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Agoraphobia prevention and treatment

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Dr Rati Parwani
Dr Rati Parwani is a Practising Professional BHMS Doctor having experience of 8 years in the medical field. She is a good homeopathic doctor.Her approach towards each and every patient is the utmost professional with high standards of homoeopathic practice. She has nurtured her writing skills and proves it as an asset to her professionalism. She has experience in content writing and likes her writing ethical and scientific-based Her expertise in curing chronic cases of osteoarthritis,, endocrinological disorders, lifestyle disorders, Female health problems such as acne PCOS, uterine fibroids and endometriosis, skin problems such as psoriasis and eczema, GIT troubles, Respiratory issues and other ailments . Her expertise lies in treating chronic cases. Medical Education Bachelor of homoeopathic medicine, bachelor of surgery - BHMS Medicine A+ Padmashree Dr D. Y. Patil Medical College, Hospital and Research Centre, Pune

Agoraphobia: Overpower the fear in you.

Agoraphobia is a chronic disorder that occurs due to fear. It is a type of anxiety disorder which affects your personality in the long run. What if you are stuck in a place and want to get out from there. A panic attack sets in. But the fear of this attack setting in is termed as Agoraphobia.

One such phobia that we come across generally but fail to classify is agoraphobia. It is also classified as an anxiety disorder which is related to fear of situations or places from which a patient or individual wants to escape. It is important to recognise this fear at early stages before you fall into complications of it. It affects your personality and gives it an image full of negative symptoms like restlessness, panicky, lack of confidence in situations or places which makes it impossible to deal.

An individual with such a disorder feels better by avoiding places like a shopping centre, movie hall, house parties, elevator or any kind of places where he or she gets uncomfortable. Its same classification as an anxiety disorder but a qualified doctor will be able to differentiate it. A panic attack in elevator or panic attack driving the car over the bridge are some of the examples of this attack. This confines you stay in one place. WORRY is the best language to be explained in. It is not weird thinking but a REAL thing. Escape is difficult from this fear. Anticipating problem as anxiety attack which is difficult to deal with is what is generally noticed in patients. This is how anxiety is dealt with but not the REAL situation of agoraphobia. It’s like the anxiety cycle which you need to break up as it affects your life and work.

It feels like a panic attack coming on and causing worry to deal with it. People who struggle with it can also be diagnosed with a panic attack. Many people will struggle with panic disorder as well with agoraphobia. Agoraphobia usually begins with a stressful event, like for instance, this begins by losing a job or traumatic event like losing a loved one. Any stressful situation could trigger it. Well-Defined avoidance behaviour is noticed in an individual where he tries to avoid outside world fearing and worrying about the panic attack. Avoidance is not a solution to it. Dealing it and managing it with the path of recovery is a solution. It develops over time. A trigger which created this panic is the root cause of the problem. The individual may feel more distressed at work or at home.

The person may recognise that this fear is without any reason but feels helpless to cure it. This can affect any age group at different stages of life without any reason or specific cause.

In children:

Children with generalised anxiety disorder spend a lot of time thinking about a lot of different things. Children with agoraphobia have sudden attacks of fear and rush to panic attacks that are difficult to manage because they are afraid it might lead to panic attacks or such situations from where they cannot escape. These attacks are characterised by extreme fear and embarrassment with behavioural disorders that they might be difficult to escape from like avoiding certain things, situations, places. Understanding Agoraphobia is important in children. It can range from mild to severe.

So have a close watch in children or individuals suffering from it. It can lead to complications if left untreated like depression and anxiety-related disorders. It goes unnoticed in children at initial stages as children tend to be moody in behaviour during their school and activity life. In adolescents, it should be dealt with extreme caution because of the tender age factor. To get them out of this fearful zone is difficult. Motivation with affection is required by parents.

Agoraphobia is a wide range of psychological symptoms covering an emotional and physical aspect of the individual as each person suffers from different symptoms during the panic attack.

In severe cases, it would be difficult in engaging with activities which were previously enjoyed.

In adults

it is an unusual fear and worry which makes it impossible to get into the outside world. There are many strange cases of agoraphobia that we come across where many people are scared to even discuss the problem. They feel stressed out about it which may lead to long term problem affecting their health in the long run leading to severe complications of mental health. In some cases, people might be dreaded doing their daily activities like going to the grocery market or shopping mall. It important for them to come out of this feeling and tension that prevails with them. A build-up of this feeling can lead to various neurological problems affecting their overall mental and physical well being. An adult stage is as good as childhood when it needs to be treated with extreme care and affection.

These factors can be taken into account while treating at different stages of life where every individual would react differently. For children and adult, some of the symptoms would remain the same. They are as outlined below.

With agoraphobia you might worry when you are in:

  • Public transportation
  • Large open space
  • Closed in spaces
  • Being in a crowd
  • Standing inline
  • Being outside the house when alone

You may just be willing to go to a handful of places This might cut down the panic attack, but not provide you solution to the problem.

Causes of agoraphobia

The exact cause of Agoraphobia is still unknown. Most experts think the exact cause may be due to triggers, risk factors and biological theories. How you react to certain situations of life is equally important rather than avoiding it.

Genetic: About 61 % deal with it because it is hereditary. For them, it will always be in the background. So what causes it? As we can’t test it.The sooner the help the better.

Some trigger issues like traumatic events or situations in childhood can make you struggle with agoraphobia.

Underlying medical illness which relates to stress: Stress induces hormone cortisol which can cause dysfunction and disharmony in the body affecting the mental and emotional aspect of the patient. Patients suffering from agoraphobia usually consider home to be a safe place and they are confined to the home.

Risk factor which triggers agoraphobia: The exact cause remains unknown, however, any kind of following consequences can lead to agoraphobia

  • A previous history of mental disorder
  • History of abuse as a child
  • Substance abuse: Smoking or alcohol or drug abuse
  • Being on certain medication which may cause excessive sweating and palpitations
  • Being a victim of crime
  • Being affected by serious medical illness
  • History of physical or sexual abuse
  • Anxiety disorders like social phobia.
  • Depression
  • Being unhappy in a relationship

There are various biological theories associated with it :

The neurotransmitters: Imbalance of neurotransmitters can worsen a panic attack.

Adrenaline rush:

Fight, flight or freeze reflex is an important reaction of the individual in a specific situation especially when stressed. There are various external manifestations seen in form of physical symptoms such as palpitations with an increase in heart rate and sweating can cause to fight and flight response where you may feel like running away from the problem instead of managing it well. It is the way a body responds to stressors in your day to day life which may affect your daily activities.

The Fear factor which suggests that there is a brain malfunction when it comes to panic attack resulting in a change of mood and behaviour. This may bring up physical symptoms like giddiness and vertigo along with vomiting and heaviness of head

Hormonal imbalance Stress:

the hormone called cortisol is released when in stress which helps you to function well and cope up with it. When you are unable to cope up with it .it would result in stress which is difficult to manage and would again lead to external manifestations of internal condition which calls for help.

Symptoms  of agoraphobia

  • Breathlessness, sweating, dizziness
  • Rapid heartbeat with a racing heart
  • Trembling and shaking
  • Chest pain
  • Chills
  • Hypertension: elevated levels of blood pressure
  • Lack of confidence and low self-esteem
  • Nausea and Diarrhoea: increases in peristalsis (movement of the gut )
  • Helplessness about the situation
  • Fear of dying
  • The tingling sensation and going numb.
  • Constant worry and fear about the panic attack
  • “Avoidance behaviour”: A very characteristic behaviour seen in many patients to avoid the outside world fearing the attack would occur anytime
  • It can affect the QOL( quality of life).

So there is a solution to it 

Diagnosis is usually based on individual symptoms. However, a well qualified professional doctor will be able to differentiate a common panic disorder or classify anxiety disorder. A solution from the root cause is essential to treat this problem along with the triggers which may cause the attack.

It’s difficult to talk to someone else about what you feel. But on the other hand, Consulting a specialist doctor who is professional in dealing with such disorders would help you majorly in achieving and managing the panic attack and avoiding the same. Your GP needs to know all the possible symptoms and correct diagnosis and treatment are required for the same.

Confirming the diagnosis:

Confirming the diagnosis is equally important to rule out certain conditions like high blood pressure, underactive and overactive thyroid gland or menopausal syndrome which relates to hot flushes. Your GP might write a certain test to make sure you are being treated for correct diagnosis. Your doctor will take down your medical history along with your past and family history to relate to this stressful disorder.

A stepwise approach is recommended relating to different stages of life whether be it in childhood or adulthood. How agoraphobia is tackled is equally important in managing the condition rather than avoid the situation in which the patient goes helpless.

Agoraphobia can develop into complication problem. If you have anxiety in initial stages make sure you get it diagnosed correctly and treat it well. Symptoms can be controlled and the severity of the attacks can be reduced with below-mentioned reasons.

To be diagnosed with Agoraphobia your symptoms need to meet up the criteria in DSM American Psychiatrist association Diagnostic And Statistical Manual of Mental Disorders. The DSM manual is often used by healthcare providers to diagnose Agoraphobia

But it’s better to be diagnosed during the initial stages of the disorder rather than wait to meet up the criteria for health and sound mental condition.

Treatment options

  • Psychotherapy: Guided self-help to boost your self-confidence and morale
  • Cognitive behavioural thinking. It changes faulty thinking hindering your life
  • Medications Benzodiapenes, Antidepressants.
  • Relaxation therapy: Take a deep breath when you are trapped in a situation where you need help
  • Counselling and self-esteem therapy
  • Support group: Participate therapy would work in the childhood stages of the disorder.
  • Reach out to doctor: Venting out is also a suitable idea
  • Step out in nature: is the best idea to get rid of your anxiety
  • Cope up with anxiety in a healthy way
  • Do not consume alcohol or smoking is a bad practice to release your anxiety.
  • Trust someone who can help you cope up with your anxiety levels.
  • Keep a diary: write about the anxious situations that lead the too panic attack.
  • Learn how to act or cope up with it.
  • Do not try the avoidance behaviour as its the easy way out.
  • Learn to deal well and cope up with the situations which are tricky to handle
  • Come out of your comfort zone: do not be confined to your house.
  • Interact with people
  • Sleep well: Sleep well when it comes to anxiety attacks so that you are refreshed for next day challenges. Never give up
  • Mind care is extremely important. Its the need of an hour. Keep away from negative disruptors in life
  • De-stress your self: It’s not just on holidays that you need to destress yourself but every day by inculcating the good and healthy idea of positivity in you.
  • Lifestyle modifications if required: like focussing and challenging your fear is an essential practice in day to day life is essential.
  • Take regular exercise and a healthy diet.
  • Avoid caffeine intake.
  • Spots the signs of feeling and tension.
  • Relax your muscles.
  • Take a deep breath.

Also, remember only popping pills is not the solution from a psychiatrist to treat Agoraphobia. It should be treated with counselling and consultation to match up to the patient’s need. Pay attention to the needs of the patient rather than giving him medicines. The medicines should work with the body and mind not against it. Proper guidance and consultation are equally important along with a good line of treatment which will not only treat the patient’s symptoms but also the root cause of the problem.

Effective solutions with a comprehensive treatment plan and efficient consultation are the solution to the Agoraphobia. Detailed case consultation with regards to the mental and emotional aspect is the key to the management of this disorder. Careful analysis with good prognosis will lead to a better outcome of this disorder, in turn, avoiding complications further and effectively treating with guidance is a tool for agoraphobia.

Useful research links

https://www.ncbi.nlm.nih.gov/pubmed/17696574

https://adaa.org/understanding-anxiety/agoraphobia

https://www.anxietyuk.org.uk/wp-content/uploads/2010/05/overcoming-agoraphobia-lovell-1999.pdf

https://www.verywellmind.com/homebound-with-agoraphobia-2583911

https://www.mirecc.va.gov/visn22/panic_and_agoraphobia.pdf

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