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According to the Diagnostic and Statistical Manual-IV (DSM-IV), agoraphobia is the fear of being in places or situations from which escape might be difficult (or embarrassing). In some cases, the person may believe that help might not be avaiable in the event of suddenly developing symptoms that could be incapacitating or extremely embarrassing.
To further illustrate, the person may fear having symptoms of dizziness or falling, depersonalization or derealization, loss of bladder or bowel control, vomiting or even cardiac distress. As a result of this fear, the person either restricts travel or needs a companion when away from home, or else endures agoraphobic situations despite intense anxiety.
This ability to sometimes endure intense and uncomfortable situations baffles loved ones who may not understand why the agoraphobic does not consistently react in the same way each and every time. The purpose of this article is to explain further the dynamics of agoraphobia and how to access further help if there is a suspicion that someone you know may have the disorder.
Specifically, the DSM-IV asserts that common agoraphobic situations include being outside the home alone, being in a crowd or standing in a line, being on a bridge, and traveling in a bus, train or car. Sometimes, the person will have panic attacks when in these situations which then means that the diagnosis would be labeled as, 'Panic Disorder with Agoraphobia.' However, it is not necessary to have panic attack symptoms to be diagnosed as having 'Agoraphobia.'
To complicate the issue further, such symptoms may or may not have occurred in the past. If they have, the person may fear that symptoms will recur if reexposed to a similar situation. However, in other cases, the symptoms have never developed, but nevertheless the person fears that symptoms 'could' develop and incapacitate or be extremely embarrassing. Even more puzzling, some report feeling incapacitated in some way, but unable to specify what symptoms plague them.
Fortunately, despite the discrepancies in symptoms and presentations, researchers have been able to discover a great deal about this disorder. For instance, what they know is that this disorder is both physiological as well as psychological. From there conclusions, they have asserted that when man was first on the earth, he/she had survival instincts that were in constant use. Early man engaged in 'fight or flight' responses for accessing food and warding off predators. This activity allowed the body to rid itself of unnecessary chemicals.
However, in modern times, man has had less opportunities for throwing off unnecessary chemicals unless he/she engages in aerobics for exercise. Not surprisingly, those who have 'Panic Disorder with Agoraphobia' are believed to have a physiological glitch in their endocrine system in which the build-up of chemicals finds an outlet through panic attacks.
Another discovery made by researchers entails a common feature in this disorder that encourages persons to avoid people, places and things associated with the illness. This avoidance, rather than providing relief of symptoms, tends to reinforce and make permanent the strength of the fear and worry. Therefore, researchers have concluded that persons who have agoraphobia need frequent exposure to the places of which they are most afraid. Although initially anxiety inducing, researchers and therapists have foound that nothing else conquers the illness as well.
Some therapists believe that antidepressants can enable and empower the person to expose themselves to the places they fear. A registered state and nationally licensed psychiatrist can provide the person with an education as to which antidepressant medication might be right for their circumstances. Knowledge of prior medical and psychosocial history can help the psychiatrist identify which medication might be a goodness-of-fit for the person and his/her symptoms.
One way to approach resolution of the symptoms is to list all of the places that the person fears. Much time should be given to the creation of this list, as it will determine the rest of the progression for intervention. After all of the places have been listed, the person can rank them from least worrisome to most worrisome. With the support of a therapist who is state and/or nationally licensed, the person can be encouraged to expose him/her self to the places on the list, venturing from the the least worrisome to the most worrisome. Some researchers recommend that the person not move to a more anxiety inducing place until the repeated exposures to less anxiety inducing places no longer bring about anxiety.
The assumption is that as the lesser places are conquered, the person will be motivated to move forward with the greater anxiety inducing places. However, if a person fears only one setting (such as an airport), the person with the therapist can engage in what is known as 'flooding'. In this case, the person would be encouraged to place themselves in the setting as often as possible and for as long as possible in order for the brain to become enured toward manifesting symptoms. Again, this intervention should only be encouraged to be performed with a certified therapist who has an expertise in the area of agoraphobia.
Some may have a concern that their agoraphobic will not be able to leave the home in order to find a qualified therapist. However, those who are licensed and qualified to handle the symptoms of this disorder will sometimes be willing to visit the person in the home for the initial intake interview. Probably, the therapist will interview for motivation and desire for healing before being willing to spend time and energy helping the client to surmount the disorder. There may even be a contract that they will encourage the person to sign that attests of the person's motivation and commitment. However, if the therapist believes that the client is well intentioned, initial therapies can be done in the home.
In other words, help is available. There are even support groups listed in the local newspaper that could encourage a wider social support network. Knowing that a person is not alone can sometimes go a long way toward healing. Those who have recovered from this disorder report a sense of loss that they had not sought help sooner; however, they also learned a great deal about their personal strength from having survived it. Nothing is too big or too impossible unless the mind says it is. Help is out there just waiting for a telephone call.
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