Symptoms of agoraphobia. Diagnosis and treatment.

Symptoms of agoraphobia Diagnosis and treatment

Symptoms of Agoraphobia.

Symptoms of Agoraphobia.

As in other phobias, exaggerated fear and fear are usually accompanied by an intense reaction of the vegetative nervous system. The body reacts to an unreal danger with a cascade of catecholamines that trigger numerous physical and psychological symptoms.

Physical symptoms

  • Hot flashes, redness, or intense heat.
  • Tachycardias, cardiac arrhythmias.
  • Palpitations
  • Shaking chills.
  • Profuse sweating
  • Muscle tremors in extremities.
  • Dyspnea, choking sensation.
  • Hyperventilation
  • Instability and dizziness.
  • Dizziness
  • Exhausted.
  • Dolor precordial.
  • A knotted feeling in the stomach.
  • Pollakiuria and urgency.
  • Photopsies and blurred vision.
  • Paresthesias or tingling of extremities.

Physical symptoms of agoraphobia.

Psychic symptoms.

The psychic symptoms of agoraphobia are closely related to the state of anxiety.

  • Feeling of getting out of your body.
  • Firm belief of imminent death.
  • Fear of having a heart attack.
  • Fear of fainting
  • Belief that they cannot breathe and will suffocate.
  • Fear of losing your mind or going crazy.

Although the individual understands that his fear is exaggerated and irrational, he cannot help feeling it.

This fear causes avoidance behaviors of the triggering situations. In this way, in agoraphobia we find the paradoxical situation that the individual is afraid of being afraid. That is to say, you feel fear, fear and anxiety at the thought that you may suffer an anxiety attack (where you will have panic) and you believe that you will not be able to be helped.

The patient with agoraphobia will avoid situations that he experiences as dangerous. He will try not to leave the house, not to use public transport. You will avoid shopping, eating in restaurants, going to the movies, being in public places, etc.

All this entails a great alteration of the life of the subject since the person ends up almost without leaving their home to avoid avoiding the anxiety caused by the fear of panic attacks.

Psychic symptoms of agoraphobia.

Diagnosis.

Diagnosis

The American Psychiatric Association (APA) establishes the diagnosis of agoraphobia, which appears perfectly delimited in the DSM-5 (Diagnostic and Statistical Manual of mental disorders) whose last revision was carried out in 2013.

The DSM-5 diagnostic criteria are:

1. The presence of anxiety, fear or intense fear in at least two of the situations mentioned below:

  • Use of public transport, such as subways, buses, trams, trains, boats, planes, etc.
  • Being in wide and open spaces, such as the field, parking areas, highways, markets, bridges, etc.
  • Being inside a closed place, such as elevators, tunnels, cinemas, nightclubs, etc.
  • Being immersed in a crowd or an agglomeration of people or being in a long waiting line.
  • Meet only outside your home.

2. The subject shows fear and tries to avoid these situations, believing that they have no way out or it could be difficult to get specialized help if symptoms of anxiety or other disabling symptoms appear.

3. Agoraphobic situations involve the presence of fear, anguish or anxiety.

4. Faced with agoraphobic situations, the subject actively tries to avoid them, or seeks the presence of a companion.

5. The fear or anxiety felt by the subject is disproportionate to the real danger of the agoraphobic situation.

6. These symptoms last for at least six months.

7. These symptoms cause significant discomfort or cause a deterioration in the social, work or family life of the patient.

8. The fear or anxiety should not be caused by another coexisting illness.

9. The symptoms (fear, anxiety or avoidance) are not better explained by the presence of another mental disorder (social anxiety disorder, OCD, post-traumatic stress disorder, etc).

Fear of open spaces and crowds.

Differential diagnosis.

Faced with a subject with the symptoms described above, a differential diagnosis with other entities should be considered:

– Social anxiety disorder : In this case the subject refuses social contact out of shame or fear of making a fool of himself, not for fear of suffering an anxiety attack and not finding help.

– Panic disorder : In most cases these two anxiety disorders coexist.

– Specific phobias : In some cases agoraphobia can be confused with claustrophobia or with simple phobias  of specific places.

– Depressive disorders in childhood , where sometimes they leave their homes little, due to psychomotor inhibition and not so much due to anxiety.

Agoraphobia in adolescence.

During childhood the appearance of agoraphobia is quite rare. However, the same does not happen during adolescence. The adolescent is a person who lives in a world with continuous physical and mental changes. These changes affect you and your relationships and often lead to a decrease in your self-esteem.

Treatment of agoraphobia.

As in other anxiety disorders, agoraphobia requires a combination of pharmacology and psychotherapy.

One of the peculiarities of agoraphobia is the poor result that psychotropic drugs have, although they are effective on anxiety attacks.

Pharmacological treatment of agoraphobia.

Pharmacology.

The pharmacological treatment of agoraphobia is intrinsically related to the treatment of panic attacks. In this sense, it is worth mentioning the study carried out in 2011 by the authors: Perna G, Daccó S, Menotti R and Caldirola D. These authors reviewed 25 evidence-based studies of the results of drug treatment on agoraphobia. All the patients studied had anxiety attacks plus agoraphobia.

The drugs included in these studies include the following groups:

  • SSRIs (selective serotonin reuptake inhibitors).
  • SSRIs (selective serotonin and norepinephrine reuptake inhibitors.
  • ISRNs (selective norepinephrine reuptake inhibitors) were also analyzed.
  • Tricyclic antidepressants.
  • Benzodiazepines

The best results were obtained with the use of escitalopram, citalopram, sertraline, paroxetine (all of them from the SSRI group) and clomipramine (tricyclic antidepressant).

Others such as imipramine, fluoxetine, and fluvoxamine had a more limited response.

It should be noted that the different studies analyzed have not been able to ensure efficacy on agoraphobia, because although panic attacks significantly improve, it cannot be assured whether the improvement in agoraphobia symptoms is the result of pharmacology or the improvement obtained in anxiety attacks.

Recently, some membrane stabilizing drugs with known antiepileptic effect are being used, such as pregabalin, lamotrigine or gabapentin.

More studies directed exclusively at agoraphobia are needed to be able to assess the efficacy of these drugs. Of course, its effectiveness in panic attacks has been amply demonstrated.

Psychotherapy.

Cognitive behavioral therapy has proven to be effective and in its different modalities, it always involves a certain degree of exposure to the agoraphobic situation. Even at the risk of simplification, we can say that most of these techniques have three steps:

  1. Explanation to the patient of his problem, how anxiety is triggered, how the subject reacts and the symptoms he presents.
  2. When the patient dominates the theoretical aspect, an approach to the agoraphobic situation takes place, in which the patient himself provokes situations that generate panic.
  3. After this phase, the live exposure begins. In other words, the patient faces his fears, faces the feared situation and verifies, not without suffering, that his life is not in danger and that nothing of the dreaded consequences that he had created in his mind happens.

Stress reduction techniques such as relaxation, yoga, meditation etc. have also been used. Lately, every day, mindfulness treatments are used more: Mindfulness and Focusing. The latter consists of an introspective therapy that groups and completes meditation and mindfulness exercises, among others.

Treatment of agoraphobia with medicinal plants.

Treatments with medicinal herbs.

Throughout history natural treatments have been the only remedy for agoraphobia, before the advent of modern pharmacology and psychotherapy techniques. Although these remedies have been overcome, there are still many people who resort to the use of medicinal herbs.

Among the most used natural remedies we can mention the following:

  • Scatularia is effective in balancing the nervous system and helping you fall asleep.
  • Chamomile is widely known for its relaxing effects.
  • The same happens with valerian. Its sedative effect seems to be due to the content of the plant in valepotriates, with effects similar to benzodiazepines.
  • Passionflower or passion flower: It has known relaxing and anxiolytic effects.
  • Lemon balm acts as a sedative on the nervous system and on the heart, slowing down the heart rate.
  • Lavender: This herb with anxiolytic effect, acts according to some, reducing plasma cortisol levels.

Agoraphobia associations in Spain.

Agoraphobia is such a frequent disorder that in many Spanish cities associations of affected patients have been created to form self-help groups and group therapy. There are associations in these cities:

  • Zaragoza: CAPAZ (Collective of people affected by panic and agoraphobia)
  • Castilla La Mancha: ADEA (Albacete) and CLM Agoraphobia Association (Albacete).
  • Seville: “Together We Can”.
  • Barcelona: ACTAD (Catalan Association for the treatment of Anxiety disorders.
  • Madrid: AMADAG (Madrid Association of Panic Disorders and Agoraphobia).
  • : AVAF ( n Association for Anxiety and Phobias).
  • Las Palmas de Gran Canarias: Open Horizons.
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Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.

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