By an agoraphobia the physician understands a mental disorder or phobia. The person concerned is afraid of escaping from an everyday situation (for example, in the S-Bahn or the hairdresser) can not escape. This anxiety situation then usually results in a panic attack.

What is agoraphobia?

Agoraphobia sufferers are afraid of escaping from an everyday situation (for example, in the S-Bahn or the hairdresser). This anxiety situation then usually results in a panic attack.

Anxiety knows every living thing. In the animal world and also with us humans this feeling protects us, if a threatening situation or a danger approaches. Fear is usually a natural warning signal.

Patients who suffer from agoraphobia transfer their states of anxiety into normal life situations. However, they overestimate the danger of a situation and are therefore afraid to go to certain places with a group of people. Ultimately, this exaggerated anxiety can cause them to leave their own apartment.

causes

In many cases, a severe traumatic experience triggered the agoraphobia. Cause can also be very stressful life events that last several weeks or months.

The death of a close relative, conflicts in a partnership, divorce from a spouse, job bullying, job overload, or dismissal can be a trigger for agoraphobia.

The fact that everyone reacts differently to stress or stressful life situations is partly due to genetic factors, but also a consequence of the behavioral patterns learned in childhood. Every person has their own personal weaknesses and reacts differently to mental injuries, wounds or stress.

Symptoms, complaints & signs

The agoraphobia causes anxiety, which can spread to panic attacks. Those affected are afraid of large squares, of confusing spaces or even of an accumulation of people and crowds. At first, the fear only creeps slowly and begins with a great malaise in the situation in question.

Only with time, the fears manifest more and more, until the person concerned can name them directly. At this point, medical attention should be sought. If the agoraphobia is not treated, it can lead to a significant reduction in quality of life and freedom of movement. Those affected try to help themselves and usually resort to so-called avoidance strategies.

If the fear occurs especially in large squares, large squares are avoided or no longer crossed, but circled cumbersome on the edge. In most cases, however, this does not improve but rather worsens the situation. The circumstances that create fear are widening, so that new additional avoidance strategies become necessary.

In the worst case, this can lead to people even being afraid of leaving the apartment or the house at all. In the long term, it may be possible that they can no longer participate in public life.

Diagnosis & History

In an agoraphobia psychic and physical reactions in the affected person. Many fears determine his thinking, his feelings and his behavior. This is expressed in the fact that he constantly fears that something bad could happen to him or he could be alone and helpless or even in mortal danger.

Will I come out alive again? What if I get a heart attack? I can not do that alone! I can not take it anymore! What happens if I stop breathing or faint? - Fainting of this kind lead to high blood pressure and the muscles in the body tense up.

This leads to physical reactions, which in turn trigger anxiety again. Sweating, a dry mouth, shaking, severe heart palpitations or a fast and irregular heartbeat, shortness of breath, nausea and vomiting, urinary and fecal urgency, dizziness and drowsiness are some possible physical symptoms of agoraphobia.

Because the person concerned is afraid of these physical reactions, he begins to avoid certain situations or places. He no longer goes to public places, department stores, supermarkets, inns or hotels, cinemas or theater events. He avoids using public transport or taking long-distance travel by plane or train.

Those who suffer from agoraphobia initially experience their symptoms in stages. Increasingly, however, he becomes more insecure and believes that he is indeed affected by a severe organic disease. If an agoraphobia remains untreated, the further psychological course is unfavorable.

complications

Agoraphobia can severely limit life. In case of a severe severity of the anxiety disorder, some people no longer leave their apartment or only venture out in front of a door accompanied by a confidant. Everyday tasks often become insurmountable obstacles. Professional and family complications are almost inevitable in severe agoraphobia.

Friendships and other social contacts often suffer from agoraphobia. This isolation in turn favors other mental health problems, such as obsessive-compulsive disorder or depression. A depressive episode can also occur despite treatment or be triggered by the treatment - if the person concerned realizes that he has (often many years) subjected his life to a treatable disorder.

Agoraphobia can occur with or without panic attacks. Since the panic attacks can resemble a heart attack or other medical complications, a careful clarification is necessary (especially at the beginning of the anxiety disorder). In addition, the anxiety disorder is often associated with personality disorders. Dependent personality disorder and fearful personality disorder are the most common.

Furthermore, another anxiety disorder can occur in addition to agoraphobia. Specific phobias, generalized anxiety disorder and social phobia are considered. Harmful use of medication or alcohol may be a form of self-medication.

When should you go to the doctor?

A phobia like agoraphobia can potentially arise at any time of life. Most of the time, latent fears of places have already been present for a long time, on which those affected feel defenseless. They avoid crowds of people in public places or avoid trips to unknown places.

Agoraphobia often occurs as a result of unprocessed trauma or as a result of life crises. It is necessary to go with such complaints confidently to the family doctor, so that the symptoms do not worsen. An increasing social withdrawal has far-reaching consequences. These can mean the loss of a job and the usual ability to act. Mostly, those affected can not free themselves from their fears alone. Often, going to the family doctor is problematic. To the fears shame can join.

The family doctor transfers the person concerned to an exposure or behavioral therapy or another psychotherapeutic measure. He can also prescribe anxiolytic drugs that return the patient a bit of normalcy. Since this may be a combination of anxiety disorders with or without panic attacks, further action may be needed. The anxiety disorder can already be generalized, as it has often been present for a long time. However, the patient can learn through therapy that anxiety is lost over time.

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Treatment & Therapy

If the psychotherapist has excluded other illnesses such as psychosis or organic illnesses and has diagnosed agoraphobia, he clarifies to the person concerned by means of examples from his own anamnesis the connection between his anxiety and his behavior as a victim.

If an addictive behavior with regard to alcohol or medication has developed in the person affected in order to endure anxiety situations, this must also be treated therapeutically.

For the therapeutic treatment of agoraphobia there are practically two ways:

In the case of systematic desensitization, the therapist tries to help the affected person gradually. First, individual coping strategies are developed during a talk therapy. It may be helpful to learn a relaxation procedure, which is subsequently practiced in the practical confrontation exercises or desensitization therapy.

In addition, an imaginative therapy could individually prepare the affected person. Furthermore, hypnotherapy could be used to remove strong blockages. After that, the person concerned should gradually confront the specific anxiety situation with his therapist until he has learned that it is unrealistic to have this fear or that he has experienced how he can handle this fear positively in this situation.

The other treatment option is called flooding. The patient dares to voluntarily face his most difficult anxiety situation while the therapist observes in the background.

Outlook & Forecast

Many patients who have more or less severe agoraphobia, in addition to their anxiety symptoms, are concerned about whether these unpleasant attacks remain or can disappear spontaneously or through appropriate therapy. In general, agoraphobia has a favorable prognosis, though it depends on two factors in particular.

On the one hand, the success of a treatment is often better if the patient goes into treatment as early as possible in the case of more severe cases. Rapid initiation of therapy often avoids chronification of the clinical picture in advance. This means that unwanted side effects and complications such as the formation of a strong anxiety about the next onset of panic or a strong avoidance behavior in terms of anxiety-triggering situations can often be avoided by early therapy.

On the other hand, the cooperation and motivation of the patient (the so-called compliance) is also an important factor for the success of a therapy and thus the prognosis of the disease. It is important in agoraphobia, above all, to expose themselves to anxiety situations and to learn that these situations are harmless. In mild cases, a motivated patient can manage to perform these exposures on his own. In case of stubborn cases, the responsible therapist initiates, but for the success of the treatment also depends on the participation of the person concerned.

prevention

The learned relaxation techniques and behavioral strategies with individual positive affirmations also help the person concerned to prevent acute anxiety states of agoraphobia.

aftercare

The agoraphobia is one of the anxiety disorders that generally require careful follow-up, as they can easily flare up again. This can be done by the attending psychologist or psychotherapist who offers regular stabilization sessions. However, this can also be done on their own, as the affected are sensitized by the therapy for the thought patterns that trigger or favor the agoraphobia.

Self-observation is an important part of the aftercare. If a patient realizes that it is increasingly difficult for him to stay in crowds and in free places, it is important to consciously seek these situations again. The learned from the confrontation therapy can be used here specifically. Remembering that supposed dangers do not really exist in these situations is important for aftercare and stabilizes your health in terms of anxiety disorder.

Self-help groups can support the aftercare significantly. The community of former and current anxiety patients supports periods of weakness and the exchange of experiences extends the action strategies that are available when agoraphobia occurs.

For aftercare can also contribute to forms of activity and relaxation. Physical activity helps to increase confidence in your body and reduces the adrenaline output. Relaxation techniques promote the ability to become calmer and more relaxed. Autogenic training, progressive muscle relaxation and yoga are important here.

You can do that yourself

Which self-help measures are appropriate in everyday life, can be very different, since the agoraphobia varies from person to person. In the treatment of agoraphobia, the confrontation occupies an important position. Those affected can therefore face little challenges in everyday life, instead of avoiding fear-filled situations. At the beginning, the accompaniment or guidance by a psychotherapist often makes sense. The professional support ensures that the fear is not avoided, but actually wears off on its own. In addition, the therapeutic accompaniment can give a sense of security.

Especially with a behavioral therapy, it is important that patients do their "homework". Active participation in one's own therapy makes it possible to make the best possible use of the therapeutic sessions. In addition, such homework can contribute to implementing what is learned in therapy in everyday life.

Some people who suffer from agoraphobia will find it easier to understand the fear better. Suitable literature can be found, for example, on the Internet and in books. However, the quality of such publications varies greatly. It is advantageous if authors have a scientific background or are therapists.

Agoraphobia can be associated with other mental disorders. These should not be left untreated, but should be included in the therapy as well as in everyday life.

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