What is agoraphobia?

Agoraphobia means anxiety and avoidance behavior for certain situations. The word comes from the Greek and literally means ‘fear of the market square’. In the Netherlands it is referred to as ‘square fear’.

However, there are many more situations that can trigger anxiety, such as:

  • go far from home
  • shopping in a supermarket or department store
  • stand in a row in front of the cash register or counter
  • driving on a highway
  • only drive the car
  • in public transportation
  • on a bridge
  • in a tunnel
  • in a plane
  • in an elevator
  • on a high building
  • in the chair at the hairdresser’s
  • in a restaurant
  • in the cinema
Typical of situations that cause anxiety in some people is that there are many people together. These situations can give the feeling that it is impossible to escape, such as in an airplane. The feeling of fear can also arise because you think that others would find it strange if you suddenly left.
People with agoraphobia are often afraid of leaving a ‘safe’ place, such as their own home, or a ‘safe’ person. They often dare more if there is someone familiar with them.
About five percent of adults (three and a half percent of men and seven percent of women) go through one or more periods of agoraphobia in his or her life.

Symptoms agoraphobia

You can usually easily recognize agoraphobia in yourself: you become tense or anxious about the idea that you have to go into a certain situation. You avoid this situation or can only endure the situation with a very anxious feeling. Because of the fear and the limiting influence this has on your life, you can start to feel sad. Agoraphobia is often accompanied by panic attacks, especially in the beginning.
The fear of getting a panic attack and then not being able to leave, not getting help or making a fool of yourself, will make you avoid situations.
Agoraphobia is difficult to recognize in others, because the scaring situations are often avoided. As long as someone avoids the situation that frightens him, the fear does not eventually occur and apparently nothing is wrong. What can be noticed is that someone avoids many situations, or only dares to do this together with someone else.

How does agoraphobia arise?

Avoidance Behavior with Panic Attacks Agoraphobia often starts with panic attacks, which causes someone to avoid the situation in which they felt anxious. This is called avoidance behavior. This has a positive effect in the short term: avoiding the situation will not cause a panic attack. This initially gives a sense of relief. And people tend to repeat behaviors that make them feel better. So there is a good chance that you will avoid a certain situation again the next time, so that you do not have to feel anxious. However, this behavior can cause problems in the long term.
By avoiding behavior you can no longer experience that there is actually no reason to be afraid and that you can best handle the situation. Your own anxious thoughts and suspicions are always confirmed in this way and you are increasingly convinced of them. In serious cases, this can lead to you barely leaving your house.
Avoidance Behavior without Panic Attacks You can also get avoidance behavior without ever having panic attacks. Just the idea that you might become anxious or not feel well may be enough. These kinds of fears can easily be learned by seeing fear in others. For example, some children are afraid of the same situations that parents have shown to be scary.
Many people with agoraphobia overestimate the danger of certain situations, such as when traveling by plane. Furthermore, the fact that you have once felt uncomfortable in a certain situation may make you avoid that situation in the future.
In addition to fear, other feelings can also be important, such as anger or sadness. If you have ever felt enormously angry in a situation, you may be afraid that you will get an uncontrolled outburst of anger if you return to this situation again. Again avoidance behavior can result from this.

Is it serious and what can you expect?

Agoraphobia often does not resolve itself. This phobia tends to expand further and further. More and more situations may arise that you must avoid because you become tense. It is therefore wise to call in expert assistance on time.
Yet there are also people who avoid one particular situation throughout their life and also function normally. They will not be inclined to seek help for this.

When to the doctor?

If you are limited by your fear in your actions, it is always wise to go to the doctor. Your doctor will discuss with you what you can do best in your case.
Agoraphobia is a treatable condition. If the anxiety is too high, your doctor may prescribe you medication (temporarily). A sedative can be prescribed for a short-term solution. There are objections to this type of medication, such as the risk of addiction with long-term use. They should therefore preferably be used for a maximum of a few weeks.
Certain antidepressants work well for long-term treatment of anxiety. They have to be swallowed for a longer period, the first effect is usually noticeable after a few weeks. The use of antidepressants is not dangerous, but there can be unpleasant side effects. They mainly work against anxiety. After the strike there is a chance that your feelings of fear will return.
Treatment with medication must therefore generally be combined with another treatment. The doctor can refer you to a psychologist or another therapist who has experience in treating anxiety complaints. Such a treatment usually consists of a number of steps. You learn relaxation exercises and possibly other methods to deal with anxiety.
In addition, attention is paid to learning a more realistic way of thinking, so that you can tackle frightening thoughts yourself. You will gradually have to re-enter the situations that you have avoided so far. Sometimes you practice this first, together with the therapist, in your imagination. Subsequently, you will also be looking for those situations more often and longer in reality. In this way you learn that even if you feel anxious, you can handle the situation and that nothing serious or dangerous happens. The fear will subside over time.
It appears that many people with agoraphobia, but also with other anxiety complaints, find it difficult to stand up for themselves and their own interests. A training in social skills or assertiveness can then be a good addition to the treatment.

What can you do about it yourself?

  • Learn to relax. You don’t necessarily have to go to a therapist to learn how to relax. It is quite possible to learn and apply relaxation exercises yourself. Practicing regularly, especially in the beginning, preferably several times a day is important. This does not have to take much time, fifteen minutes is often enough. If you enter the dreaded situations in a more relaxed way, the fear is much less likely.
  • Do breathing exercises. Not only does this make you calmer, but it can also give you the feeling that you can influence your situation again, which makes you feel stronger.
  • Find out what your feelings of anxiety have to do with. Are they real? Are the frightened thoughts in your head really correct, or can you look at it differently? By becoming aware of these thoughts, it is often possible to put them into perspective (in part), which will reduce the fear. Put the new, putting things into perspective for yourself on paper and carry it with you so that you can look at it again at difficult moments.
  • Say to yourself: “there is no danger”. Keep telling yourself that you are not really in danger if you panic, although it feels different at that time. For example, you can say softly to yourself “calm down, nothing happens” or “you can handle it.” Many people benefit from reassuring themselves in this way when fear threatens.
  • Seek distraction if you are in a situation that you find exciting. Do not let yourself be carried away by the fearful feelings or thoughts. You can better focus your attention on the things around you. For example, look consciously at other people, what they look like, what they are wearing, and so on. Or give yourself an assignment, such as counting down from a thousand in steps of three. Because you are busy with other things, the fear is much less likely to get a hold of you.
  • Prepare for anxious situations by thinking in advance what could happen and how you could resolve it. Avoiding or leaving the situation quickly is not a good solution in the long run. Find out what could happen to you and how you could deal with it. Write down possible solutions for yourself and take them with you. Experience shows that it is difficult to keep thinking clearly if you are in danger of becoming anxious. It can help if you can simply use your previously conceived solutions.

General advice and precautions

If you suffer from agoraphobia, it is important not to avoid situations that you experience as threatening. Try as much as possible to do the things that give you a feeling of fear or tension. In this way you prevent that you continue to be restricted in your normal functioning.
Do not resort to alcohol or other drugs that have a narcotic effect to ward off your fear. Although it sometimes seems that these remedies make you calmer, that is not really the case. Alcohol and drugs, on the other hand, reinforce emotions and therefore fear. You do not solve your problem with it, and you even run the risk of having a problem later.
It is also important to talk to others about your feelings of fear. You don’t have to be ashamed of this. If you talk to others about it, you will find that many people have been troubled by anxiety. You are certainly not alone. If you think you have agoraphobia, go actively in search of expert help, so do not keep walking with your complaints. Research indicates that a treatment has good results in more than eighty percent of the people.
Source : dokterdokter

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