Agoraphobia: how does the patient experience it?

Agoraphobia is an anxiety disorder that has to do a lot with the anticipation that something bad might happen. As Dr. Lerma Carrillo, a specialist in psychiatry who for the last ten years has been combining his private practice of psychiatry in Santiago de Compostela with his work, explains.

What is agoraphobia?

Agoraphobia is included within the anxiety disorders; and although it is a condition that can appear in isolation, it is very often a form of complication of a panic disorder. Agoraphobia is defined as the occurrence of anxiety when being in places or situations where escape may be difficult (or embarrassing) or where, in the event of an unexpected anxiety attack, help may not be available. The fundamental thing is this fear of helplessness that can appear in a thousand different situations: in closed places, such as a bar or a classroom full of people, but also in open spaces such as on a hike in the mountains; or while driving along the highway and there is no exit nearby.

That is to say, they have to do a lot with the anticipation that something bad might happen, something like: “the anguish for the possibility of anguish”. This type of sensation leads the patient to more or less consciously avoid these situations in order to keep the anxiety under control.

What sensations does the patient suffering from anxiety have?

In most cases, people with agoraphobia describe the need to avoid certain situations for fear of experiencing panic symptoms such as difficulty breathing, chest tightness, tachycardia, fear of dying, going crazy or losing control.

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The specific symptoms encompassed within the feeling of “losing control” are subject-specific and may include fears such as losing bladder or bowel control, vomiting, fainting, or the inability to perform any simple task. Sometimes it can be difficult to describe the nature of the fear being experienced and is described as a feeling of generalized fear or that something bad is going to happen imminently.

Why and how does it occur?

Although the ultimate reason for agoraphobia is currently unknown, the most recent research suggests that it is a condition with a biological component, related to genetic predisposition; a psychological component, related to certain personality traits; and an environmental component, related to learning processes in the context of anxiety.

What treatment should the patient follow?

The first step in the treatment recommended by psychiatric specialists is a correct diagnosis. This includes ruling out other conditions that may give rise to symptoms similar to those of agoraphobia, such as social anxiety disorder, simple phobias, post-traumatic stress disorder, obsessive-compulsive disorder or depressive disorder. Once the diagnosis has been made and depending on the intensity of the symptoms and how they affect the patient’s daily functioning, there are different therapeutic strategies that may include drugs, such as antidepressants and anxiolytics, and cognitive-behavioral psychotherapies. The choice of the therapeutic plan should always be made on an individual basis, with a professional experienced in the management of anxiety problems and taking into account the patient’s preferences.