Fear of Open Spaces (Agoraphobia): Characteristics, Diagnosis, Treatment

The fear of open spaces, also called agoraphobia , is what people suffer when they are outdoors, which generates in them anguish, anxiety and sweating in most cases, according to specialists. It is important to mention that those affected avoid the triggering situations and, in extreme cases, can no longer leave their own homes. Agoraphobia also occurs when people avoid long distances or traveling alone or generally due to fear.

Terminology

Agoraphobia (from Ancient Greek ἀγορά agorá, German ‘Marktplatz’ and Ancient Greek φόβος phóbos, German ‘Furcht’) or claustrophobia is a certain form of anxiety disorder.

All of these situations have the fear of losing control in common. For example, affected people fear that in the event of panic or potentially threatening physical conditions, they will not be able to escape quickly enough, that help is not available quickly enough, or that they will find themselves in embarrassing situations. Agoraphobia often occurs in conjunction with panic disorder .

The fear of wide spaces is called claustrophobia in psychology, a term used in colloquial language for the opposite state of anxiety, that is, claustrophobia (fear of narrow spaces), which is called claustrophobia in technical jargon.

Characteristics

• The main characteristic of agoraphobia, which was described by the Berlin neurologist and psychiatrist Carl Westphal under this name in 1871, is an unfounded or unrealistic fear of certain places or trips.
• This fear is beyond voluntary control and cannot be eliminated by rational argument.
• As a general rule, affected people show strong avoidance behavior, since panic attacks can occur to different degrees.
• Fear can be limited to entering public places or shops, often avoiding particular crowds.
• In pronounced cases, the fear begins already in the apartment, so that it is no longer left.

Diagnosis

The first diagnostic step is to clarify whether agoraphobia in an affected patient exists as an independent disease pattern or is a symptom of another underlying mental or organic disease.

In the past, the term agoraphobia was used exclusively out of fear of large public places.

Meanwhile, it also includes fear of other situations, so that according to ICD-10 at least two must be detectable as anxiety triggers:

• Crowd
• Public places
• Travel far from home
• Travel alone

Several studies carried out by specialists with international validity on the fear of open spaces do not distinguish between the presence or absence of panic attacks. While subsequent studies indicate that the occurrence or absence of panic attacks is specified within the diagnosis of agoraphobia. Agoraphobia is supposed to be superior and can be classified as panic disorder or panic disorder. In contrast, agoraphobia in DSM-IV is subordinate to panic disorder.

Panic disorder is primary and can be specified with or without agoraphobia. The diagnosis “agoraphobia” without panic disorder in history exists separately. It also subsumes ochlophobia – from Greek: eights (“crowd”) and phobos (“fear, fear”), enochlophobia – Greek: en-, (“inside”) and demophobia – Greek: demos (“people”) under agoraphobia.

You might be interested in reading: fear of change

Frequency

• According to a study by McCabe, agoraphobia was detected in 0.61% of a study population of 12,792 (55 years or older).
• Therefore, the frequency of the disturbance here was lower than is normally reported.
• Based on the National Comorbidity Survey Replication in the US, figures on the relationship between agoraphobia, panic attacks, and panic disorder (as defined by DSM-IV) were also published in 2006.
• Consistent with this, the lifetime prevalence in 9,282 subjects at least 18 years of age was in the possible combinations:
• 7% for isolated panic attacks
• 8% for panic attacks in combination with agoraphobia
• 7% for panic disorder without agoraphobia
• 1.1% for panic disorder with agoraphobia

It could be shown that from the 1st to the 4th group there was a continuous increase in the individual characteristics examined, such as the persistence of symptoms, the number of attacks, the number of years of illness, the severity of the individual episodes and the accompanying illnesses. In 2005 Kituchi of the University of Kanazawa in Japan examined 233 outpatients with panic disorder (99 men, 134 women), 63 without, and 170 with agoraphobia. The latter group had on average a prolonged panic disorder and a higher prevalence of a generalized anxiety disorder .

There were no differences in pronounced depressive episodes, severity of individual panic attacks, or gender distribution. It was also found that just over 40% of those who had developed panic disorder also had agoraphobia within 24 weeks and that this group did not differ in age or gender. A possible trauma should always be considered as a possible cause. Agoraphobia is among the possible mental disorders that can develop in addition to the classic symptoms of post- traumatic stress disorder (PTSD) and also among the symptoms of complex PTSD (comorbidity).

Treatment

• If agoraphobia is a symptom of an underlying disease, it is treated accordingly.
• If agoraphobia is present as a separate disorder, both psychotherapy and medication are standard.

Advice

• Talk therapies are generally not very effective in pure agoraphobia.
• A proven treatment for agoraphobia is exposure therapy, which is done as part of behavioral therapy .
• The affected person and his therapist go to the respective place, which causes fear and is therefore avoided.
• With the help of the therapist, the affected person faces their fears and allows them to stand up in full force to experience that the fear is unfounded and disappears completely on its own with time.
• The therapist supports the patient to visit the situation, stay in the situation and not apply avoidance strategies.
• Avoidance behavior can alleviate fear in the short term, but in the long term it leads to the maintenance of fear.
• There are at least two types of confrontational therapy.
• On the one hand, systematic desensitization, which is carried out step by step.
• On the other hand, there is also the so-called “flood”, in which the client is immediately faced with a particularly anxiety-provoking situation.
• Usually the client remains alone and the therapist remains in the background or at a greater distance.
• However, forced flooding, which the client does not accept voluntarily, can have the opposite effect and exacerbate the problem.

Medicines

• Agoraphobia, like other anxiety disorders, can be treated with medication.
• However, as a general rule, these medications are not curative, but only relieve symptoms as long as you take them.
• The main anxiolytics, tricyclic antidepressants and selective serotonin reuptake inhibitors are used.
• The use of benzodiazepines is critically evaluated in long-term use.

Clarification of terms

Agoraphobia is often mistakenly referred to as claustrophobia. However, this is more of a fear of space, although fears can also be situational. People affected by agoraphobia are afraid of large, open spaces and situations where they cannot escape or where help seems to be impossible.

How does agoraphobia manifest?

• As soon as fear or panic erupts, those affected suddenly have the feeling that they can no longer move.
• They cut their throats and think they can’t breathe.
• The hands are sweating and shaking.
• Also, vision is affected by small black dots and vision becomes blurry.
• Physical reactions should not be underestimated.
• Eventually, they drive the affected person even further into fear.
• Agoraphobics suffer their fears when they feel that they cannot escape from a place or when they feel that they cannot escape from a certain situation.
• Therefore, agoraphobia is not a pure fear of space, it can also be triggered by certain situations from which you cannot escape.

What treatment options are there?

• Confrontation therapy and cognitive behavioral therapy can help combat agoraphobia.
• During therapy, the affected person will go together with the therapist to places that scare them or expose them to situations that scare them.
• Unfortunately, this agoraphobia treatment is not always effective.
• Many people who suffer from agoraphobia are afraid of confrontational therapy.
• After all, in this case they have to face their fear.
• Even the so-called avoidance strategy is rarely crowned with success. Here the agoraphobic is distracted with the help of music or something similar.
• Distraction is successful, if at all, usually only in the short term.
• Talk therapy is often more effective, but very long and time consuming.
• Those who suffer from agoraphobia are very limited in daily life.
• After all, agoraphobics also find it difficult for most people to go shopping or the like.
• Affected people want quick help, which can often be provided by hypnosis.

In confrontational therapy or talk therapy, additional relaxing and calming medications or even antidepressants are usually used. These drugs have strong side effects. As soon as the first successes occur, the tablets are usually discontinued, so the relapse rate is very high and the patient quickly returns to agoraphobia.

Agoraphobia caused by childhood trauma

• Behind many phobias , including agoraphobia, there are often childhood problems.
• Some of them only come to light in adulthood.
• Many people do not remember the problems of their childhood.
• With the help of hypnosis, it is easier for the affected person to remember where their agoraphobia comes from.
• However, hypnosis can’t just bring memories to light.
• In many cases, it can eliminate the fears of people suffering from agoraphobia.
• Hypnosis also makes it clear to most agoraphobics that it is not the situation, the grand halls, or the public place that is frightening, but rather the trigger for the agoraphobia that is completely different.