Agoraphobia with panic disorder – understand and treat

Understand fear

Agoraphobia (with and without panic disorder)

As agoraphobia is an anxiety disorder called triggers in crowds or wide squares. In the International Classification of Diseases she is assigned the number F40.01. She will also be technical agoraphobia This term refers colloquially to claustrophobia (ie fear of confined spaces).

Agoraphobia can both With as well as without panic disorder occur. The severity can range from mild discomfort to extreme anxiety, which at worst prevents those affected from leaving the house. Basically, fear of a loss of control and associated humiliation or danger is central aspect of the phobia (see also fear of loss of control causes).

Symptoms and diagnosis of agoraphobia

An agoraphobia with panic disorder has the following symptoms: Fear of:

  • crowds
  • Stay far away from home
  • Travel alone
  • Public places
  • panic attacks

At least two of the first mentioned points must act as fear trigger to speak of an agoraphobia. Panic attacks often occur additionally inside or outside one of the anxiety situations in the context of an additional panic disorder, but they can also be completely absent (see also anxiety attacks). There will be a panic disorder considered as a separate and primary disease.

Panic attacks are often experienced as extremely frightening, as they are accompanied by accompanying symptoms, which are often seen as life-threatening (see also panic attacks symptoms). These include, for example, numbness and tingling, severe dizziness, palpitations and ticks, nausea and abdominal pain. Because of this people often fear being unconscious in public or being vomited (cf fear of vomiting), possibly even having a heart attack. There are also other fears: to go crazy, to stop breathing, and to stifle or otherwise lose control. All of these usually occur without any real danger or health-related history – for example, seldom is there any heart disease. A good description can be found at this point:

YOUTUBE: T) Raumzwang is a 360-degree documentary. He dives into the life of a man suffering from an anxiety disorder called agoraphobia >

If these symptoms and concomitant conditions occur, it is necessary to distinguish agoraphobia from similar diseases. First and foremost, it can be another anxiety disorder, such as a generalized anxiety disorder that also occurs in situations other than the one mentioned. In case of agoraphobias however, it is a specific phobia.

Panic attacks can be against other anxiety symptoms (see Symptoms of anxiety disorders) due to their very acute occurrence and the strengthen differentiate somatic symptoms. In the case of obsessive-compulsive disorder, on the other hand, refusing to leave the house may be an expression of other fears, most of all of improper hygiene and laborious cleaning. Last but not least, it can also be a depression, here are the reasons behind the retreat others: leaving the house or being together with other people is perceived as too strenuous or otherwise stressful, often the affected are also too depressed to activities as pleasant feel.

Causes and concomitant diseases

For an agoraphobia with panic disorder may be different causes give – but not always can be found at all a cause. One of the possible reasons is a very active and sensitive nervous system, which makes those affected very sensitive to external and internal stimuli. This can lead to sufferers on the one hand quickly overwhelmed with the amount of stimuli from the outside, but also quickly overestimate physical symptoms in their intensity and dangerousness.

Suffering traumas can also lead to agoraphobia, in part as part of a post-traumatic stress disorder. However, it is also the first anxiety attack – often due to an acute stress situation or excessive demands – be perceived as so traumatizing that develops as a result agoraphobia with panic disorder.

Agoraphobia can be highly comorbid with other anxiety disorders. These may be additional specific phobias as well as generalized anxiety or panic disorders. Also, depression is also common. However, these can occur both as a primary disease and secondarily from the agoraphobia attributable limitations and burdens. Because of this, it is also possible that sufferers abuse alcohol or tablets to relieve their symptoms and develop a dependency disorder. In fact, almost 50% of the agoraphobic participants in a study found problematic alcohol consumption. Posttraumatic stress disorder can also occur both causally and parallel to the anxiety disorder.

Course of agoraphobia

The most problematic aspect of an anxiety disorder is the maintenance of the associated avoidance strategies. Not always, but often an anxiety attack is the beginning of an agoraphobia. However, such a seizure rarely leads to the development of an anxiety disorder. In some cases, however, it impresses the person concerned so much that from then on he takes steps to prevent a recurrent attack and to avoid the associated negative experience. These strategies often include certain items with which sufferers associate reassurance or security, such as phone numbers, medicines, or the like. Often, the house will not leave alone, but only in the company of a trusted person. Certain places or situations such as bridges, cinemas, restaurants, events, etc., which are associated with a previous or feared future anxiety attack, are shunned to protect themselves from further occurrence. The same is often the case for physical exertion, as associated signs such as sweating, heart palpitations or fatigue are similar to those of an anxiety attack.

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Often, the fear of being in a shameful or helpless situation in the public, such as suffering a heart attack, fainting or vomiting, often plays a big role. The feared loss of control can potentially become the main driver of the disease. These seemingly protective measures, the agoraphobia with panic disorder but only maintained or even intensified. However, their strength is not necessarily consistent, the disease can show marked fluctuations and symptom-free phases. In the longer term, agoraphobia is often chronic and is much more difficult to combat. In that case spontaneous healing is unlikely and patience is necessary in therapy.

Agoraphobia treatment

Often the symptoms of agoraphobia with panic disorder do not return naturally, especially if it is aided by avoidance behaviors. Often, self-help is no longer possible – in this case, it is essential to seek therapy, which may require some experimentation to find the right path for you personally (see psychotherapy, behavioral therapy)..

Agoraphobia self-help

In the case of self-help, there are various options to choose from. Firstly, sufferers can network with each other, either through self-help groups or online forums. This gives them the opportunity to exchange views on therapists, methods and other aspects of the disease and to support each other. They may also be concerned that they are the only ones in the world to suffer from the often strange and embarrassing thoughts and feelings associated with panic disorder agoraphobia. Under certain circumstances, this knowledge makes it easier to deal with one’s own illness and alleviates the need to seek further help.

Another aspect of self-help can be the knowledge of the nature of the disease. For many phobics, it is reassuring to learn that their symptoms do not grow into the feared physical consequences. This is particularly true for the very impressive panic attacks of an associated panic disorder. Thus, it is often a great relief that palpitations do not lead to a heart attack, dizziness in the very rare cases to unconsciousness and nausea as rarely to vomiting in public. To constantly hover the fearful idea in mortal danger can be so frightening. With this knowledge in the background, the symptoms can be counteracted differently. In addition, there are skills that should contribute to the solution of anxiety, such as meditation or autogenic training. Even relieving only the physical symptoms can be enormously helpful.

Psychotherapy for the treatment of agoraphobia with panic disorder

Two things are essential if therapy is to be successful: a competent and experienced therapist and a good relationship of trust between specialist and patient. the drug of choice in a treatment is usually the confrontation. While concomitant talk therapy may be useful in understanding the causes and the onset of the disease, it rarely leads to recovery. In most cases, a systematic desensitization is used, which is to accustom the patient in small steps to anxiety-related situations. Here he is accompanied by his therapist, often a certain distance is maintained. The confrontation should help to show the person concerned that his fears in the situation do not occur.

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A similar approach follows the treatment by means of the so-called “Flooding”, in which immediately a maximum anxiety-triggering situation is chosen. However, this procedure is not risk-free and is rejected by many patients because the burden is relatively high. In addition, in a panic disorder with agoraphobia, a cognitive restructuring, also called “Entkatastrophisierung“For use. She works with positive self-instructions, in which the patient learns to show himself the harmless nature of his symptoms. For this purpose, consciously physical symptoms can be generated or a past or future panic attack can be introduced to practice dealing with it.

Agoraphobia with panic disorder – treatment by drugs

If an agoraphobia with panic disorder reaches extreme levels and prevents those affected from leaving the home, a drug therapy can be helpful in the beginning. In this case, anxiolytic drugs (anxiolytics) can help to regain a minimum level of everyday ability and to take important appointments such as doctor visits. In addition, they can help to tackle a causal therapy – in this case, medications under no circumstances represent a permanent solution, they only alleviate the symptoms. It is also important to make sure that the medication is not only used as an additional crutch and in this way creates a strong dependence. An additional therapy is therefore inevitable, even if initially improvement occurs. Common drugs include serotonin reuptake inhibitors (SSRIs), which are otherwise used to fight depression. Benzodiazepines can also be used in an emergency, but they must only be taken over a very short period of time, since they have a considerable risk of dependency.

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