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Agoraphobia

Overview

This disorder involves an incapacitating fear of open spaces. Agoraphobia is a form of phobia characterized by avoidance of crowds, open and public places; particularly if escape or assistance may not be immediately available. Its onset may be accompanied by other types of panic disorder, or it may occur alone. Thus, causing people to restrict their activities to a much smaller area, and eventually leading to the inability to leave home without suffering a panic attack. Other characteristics of this disorder may be excessive dependence upon others. People might perceive that their body is unreal, called a feeling of depersonalization, or that their environment is unreal or derealization. They may also show signs of depression. The onset usually occurs around the 20s; women are more likely to be affected by this disorder than men. People with this disorder may become house bound for years, causing impairment of social and interpersonal relationships.


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Causes

The onset of this disorder may originate with a panic attack in a public setting, or in situations or events that cause a person to feel uncomfortable in a public place, which is followed by avoidance of similar situations.


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Signs & Symptoms

The main symptoms seen are the fear of being alone, of losing control in a public place and fear of being in places where escape might be difficult. People become house bound for prolonged periods, which causes feelings of detachment or estrangement from others, helplessness, dependence upon others, feeling that the body  and the environment are unreal. Anxiety or panic attack, unusual temper or agitation along with trembling or twitching is also seen. Additional symptoms that may occur are lightheadedness, dizziness, excessive sweating, and skin flushing, breathing difficulty, chest pain, rapid heartbeat, nausea and vomiting, numbness and tingling. The person has confused or disordered thoughts and an intense fear of going crazy or that of dying.

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Prevention

Prevention may not be possible for panic disorders; but early intervention of the condition may reduce its severity.


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Treatments
Behaviour Therapy Psychotherapy

Educating the patient about his condition is very important, they need to be given reaasurance that their condition does not make them mentally ill and it is manageable.

An effective behavior therapy for agoraphobia is exposure with response prevention. In this treatment, the patient is, first, exposed to a situation that causes anxiety or panic and then he or she learns to "ride out" the distress until the anxiety or attack passes. With each session, the duration of exposure is gradually increased. For effective functioning of the treatment, it is best if the patient is not taking tranquilizers as they can prevent that experience of anxiety from occuring.

Medication Modern Medicine

Medication is often used for treating phobias. Antianxiety and antidepressive medications are given to help relieve the symptoms associated with phobias. Some antidepressant medications have been shown to reduce the occurrence of panic attacks. Paroxetine is also shown to be quite effective in treatment. Benzodiazepines are used in treating anticipatory anxiety as well as symptoms of panic attacks.

Systematic Desensitization Psychotherapy

The treatment focusses on achieving normal functioning of the phobic person. The success of the treatment depends on the severity of the condition.

Early intervention in the disorder can reduce anxiety and avoid the reccurence of the symptoms. Both therapeutic and medical treatment is used to treat Agoraphobia. It can become very difficult to maintain regular treatment appointments of agoraphobics, as they fear meeting the psychologist People suffering with agoraphobia often have difficulty getting to the office of a psychologist. This is an important issue that needs to be taken care of during treatment.
Many therapists look at confrontation with the feared object as a way of tackling the phobia. This method involves systematic desensitization. In which the patient thinks about the feared stimulus and then consequently learns to relax his or her body. This state of deep relaxation coupled with thinking about a series of frightening events proves beneficial in eliminating or to the least reducing the phobia. Also, fearful clients are exposed to live demonstrations about others interacting fearless with feared objects. For example, handling non poisonous snakes fearlessly or petting friendly dogs. This observation might be helpful for the patient in confronting his or her own phobias.

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