La Fleur douce de Rue

Agoraphobia is something that I have, something that I live with and something that most people in my life refuse to acknowledge exists. By talking about it more and more and sharing what it actually is, my hope is that people will understand and accept it.

The life of an agoraphobic is hard enough, but when those you love and care about persecute you for things that are out of your control and/or mock you for your affliction, it can do irreparable damage.

A) Agoraphobia Definition
B) Agoraphobia Symptoms
C) Causes of Agoraphobia

A) Agoraphobia Definition

The term agoraphobia is translated from Greek as “fear of the marketplace.” Agoraphobia today describes severe and pervasive anxiety about being in situations from which escape might be difficult or embarrassing and/or from which help may not be available should a panic attack occur.

This anxiety leads to the following behavior:

1) avoidance of these types of situations, i.e., being alone outside of the home, traveling in a car, bus, or airplane, being in a crowded area, or being on a bridge;
2) endurance of such situations under great stress, i.e., a panic attack may occur; or
3) requiring another person's company when in said situations.

Agoraphobia typically accompanies a panic disorder although on rare occasions, it may also occur when criteria of a panic disorder are not fully met (Morrison, 1995). In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. This fear—called anticipatory anxiety or fear of fear—can be present most of the time and seriously interfere with the person's life even when a panic attack is not in progress. In addition, the person may develop irrational fears called phobias, such as agoraphobia, about situations where a panic attack has occurred. If agoraphobia occurs with panic disorder, the onset is usually during the 20s, and women are affected more often than men.

Agoraphobia affects about a third of all people with panic disorder. Typically, people with agoraphobia restrict themselves to a "zone of safety" that may include only the home or the immediate neighborhood. Any movement beyond the edges of this zone creates mounting anxiety. As noted earlier, sometimes a person with agoraphobia is unable to leave home alone, but can travel if accompanied by a particular family member or friend. Even when they restrict themselves to "safe" situations, most people with agoraphobia continue to have panic attacks at least a few times a month.

People with agoraphobia can be seriously disabled by their condition. Some are unable to work, and they may need to rely heavily on other family members, who must do the shopping and run all the household errands, as well as accompany the affected person on rare excursions outside the "safety zone." People with this disorder may become house-bound for years, with resulting impairment of social and interpersonal relationships. Thus the person with agoraphobia typically leads a life of extreme dependency as well as great discomfort.

B) Agoraphobia Symptoms:

Fear of being alone
Fear of losing control in a public place
Fear of being in places where escape might be difficult
Becoming house bound for prolonged periods
Feelings of detachment or estrangement from others
Feelings of helplessness
Dependence upon others
Feeling that the body is unreal
Feeling that the environment is unreal
Anxiety or panic attack (acute severe anxiety)
Unusual temper or agitation with trembling or twitching

Additional symptoms that may occur:

Lightheadedness, near fainting
Dizziness
Excessive sweating
Skin flushing
Breathing difficulty
Chest pain
Heartbeat sensations
Nausea and vomiting
Numbness and tingling
Abdominal distress that occurs when upset
Confused or disordered thoughts
Intense fear of going crazy
Intense fear of dying

There may be a history of phobias, or the health care provider may receive a description of typical behaviors from family, friends, or the affected person. The pulse (heart rate) is often rapid, sweating is present, and the patient may have high blood pressure. A person may be described as having Agoraphobia if other mental disorders or medical conditions do not provide better explanation for the person's symptoms.

C) Causes of Agoraphobia

The etiology of most anxiety disorders, although not fully understood, has come into sharper focus in the last decade. In broad terms, the likelihood of developing anxiety involves a combination of life experiences, psychological traits, and/or genetic factors. The anxiety disorders are so heterogeneous that the relative roles of these factors are likely to differ. It is not clear why females have higher rates than males of most anxiety disorders, although some theories have suggested a role for the gonadal steroids. Other research on women's responses to stress also suggests that women experience a wider range of life events (e.g., those happening to friends) as stressful as compared with men who react to a more limited range of stressful events, specifically those affecting themselves or close family members.

Here is a description of some of the most important research by the National Institute of Mental Health on panic disorder and its causes.

Genetics. Panic disorder runs in families. One study has shown that if one twin in a genetically identical pair has panic disorder, it is likely that the other twin will also. Fraternal, or non-identical twin pairs do not show this high degree of "concordance" with respect to panic disorder. Thus, it appears that some genetic factor, in combination with environment, may be responsible for vulnerability to this condition.

Brain and Biochemical Abnormalities. One line of evidence suggests that panic disorder may be associated with increased activity in the hippocampus and locus coeruleus, portions of the brain that monitor external and internal stimuli and control the brain's responses to them. Also, it has been shown that panic disorder patients have increased activity in a portion of the nervous system called the adrenergic system, which regulates such physiological functions as heart rate and body temperature. However, it is not clear whether these increases reflect the anxiety symptoms or whether they cause them.

Another group of studies suggests that people with panic disorder may have abnormalities in their benzodiazepine receptors, brain components that react with anxiety-reducing substances within the brain.

In conducting their research, scientists can use several different techniques to provoke panic attacks in people who have panic disorder. The best known method is intravenous administration of sodium lactate, the same chemical that normally builds up in the muscles during heavy exercise. Other substances that can trigger panic attacks in susceptible people include caffeine (generally 5 or more cups of coffee are required). Hyperventilation and breathing air with a higher-than-usual level of carbon dioxide can also trigger panic attacks in people with panic disorder.

Because these provocations generally do not trigger panic attacks in people who do not have panic disorder, scientists have inferred that individuals who have panic disorder are biologically different in some way from people who do not. However, it is also true that when the people prone to panic attacks are told in advance about the sensations these provocations will cause, they are much less likely to panic. This suggests that there is a strong psychological component, as well as a biological one, to panic disorder. (Further reading...)
Bland Street Bloom
(Provided by Psychology Today) (photo by OlliK)