoraphobia is theorized as a response to apparent threat in the absence of a secure space, characterized by unrecognized person or space. Phobias are generally not reported and diagnosed incorrectly, perhaps because the person stricken with phobia find ways to avoid any situation that may cause them to feel phobic. Conversely, agoraphobia many times occurs in combination with panic disorder making it even more difficult to keep track of how often it takes place. Agoraphobia varies from person to person. Other statistics about agoraphobia estimate it occurs less than 1% to almost 7% of the population. Agoraphobia is one of the most difficult disorders of anxiety because it produces the highest level of incapacitation (Jacobson, K., 2011). Most patients treated with agoraphobia have been home stricken for many years (Holmes, J., 2008). Agoraphobia mainly affects women, for the reason that women are socialized to see themselves as vulnerable and weak in comparison to men; disadvantaged in terms of power, control and influence. Its age of onset is most often during the mid to late 20s. Most studies propose a large percentage of people diagnosed with agoraphobia are female (Jacobson, K., 2011). Some research has shown a more chronic and debilitating course in African-American individuals. One challenging statistic related to treatment is that less than half of suffers of agoraphobia in the United States are receiving treatment.

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Studies suggest that anxiety disorders may be associated with high activity in the hippocampus and the locus coeruleus, a part of the brain that screens external and internal stimuli and controls the brain’s responses to them. Additionally, anxiety disorder patients have an increase in activity in portions of the nervous system called the adrenergic system, which controls such physiological functions as heart rate and body temperature. Conversely, it is not clear if these increases reflect the anxiety symptoms or if it may be the cause of them. Another study suggest that patients with anxiety disorders, such as, agoraphobia may have abnormalities in their benzodiazepine receptors. Researchers use several different methods to provoke panic type symptoms known as intravenous administration of sodium lactate, the same chemical that normally builds up in the muscles during heavy exercise. Researchers have found that these type of exercises performed do not trigger anxiety in patients that do not suffer from these type of disorders. Individuals that already have an anxiety disorder are biologically different in some ways from people who do not have these disorders. Interestingly, caffeine is used in patients that are susceptible to anxiety (5 cups or more are required) to trigger a panic. Researchers are studying the basic thought processes and emotions of patients diagnosed with anxiety type disorders to find what comes into play during a panic attack (Harvard Mental Health Letter, 1996).

The symptoms of agoraphobia include but are not limited to anxiety; that one will have a panic attack in open spaces or even tight spaces where others are present causing them to feel they have no escape or will face an embarrassing situation. The physical symptoms and signs are intense fear, disorientation, rapid heartbeat, dizziness, and diarrhea (Harvard Mental Health Letter, 1996). Agoraphobia may cause many complications. It increases the probability that the person will suffer from other anxiety disorders, such as social, panic, or posttraumatic disorders. Agoraphobics are at a higher risk of suffering from alcoholism. Furthermore, agoraphobia is likely to occur more in people with a number of different physical conditions such as, irritable bowel syndrome and asthma. If agoraphobia is left without treatment it may worsen to the point the person’s life will be seriously affected by the disease and or other health problems. Furthermore, some people have problems with friends and family, failed with their education, career, and job lost (Aslam N., 2012).

The prognosis of agoraphobia in patients may show improvements or periods of improvements of symptoms. The condition does not usually go away on its own unless there is treatment that is designed specifically to help such disorder. As agoraphobia many times develops as a fear reaction to being in a situation that may cause them to not be able to get out of, prevention of agoraphobia is nearly impossible. Therapy focuses on ways to cope with the anxiety and the possibilities of another attack without avoiding the place the attack takes place (Holmes, J. (2008).

The first account of agoraphobia is recognized by Westphal’s, he was a German neurologist and psychiatrist from Berlin. He was the inventor of the term “agoraphobia”, when he witnessed patients display extreme anxiety and feelings of terror when they had to enter certain public areas of the city (Holdorff, B., 2005). This was Westphal’s classical description (1871) of the syndrome that during the major part of the last century, served as a model example of anxiety disorders in general. From that time until the introduction of DSM-III-R, agoraphobia was often labeled and described in literature as a common and distressing phobic disorder or as phobic neurosis in the older literature. Universally, agoraphobia was presented and classified as an independent diagnostic entity and unique syndrome of multiple fears in the 1970s, where it retains this status even today (Wittchen, H., et al., 2010).

Agoraphobia is usually associated with panic attacks. It is not known why agoraphobia occurs and may be very complex. Agoraphobics feel they cannot escape the situation they find themselves in, therefore they avoid any situation that may place them in a phobic state. Adolescent and young adults are prone to experience an anxiety disorder such as agoraphobia because of the developmental stages as such the disorder may be overlooked as a phase. As other forms of anxiety, agoraphobia is mainly learned. There are theories that say, someone develops agoraphobia after a panic attack in a crowded or unfamiliar place. Afterwards, the person starts to fear that similar situation will trigger another panic attack and starts to avoid any activities that may cause a panic attack (Miller, M.C., 2011). Agoraphobia is not the same as social anxiety. Social anxiety produces extreme fear of situations in which you believe others will watch or critic you. Agoraphobia is a disorder in which you avoid situations that you are afraid might cause you a panic attack (Mayo Clinic Health Letter, 2012).

Agoraphobia is mainly treated with cognitive behavior therapy, and in some incidents with medication. The most effective treatment is when you explain to the patient suffering from agoraphobia what cause the disorder. The key lies in understanding the state in which the nervous reaction to stress is typically intense and rapid. Sensitization, confusion, and terror are three reactions which lead to an anxiety state of which agoraphobia, when present, is the most crippling symptom (Weekes, C., 1973). Teaching the person with agoraphobia how to cope in stressful situation is also an effective tool. Exposing the person to a stressful stimuli and helping them through it brings a sense of ease to agoraphobics. A study showed that using virtual reality googles to place the agoraphobic in grocery stores, beaches, and large malls to confront their fear, recovered three times more rapidly than those in traditional cognitive therapy. Mainly, affirming the agoraphobic person that stressful, confusion, and fearful situation are a part of everyone’s everyday life. They are not alone and they have the ability to overcome, with therapy and encouragement they may be able to overcome phobic attacks. Finally, to desensitize the agoraphobic; and stressing that repetition of advice is the root of treatment for agoraphobia (Miller, M.C., 2011).

What may cause agoraphobia? A number of theories about what can cause agoraphobia are known. Studies have shown that agoraphobia develops in reaction to constant experiences to anxiety-provoking events. Mental-health professionals that focus on how individuals react to inner emotional conflicts (psychoanalytic theory) describes agoraphobia as the result of a feeling of emptiness. Although agoraphobia, as other mental disorders, are related to a number of psychological and environmental risk factors, it too has a tendency to run in families, in addition for some people, it may have a clear genetic factor contributing to its development. Young female and women are at greater risk to develop agoraphobia compared to male children and men. For people of different ethnics and minorities in the United States, a large factor of influence of developing agoraphobia or any other anxiety disorder are higher than any other groups. Like immigration from another country, language proficiency, feeling discriminated against, as well as the specific ethnicity of the individual (Mayo Clinic Health Letter, 2012). It is still unknown the causes of agoraphobia research is still being done to better understand what causes someone to suffer from agoraphobia. Conversely, with most mental illnesses, agoraphobia is mostly caused by a mix of complex deficiencies such as, biology and genetics, life experiences, temperament, and character traits (Pam, A., Inghilterra K., 1994).

As I have explored this topic I have clearly understood the processes of this disorder. It sadness me to know there are so many people suffering from this disorder without treatment. Although agoraphobia is still being researched for its cause and best treatment it is good to know that extensive research is being done. To my surprise agoraphobia strikes so many although the percentages of suffers according to research is low, there are so many agoraphobics that do not seek help. Conversely, the fact that women are prone to this disorder over men; for centuries women have been treated as the lesser vessel and their characters have been demeaned. I can see why women over men are affected by this disorder.

With so many breakthroughs in medicine and therapy we must continue to strive to get this disorder out of the lives of so many people that have the ability to achieve and succeed. Because they are bound to this illness they are psychologically struck by the possibilities of overcoming this illness.

References

Holdorff, B. (2005) Carl Westphal (1833–1890). Journal of Neurology, Vol. 252(10), pp.1288-1289. Retrieved June 24, 2015. http://ehis.ebscohost.com.db20.linccweb.org/ehost/pdfviewer/pdfviewer?vid=3&[email protected]&hid=4105

Holmes, J. (2008). Space and the secure base in agoraphobia: a qualitative survey. Area, 40(3), 375-382. Retrieved June, 27 2015. http://ehis.ebscohost.com.db20.linccweb.org/ehost/pdfviewer/pdfviewer?vid=14&[email protected]&hid=4210

Is agoraphobia the same thing as social anxiety disorder? (2012). Mayo Clinic Health Letter, 30(8),8. Retrieved June 27, 2015.

http://search .ebscohost.com/login.asp?direct=true&db=mnh&an=23045742&site=ehost-live.

Jacobson, K. (2011). Embodied Domestics, Embodied Politics: Women, Home, and Agoraphobia. Human Studies, Vol. 34, No. pp. 1-21. Retrieved November 25, 2013. http://www.jstor.org.db20.linccweb.org/stable/41478453.

Miller, M.C. (2011). What is agoraphobia? Harvard Mental Health Letter, 27(11), 8. Retrieved June 23, 2015. http://search.ebscohost.com/login.aspx?direct=true&bd=rzh&an=2011002412&site=ehost-live.

Pam A, Inghilterra K. Agoraphobia: The interface between anxiety and personality disorder. Bulletin of The Menninger Clinic [serial online]. Spring 94 1994; 58(2):242. Available from: Academic Search Complete, Ipswich, MA. Accessed June 28, 2015.

Weeks, C. (1973). A Practical Treatment of Agoraphobia. The British Medical Journal, vol.2, No. 5864, pp. 469-471. Retrieved June 23, 2015. http://www.jstor.org/stable/254425732.

Wittchen, H., Gloster, A. T., Beesdo-Baum, K., Fava, G. A., & Craske, M. G. (2010). Agoraphobia: a review of the diagnostic classificatory position and criteria. Depression & Anxiety (1091-4269), 27(2), 113-133. Retrieved June 24, 2015.

http://ehis.ebscohost.com.db20.linccweb.org/ehost/pdfviewer/pdfviewer?vid=15&[email protected]&hid=4102

Panic attacks and panic disorder–part II.Harvard Mental Health Letter[serial online].

May 1996; 12(11):1. Available from: Academic Search Complete, Ipswich, MA.

Accessed June 27, 2015.

Aslam N., Management of Panic Anxiety with Agoraphobia by Using Cognitive Behavior Therapy. Indian Journal of Psychological Medicine [serial online]. January 2012; 34 (1):79-81. Available from: Academic Search Complete, Ipswich, MA. Accessed June 28, 2015.

Agoraphobia among the anxiety disorders and describes it as anxiety, or avoidance of places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack or panic-like symptoms. The greek work “agora” means, “assembly or market place” (Wittchen, H., Gloster, A. T., Beesdo-Baum, K., Fava, G. A., & Craske, M. G., 2010). Agoraphobic fears typically involve characteristic clusters of situations that include being outside the comfort and safety of their own home, although others are able to venture outside there homes. Furthermore, they fear traveling on a bus, train, or car. Walking on a bridges, standing on a large field or meeting with friends; being among many people, and waiting in a line. Additionally, they may also fear certain weather conditions. Agoraphobia is theorized as a response to apparent threat in the absence of a secure space, characterized by unrecognized person or space. Phobias are generally not reported and diagnosed incorrectly, perhaps because the person stricken with phobia find ways to avoid any situation that may cause them to feel phobic. Conversely, agoraphobia many times occurs in combination with panic disorder making it even more difficult to keep track of how often it takes place. Agoraphobia varies from person to person. Other statistics about agoraphobia estimate it occurs less than 1% to almost 7% of the population. Agoraphobia is one of the most difficult disorders of anxiety because it produces the highest level of incapacitation (Jacobson, K., 2011). Most patients treated with agoraphobia have been home stricken for many years (Holmes, J., 2008). Agoraphobia mainly affects women, for the reason that women are socialized to see themselves as vulnerable and weak in comparison to men; disadvantaged in terms of power, control and influence. Its age of onset is most often during the mid to late 20s. Most studies propose a large percentage of people diagnosed with agoraphobia are female (Jacobson, K., 2011). Some research has shown a more chronic and debilitating course in African-American individuals. One challenging statistic related to treatment is that less than half of suffers of agoraphobia in the United States are receiving treatment.

Studies suggest that anxiety disorders may be associated with high activity in the hippocampus and the locus coeruleus, a part of the brain that screens external and internal stimuli and controls the brain’s responses to them. Additionally, anxiety disorder patients have an increase in activity in portions of the nervous system called the adrenergic system, which controls such physiological functions as heart rate and body temperature. Conversely, it is not clear if these increases reflect the anxiety symptoms or if it may be the cause of them. Another study suggest that patients with anxiety disorders, such as, agoraphobia may have abnormalities in their benzodiazepine receptors. Researchers use several different methods to provoke panic type symptoms known as intravenous administration of sodium lactate, the same chemical that normally builds up in the muscles during heavy exercise. Researchers have found that these type of exercises performed do not trigger anxiety in patients that do not suffer from these type of disorders. Individuals that already have an anxiety disorder are biologically different in some ways from people who do not have these disorders. Interestingly, caffeine is used in patients that are susceptible to anxiety (5 cups or more are required) to trigger a panic. Researchers are studying the basic thought processes and emotions of patients diagnosed with anxiety type disorders to find what comes into play during a panic attack (Harvard Mental Health Letter, 1996).

The symptoms of agoraphobia include but are not limited to anxiety; that one will have a panic attack in open spaces or even tight spaces where others are present causing them to feel they have no escape or will face an embarrassing situation. The physical symptoms and signs are intense fear, disorientation, rapid heartbeat, dizziness, and diarrhea (Harvard Mental Health Letter, 1996). Agoraphobia may cause many complications. It increases the probability that the person will suffer from other anxiety disorders, such as social, panic, or posttraumatic disorders. Agoraphobics are at a higher risk of suffering from alcoholism. Furthermore, agoraphobia is likely to occur more in people with a number of different physical conditions such as, irritable bowel syndrome and asthma. If agoraphobia is left without treatment it may worsen to the point the person’s life will be seriously affected by the disease and or other health problems. Furthermore, some people have problems with friends and family, failed with their education, career, and job lost (Aslam N., 2012).

The prognosis of agoraphobia in patients may show improvements or periods of improvements of symptoms. The condition does not usually go away on its own unless there is treatment that is designed specifically to help such disorder. As agoraphobia many times develops as a fear reaction to being in a situation that may cause them to not be able to get out of, prevention of agoraphobia is nearly impossible. Therapy focuses on ways to cope with the anxiety and the possibilities of another attack without avoiding the place the attack takes place (Holmes, J. (2008).

The first account of agoraphobia is recognized by Westphal’s, he was a German neurologist and psychiatrist from Berlin. He was the inventor of the term “agoraphobia”, when he witnessed patients display extreme anxiety and feelings of terror when they had to enter certain public areas of the city (Holdorff, B., 2005). This was Westphal’s classical description (1871) of the syndrome that during the major part of the last century, served as a model example of anxiety disorders in general. From that time until the introduction of DSM-III-R, agoraphobia was often labeled and described in literature as a common and distressing phobic disorder or as phobic neurosis in the older literature. Universally, agoraphobia was presented and classified as an independent diagnostic entity and unique syndrome of multiple fears in the 1970s, where it retains this status even today (Wittchen, H., et al., 2010).

Agoraphobia is usually associated with panic attacks. It is not known why agoraphobia occurs and may be very complex. Agoraphobics feel they cannot escape the situation they find themselves in, therefore they avoid any situation that may place them in a phobic state. Adolescent and young adults are prone to experience an anxiety disorder such as agoraphobia because of the developmental stages as such the disorder may be overlooked as a phase. As other forms of anxiety, agoraphobia is mainly learned. There are theories that say, someone develops agoraphobia after a panic attack in a crowded or unfamiliar place. Afterwards, the person starts to fear that similar situation will trigger another panic attack and starts to avoid any activities that may cause a panic attack (Miller, M.C., 2011). Agoraphobia is not the same as social anxiety. Social anxiety produces extreme fear of situations in which you believe others will watch or critic you. Agoraphobia is a disorder in which you avoid situations that you are afraid might cause you a panic attack (Mayo Clinic Health Letter, 2012).

Agoraphobia is mainly treated with cognitive behavior therapy, and in some incidents with medication. The most effective treatment is when you explain to the patient suffering from agoraphobia what cause the disorder. The key lies in understanding the state in which the nervous reaction to stress is typically intense and rapid. Sensitization, confusion, and terror are three reactions which lead to an anxiety state of which agoraphobia, when present, is the most crippling symptom (Weekes, C., 1973). Teaching the person with agoraphobia how to cope in stressful situation is also an effective tool. Exposing the person to a stressful stimuli and helping them through it brings a sense of ease to agoraphobics. A study showed that using virtual reality googles to place the agoraphobic in grocery stores, beaches, and large malls to confront their fear, recovered three times more rapidly than those in traditional cognitive therapy. Mainly, affirming the agoraphobic person that stressful, confusion, and fearful situation are a part of everyone’s everyday life. They are not alone and they have the ability to overcome, with therapy and encouragement they may be able to overcome phobic attacks. Finally, to desensitize the agoraphobic; and stressing that repetition of advice is the root of treatment for agoraphobia (Miller, M.C., 2011).

What may cause agoraphobia? A number of theories about what can cause agoraphobia are known. Studies have shown that agoraphobia develops in reaction to constant experiences to anxiety-provoking events. Mental-health professionals that focus on how individuals react to inner emotional conflicts (psychoanalytic theory) describes agoraphobia as the result of a feeling of emptiness. Although agoraphobia, as other mental disorders, are related to a number of psychological and environmental risk factors, it too has a tendency to run in families, in addition for some people, it may have a clear genetic factor contributing to its development. Young female and women are at greater risk to develop agoraphobia compared to male children and men. For people of different ethnics and minorities in the United States, a large factor of influence of developing agoraphobia or any other anxiety disorder are higher than any other groups. Like immigration from another country, language proficiency, feeling discriminated against, as well as the specific ethnicity of the individual (Mayo Clinic Health Letter, 2012). It is still unknown the causes of agoraphobia research is still being done to better understand what causes someone to suffer from agoraphobia. Conversely, with most mental illnesses, agoraphobia is mostly caused by a mix of complex deficiencies such as, biology and genetics, life experiences, temperament, and character traits (Pam, A., Inghilterra K., 1994).

As I have explored this topic I have clearly understood the processes of this disorder. It sadness me to know there are so many people suffering from this disorder without treatment. Although agoraphobia is still being researched for its cause and best treatment it is good to know that extensive research is being done. To my surprise agoraphobia strikes so many although the percentages of suffers according to research is low, there are so many agoraphobics that do not seek help. Conversely, the fact that women are prone to this disorder over men; for centuries women have been treated as the lesser vessel and their characters have been demeaned. I can see why women over men are affected by this disorder.

With so many breakthroughs in medicine and therapy we must continue to strive to get this disorder out of the lives of so many people that have the ability to achieve and succeed. Because they are bound to this illness they are psychologically struck by the possibilities of overcoming this illness.

References

Holdorff, B. (2005) Carl Westphal (1833–1890). Journal of Neurology, Vol. 252(10), pp.1288-1289. Retrieved June 24, 2015. http://ehis.ebscohost.com.db20.linccweb.org/ehost/pdfviewer/pdfviewer?vid=3&[email protected]&hid=4105

Holmes, J. (2008). Space and the secure base in agoraphobia: a qualitative survey. Area, 40(3), 375-382. Retrieved June, 27 2015. http://ehis.ebscohost.com.db20.linccweb.org/ehost/pdfviewer/pdfviewer?vid=14&[email protected]&hid=4210

Is agoraphobia the same thing as social anxiety disorder? (2012). Mayo Clinic Health Letter, 30(8),8. Retrieved June 27, 2015.

http://search .ebscohost.com/login.asp?direct=true&db=mnh&an=23045742&site=ehost-live.

Jacobson, K. (2011). Embodied Domestics, Embodied Politics: Women, Home, and Agoraphobia. Human Studies, Vol. 34, No. pp. 1-21. Retrieved November 25, 2013. http://www.jstor.org.db20.linccweb.org/stable/41478453.

Miller, M.C. (2011). What is agoraphobia? Harvard Mental Health Letter, 27(11), 8. Retrieved June 23, 2015. http://search.ebscohost.com/login.aspx?direct=true&bd=rzh&an=2011002412&site=ehost-live.

Pam A, Inghilterra K. Agoraphobia: The interface between anxiety and personality disorder. Bulletin of The Menninger Clinic [serial online]. Spring 94 1994; 58(2):242. Available from: Academic Search Complete, Ipswich, MA. Accessed June 28, 2015.

Weeks, C. (1973). A Practical Treatment of Agoraphobia. The British Medical Journal, vol.2, No. 5864, pp. 469-471. Retrieved June 23, 2015. http://www.jstor.org/stable/254425732.

Wittchen, H., Gloster, A. T., Beesdo-Baum, K., Fava, G. A., & Craske, M. G. (2010). Agoraphobia: a review of the diagnostic classificatory position and criteria. Depression & Anxiety (1091-4269), 27(2), 113-133. Retrieved June 24, 2015.

http://ehis.ebscohost.com.db20.linccweb.org/ehost/pdfviewer/pdfviewer?vid=15&[email protected]&hid=4102

Panic attacks and panic disorder–part II.Harvard Mental Health Letter[serial online].

May 1996; 12(11):1. Available from: Academic Search Complete, Ipswich, MA.

Accessed June 27, 2015.

Aslam N., Management of Panic Anxiety with Agoraphobia by Using Cognitive Behavior Therapy. Indian Journal of Psychological Medicine [serial online]. January 2012; 34 (1):79-81. Available from: Academic Search Complete, Ipswich, MA. Accessed June 28, 2015.

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