agoraphobia

Literal translation for the Latin is Fear of The Market Place.

Agoraphobia is a Psychological condition that can manifest at anytime in life, although it is usually occurs in the 20's and is suffered by Women more than Men. It is characterised mainly by the sufferer avoiding crowds and public places. In some cases sufferers also fear open spaces.

People will often start to restrict their activities to a smaller and smaller area, eventually leading to a situation where even the leaving the home will cause a Panic Attack. Depression is another symptom.

Below are some more common symptoms that people may suffer from, although I personally have not experienced all of the below.

• Fear of being alone
• Fear of losing control in a public place
• Fear of being in places where escape might be difficult
• Becoming house bound for prolonged periods
• Feelings of detachment or estrangement from others
• Feelings of helplessness
• Dependence upon others
• Feeling that the body is unreal
• Feeling that the environment is unreal
• Anxiety or panic attack (acute severe anxiety)
• Unusual temper or agitation with trembling or twitching


• Light-headedness, near fainting
• Dizziness
• Excessive sweating
• Skin flushing
• Breathing difficulty
• Chest pain
• Heartbeat sensations
• Nausea and vomiting
• Numbness and tingling
• Abdominal distress that occurs when upset
• Chokingthat occurs when emotional
• Confused or disordered thoughts
• Intense fear of going crazy
• Intense fear of dying

People have reported that when they first experience Panic Attacks associated with Agoraphobia they feel as thought they are having a heart attack and are about to die, such is the severity of the anxiety.

Treatment

The goal of treatment is to help the phobic personfunction effectively. The success of treatment usually depends upon the severity of the phobia. Systematic desensitization is a behavioural technique used to treat phobias. It is based upon having the person relax, then imagine the components of the phobia, working from the least fearful to the most fearful. Graded real-life exposure has also been used with success to help people overcome their fears. Antianxiety and antidepressive medications are sometimes used to help relieve the symptoms associated with phobias. Dependency on the medication is a possible side effect of this treatment.

Complications

Agoraphobia may cause problems with work and social life. Also, if suffered from in the teenage years, schooling may be affected. Recovery is possible, although strong willpower is needed to overcome the initial fears. The hardest part of recovery is to come to terms with the fact that something is wrong, and that if left untreated, will seriously hamper you ability to function in life.

Additional information from www.healthanswers.com

Recent research has revealed that agoraphobia is often secondary to panic disorder (the state of having frequent panic attacks), not vice versa as these otherwise accurate writeups state (citations for this and other assertions follow). Although they have a variety of causes and predisposing factors, panic attacks are generally caused by catastrophic misinterpretation of bodily sensations that are inherently benign. Much research has demonstrated that subjects with panic disorder are more likely to interpret ordinary, transient feelings of dizziness or faintness as signs of a heart attack, stroke, or nervous breakdown (among other things). This leads to heightened arousal, which in turn intensifies their sensations, and the spiral continues upwards until they have a panic attack.

The effect of this is that these people become extremely fearful of future attacks, and worry that if they are away from home and safety they will suffer an attack and something horrible will happen. This hypervigilance, of course, just increases their chances of having one. In this manner, panic disorder actually leads to agoraphobia. Similarly, treatment for panic disorder (involving education about the mechanisms above and gradual exposure to sensations like racing heart and hyperventilation, along with relaxation training) can lead to substantial improvement in agoraphobia as the subject's confidence in their basic safety and coping skills increases.

For basic information on the PD-agoraphobia link, see http://text.nlm.nih.gov/nih/cdc/www/85txt.html.
For information on panic disorder and catastrophic predictions, see Salkovskis, P., Clark, D., & Gelder, M. (1996). Cognitive-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34, 453-458.
For an interpretation of agoraphobia dealing with distance from safety cues, see Rachman, S. (1984). Agoraphobia -- A safety-signal perspective. Behavioural Research and Therapy, 22, 59-70.

Agoraphobia is an oft-misunderstood condition. Pretty much everthing I've read about it has been either overly clinical or wrapped up in platitudes that only fellow panic disorder sufferers can understand that make it sound more benign than it actually is.

I am an agoraphobic. I didn't ask to be one, I am not depressed, I am in fact a fairly confident person. My intellect is reasonable and my ambition strong. By agreeing to pay my taxes and obey (most of) the law, I am by most standards a model citizen. The kind of person you could introduce your parents to.

Yet as I stare out of the patio doors, I'm reminded of the person I am for most of the outside world. In here I am my own person; oustide I'm a nervous wreck. If I'm not on the move constantly I panic, and I mean constantly. Stopping to tie my shoes - the anxiety swells. Gotta pay for that book you've been after - expect to panic in the queue.

The problem is being outside feels so goddamn surreal. Being at home I feel normal for the most part. I recognise these few rooms I call my own. Yet when I step outside and lock the door behind me I'm struck by an overwhelming sense of unfamiliarity - like my entire life has turned into the lizard fuck scene from Fear and Loathing in Las Vegas. Unsurprisingly, it doesn't take long for this to cause a panic.

I know it's all irrational. My mind knows this, it knew it before I'd developed this disorder and it'll know it after it's gone. There is nothing to fear. Of course at home in my academic ivory tower I understand that panic attacks are harmless. My initial strategy was to face up to my fear and expose myself to the panic attacks. Yet when you are faced with three panic attacks per day, it's not long before you are drawn to your house as the only place you can feel safe. Conditioning is more powerful than the rational mind and human beings are imperfectly evolved.

A lot of people even wonder what a panic attack actually is. What makes it so scary? What even makes it scary enough to avoid leaving your own house? I can only talk from my own experience of course, but a panic attack for me starts off with a sudden intensity. Suddenly, you feel hot and dread sweeps over your entire body. Your surroundings feel surreal and thoughts immediately turn to how you could possibly get out of this place if you needed to. If your current situation doesn't allow for an easy escape, your thoughts turn to how long you have until you can be at your 'safe place' again. Ten, perhaps twenty minutes? Perhaps until the evening? Perhaps until tomorrow evening? The longer the time, the worse the panic. Your chest tenses up and your breathing becomes short and frequent. Then you wonder - could the panic cause any severe physical problems? After all, a cardiac arrest can be cause by shock, can't it? "Oh Christ, don't think about that" you tell yourself and then you look around and wonder if the people around you can see that you're acting slightly strangely at least. Does your body language give it all away? Who knows, who cares, let's just get the hell out of here and back home as quick as possible. NOW.

You can imagine that having this happen every time you go outside makes you think that doing so might not be such a great idea.

It is a common misconception that agoraphobia is fear of open spaces. It is not. Agoraphobia is a fear of having a panic attack in a situation from which one cannot escape, and hence suffering embarrassment or some greater harm. It derives from the Greek words for marketplace (agora) and fear (phobos), and so it means literally "fear of the marketplace". People with severe agoraphobia find it impossible to leave their houses although they may be perfectly happy, confident and controlled within their own personal space. Hence, agoraphobia is better understood as a fear of being in public, whether in general or in certain situations.

The physical symptoms of a panic attack are reasonably well-known to everyone - hyperventilation, a racing pulse, sweating, shaking, and in extreme cases dizzyness and bodily pain. This pain is often localized in the chest and radiates out to the left arm and jaw, but it can occur in literally any part of the body that the sufferer focuses on. But much worse than any of these physical symptoms for the sufferer is the psychological element of the panic attack, and it is this psychological element that leads to the development of agoraphobia.

During their first panic attack, sufferers typically believe themselves to be suffering from a major medical emergency. Many call for an ambulance because they think they are having a heart attack or stroke; others think it is a nervous breakdown. Panic attacks are frequently accompanied by an intense fear of imminent death or of "losing your mind", and a lot of sufferers fear that they are about to lose control of their behaviour and act irrationally; a fear of uncontrolled vomiting or urination, and resultant embarrassment, is also common.

Some experienced sufferers learn that this feeling of imminence never proves to be well-founded and so can control it, but others suffer a worse fate: they begin to alter their patterns of activity because they do not feel that they can control the onset or course of panic attacks, and they became afraid that they will have a panic attack in a situation from which they cannot escape. This sufferer is well aware that they have a panic disorder and may be able to ride out the individual panic attack well enough because they know that they are not actually about to die, but their fear has become more sophisticated: now their main fear is the fear itself. This is agoraphobia.

The fear might be associated with a particular circumstance where one suffered a panic attack before, like having a haircut, or sat in a restaurant waiting for food to arrive, or on a subway train. The fear of the physical and psychological symptoms of the panic attack is compounded by the fear of appearing to act bizzarely in a public place such as these. The agoraphobic is someone who has not tackled the underlying reason for their panic attacks, but instead opted to alter their behaviour so that they are not in situations where a panic attack has occurred in the past or might occur in the future.

In extreme cases, the individual might fear leaving the house because any public place in which they cannot easily escape to privacy might be the scene of a potentially-embarrassing panic attack. Many sufferers of panic disorder feel isolated because they fear others will not take their affliction seriously, and the inability to communicate to people around them what exactly they are experiencing - because they do not feel anyone will understand - further feeds their anxiety.

The only possible cure for the agoraphobic is to seek to address the underlying reasons for their panic disorder, which agoraphobia is secondary to. Agoraphobia is not actually fear of the marketplace of such, but fear of the fear experienced in the marketplace; avoiding the marketplace rather than tackling the fear itself is clearly no solution. But even worse than agoraphobia is self-medication with drugs or alcohol to attempt to calm oneself down so that situations no longer inspire anxiety; like excluding oneself from the marketplace, excluding oneself from reality cannot be expected to address the underlying cause of panic disorder either.