What is agoraphobia?

Definition

Agoraphobia is the fear of the places where it would be difficult or embarrassing to escape or be rescued.

This phobia is based on the fear of not being able to find help and security in the place the person is located if something happened, not the place itself.

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Prevalence, age of onset and sex ratio

Prevalence

The prevalence of agoraphobia on whole life is up to 7% of the general population.

Sex ratio

The gender ratio is more than 2 women for a man.

Age of onset

The median age of onset of the disorder is 29 years.

Phobic situations

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Situations feared by agoraphobic persons can be:

– large areas: department stores, malls, large squares, clear airways;
– enclosed spaces: cars, cinemas, elevators, tunnels, airplanes;
– public places: restaurants, crowds, queues, public transport, meetings;
– places in heights escalators, bridges, floors;
– the fact to be alone, to leave home or relatives.

In the same patient, the phobic situations are usually multiple, non-specific, different places revealing common fears.

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Symptomatology

As in all phobic disorders, agoraphobia has three components:

– anticipatory anxiety of being confronted with phobic situation;
– the anxious reaction itself;
– avoidance behavior that allows the patient to reduce anxiety.

Anticipatory anxiety

Patients do not really express fears about the circumstances, about the outside, in front of a possible external threat. The fears are centered on the individual, on his/her physical or mental integrity, the ability to adapt. This is the fear of discomfort, accident, losing self-control, go mad, die on the spot.

These sensations generate maximum exposure to the fear of not being able to escape the situation, not being able to control or be rescued in case of difficulties.

Anxiety reaction

The agoraphobic feels the fear of experiencing panic attacks (or acute panic attacks) in a set of situations avoided or endured with suffering, whether or not known history of panic attacks.

Many patients do not spontaneously relate “authentic” panic attacks. Their anxiety reactions can be reduced, limited in duration or intensity, expressing themselves only by two or three predominant symptoms (high tachycardia, dizziness or isolated trembling, choking sensation, for example).

Impact and effects

To reassure themselves, patients will tend initially to adapt their behavior to circumstances: exit accompanied by people they trust, visit only certain places during calmer hours, borrow safe routes, sit near entrances enabling to leave quickly the premises.

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Relations with the environment are changing, transforming, become sources of tension, misunderstanding and conflict.

Avoidance conduct

Fully aware of the inappropriateness or even ridiculous characteristics of the fears, the agoraphobic is shared between dependence and renunciation. There is less and less place for effort and reasoning.

At maximum, avoidance establishes itself drastically, scrupulously and generally. Patients are exhausted to have to develop schemes that allow avoidance or reinsurance in front of situations that may trigger an anxiety attack.

Such behaviors tend to invade all areas of daily life, sometimes causing serious relationship or family problems.

Evolution

The spontaneous evolution is interrupted at the start by brief remissions and may result in a chronic stage in the absence of treatment, with partial recovery phases.

The consequences of this disorder can be extremely debilitating; isolated, undiagnosed patients, risking to finish cloistered at home, unable to get out, experiencing the terrifying fear of going mad.
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