
Agoraphobia is a social phobia, a problem that affects approximately 3.5% of the world’s population. This disorder is characterized by the person experiencing intense fear when they find themselves in situations or places from which it may be difficult or embarrassing to escape.
This anxiety leads to avoidance behaviour. In other words, the person restricts their range of action to places where they feel safe and begins to spend more and more time at home. Typically, they avoid mixing with people, resist travelling by car, bus or plane, do not want to get into an elevator or cross a bridge and even neglect some of the basic responsibilities at home, especially when these involve leaving the house.
Obviously, avoiding these situations, which are so common for other people, increasingly limits their interpersonal relationships.
When a person is forced to face feared situations, he or she may develop an anxiety attack, in which he or she experiences strong palpitations, sweating, chills, feels short of breath and has trouble breathing. These symptoms are accompanied by a feeling of unreality, the fear of going crazy and even dying. In the most serious cases, it is not even necessary for the person to expose themselves to the feared situation; the mere fact of remembering it or imagining that they may have to face it triggers these symptoms.
In this way, the worst predictions come true. At first, the person fears making a fool of themselves, fainting or losing control in front of others, and finally their fears become reality due to the anxiety they experience. This is how the vicious circle of phobia is established and, unless they have psychological treatment, it is very difficult to eliminate.
What are the causes of agoraphobia?
Although the exact cause of agoraphobia is not known, there are several theories that attempt to explain the condition. For example, it has been discovered that people with agoraphobia also have difficulties with spatial orientation and find it difficult to maintain balance because they are unable to combine information from the vestibular, visual and proprioceptive systems well. Many people who suffer from this phobia have difficulties with the vestibular system, so they rely more on visual and tactile signals. Therefore, when they are in open spaces or with many people, they may feel disoriented and confused.
Another explanation is based on attachment theory. According to this theory, people with agoraphobia have not been able to develop a secure attachment in their childhood and have therefore failed to develop basic social skills. Thus, agoraphobia would be nothing more than a threat response to the absence of a “safe base”. In this sense, a recent study suggests that the real problem of agoraphobics is not the difference between public and private spaces but between the perception of safety and danger. These people only feel safe when they are in a private and limited space where they have control, but they feel threatened by the presence of strangers or in places where they cannot exercise control.
Of course, there are also psychologists who refer to a genetic component, since agoraphobia often appears alongside other anxiety disorders, specific phobias or substance abuse.
However, the mechanism by which agoraphobia is established is almost always the same: the person experiences a negative experience in a place from which it is difficult to escape and from there creates a negative association that is activated when entering a similar place. In many cases, the person is aware that it is an irrational fear, that there is no reason for it, but even so they cannot control it because when the phobia appears, it takes control.
Treatment of agoraphobia
The good news is that agoraphobia has a solution. Most psychological treatments focus on two fundamental aspects: helping the person learn to control the anxiety symptoms that cause the panic attack and making the avoidance behavior disappear. Exposure to the feared stimulus in a controlled environment, known as systematic desensitization, is one of the most widely used and effective techniques, but it is not the only one; there are other methods and approaches.
For example, some centres that offer treatment for agoraphobia work with the beliefs that have given rise to or that support this disorder. Many agoraphobics think that “the world is a dangerous place”, that “you shouldn’t trust strangers because they can be dangerous” or that “you always have to be alert to avoid any accidents”.
Fortunately, about 65 to 75% of people who complete treatment for agoraphobia achieve complete remission of their symptoms.
References:
Holmes, J. (2008) Space and the secure base in agoraphobia: a qualitative survey. Area; 40(3): 375-382.
Peñate, W. et. Al. (2006) Agorafobia (con o sin pánico) y conductas de afrontamiento desadaptativas. Salud Mental; 29(2): 22-29.
Yardley, L. et. Al. (1995) Relationship between balance system function and agoraphobic avoidance. Behaviour Research and Therapy; 33(4): 435–439.
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