Agoraphobia, social phobia and thoughts of death: stories of Omsk residents who suffer from panic attacks

The unconscious fear of being in a public place without being able to leave, or of being in a situation in which panic or anxiety may develop, is called agoraphobia. What is this? The answer is: a severe mental illness of the neurotic spectrum, related to anxiety-phobic disorders, the so-called fear of open spaces. To put it simply, along with other phobias, this is also a type of neurosis.

Necessary and not so necessary information

The name “agoraphobia” comes from the merger of the Greek words ἀγορά (agora), which means “market,” and φόβος (phobos), which means “fear.” The term appeared in 1871. Previously, such pathology was considered by specialists as a manifestation of generalized anxiety. This was the case until 1980, when, based on many years of observations, it was concluded that these disorders are caused by different reasons and differ in development and response to therapy.

Fear has been living in us since the appearance of the second, it is as ancient as the very existence of homosapiens. It is based on biology and physiology, so it is very simple to justify. A man, leaving the thicket of a forest into an open space, was afraid to encounter something unknown that could threaten his life, and he had no opportunity to hide. And when global migration and clashes between tribes began, the fear of a crowd appeared, in which anyone could be injured or trampled. All this remains in our genetic memory.

Now it is clear that agoraphobia is two types of fear: panic in a crowded place and discomfort in an open area. Sometimes it is called fear of life: a person suffering from it feels calm only in his own home, he seems to be locking himself in - he cannot go to work, buy groceries, visit a museum or concert. He is not able to be on a subconscious level where everything is “seething”. A patient may experience a panic attack:

• in a market or store full of people;
• on an empty street;
• at public transport stops and inside it;
• at a rally, stadium, parade;
• in the auditorium;
• indoors with open doors and windows, etc.

Even in the hairdresser's chair, such a person can panic! And the point here is not that in some cases there is no open space and a large mass of people, but in accessibility, the lack of opportunity to escape and hide unnoticed.

The prevalence of agoraphobia has made it popular in the creative community: there are, for example, quite a lot of musical works on this topic. Cinema did not stand aside either: the plot of such films as the Russian “Closed Spaces”, the Canadian “Frozen in Fear”, the Belgian “Tom in Love”, the Italian “Best Offer”, the American “Imitator”, etc. is based on it.

Among the famous actors there were and are agoraphobes: Marilyn Monroe, who died early, Macaulay Kalin, Daryl Hannah, Kim Bassinger, as well as the notorious director Woody Allen. This disease has brought and continues to bring a lot of troubles and difficulties to all of them.

Prospects

Most patients can improve with medication or behavioral therapy. However, without prompt and effective help, the disorder may become more difficult to treat.

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Reasons for appearance

Experts cannot name the main “culprit” for the development of agoraphobia. It is believed that the root cause is a panic attack, which turns into an anxiety disorder. Others believe the diametrically opposite: first a fear of open spaces appears, and panic attacks “follow” from it. A compromise between these theories has not yet been achieved, but one thing is clear - these pathologies are very closely related.

Sigmund Freud's concept

The founder of psychoanalysis proposed his concept of the development of agoraphobia and other anxiety disorders: since they are all neurotic pathologies (neuroses), their origin is at the psychogenic level.

Freud believed that the main symptom of the disease, anxiety, is the result of an intrapersonal conflict that arose in childhood or adolescence, a compromise between the drive (“it”) and the prohibition on this desired (“superego”). This, in turn, transforms into sensations such as tremor, shortness of breath, and suffocation.

Academician Pavlov's theory

The great physiologist considered any fear to be a conditioned reflex. That is, if some incident occurs to an individual or a person close to him, causing fear, then when he finds himself in such a situation, the brain begins to “sound the alarm.” Over time, growing like a snowball, such fear transforms into agoraphobia. But one can argue with this: not all people who have experienced trouble in a crowd get sick, and on the contrary, the disorder develops in those who have not had such cases.

Is the vestibular apparatus to blame for everything?

Not so long ago, research results appeared claiming that it is problems with the vestibular apparatus that are responsible for agoraphobia. It is located in the inner ear, in the bony labyrinth, and its functional duty is to orient the movement of the human head and body. That is, the signals from the visual-muscular system and the vestibular apparatus must be balanced. However, problems with the latter do not allow agoraphobes to normally perceive tactile sensations from a surface and visually clearly see objects. This disorientation leads to agitation and a panic attack.

Diagnosis of agoraphobia

Many of the symptoms that characterize agoraphobia are similar to those of other disorders, such as heart disease, stomach problems, or breathing problems. Therefore, a person with agoraphobia may spend a year or more visiting different doctors or even calling 911 before he or his doctor realizes what is really going on.

In this case, the doctor may ask:

• Is it scary or difficult for you to leave the house?
• Do you have to avoid certain places or situations?
• What happens if you hit one of them?

Your doctor may do a physical exam and possibly order some tests to rule out any other medical conditions. If the organic cause of the existing symptoms is not established, a person with these symptoms will be advised to consult a psychotherapist or medical psychologist.

During the consultation, you will answer questions about your feelings and behavior. According to ICD-10 standards, a diagnosis of agoraphobia can be made if the following criteria are met (presented for informational purposes only, does not constitute a basis for self-diagnosis):

• psychological or autonomic symptoms are the primary expression of anxiety and are not secondary to other symptoms such as delusions or intrusive thoughts;
• anxiety accompanies at least two of the following situations: being in a crowd, public place or transport, alone outside the home or in a confined space;
• avoidance of phobic situations is or has been a prominent feature.

Important: self-diagnosis and self-medication are NOT acceptable. Only a psychotherapist or psychiatrist can establish a differential diagnosis, as well as draw up a correct treatment plan.

"Triggers" of the disorder

The factors that “trigger” the fear of open space are quite clear:

1. Genetics. If there were people suffering from agoraphobia in the family, then with a 50% chance the descendants will inherit it (as with any other types of phobias).
2. Environment. Neurosis can develop if a growing child is constantly in a tense atmosphere that adversely affects his nervous system.
3. The presence of an anxiety disorder – panic, social phobia (fear of public actions, speaking), aquaphobia, etc.;
4. Traumatic situation, stress. Weak and moderate, but constant and long-term irritants affecting a child or adolescent lead to emotional stress. They deplete the individual’s nervous system and become “fertile soil” for the development of a phobia. Sudden stress (death of loved ones, terrorist attack, natural disaster, etc.) also contributes to this.
5. Features of the structure of the body, psychological constitution. This refers to character traits, temperament, and personality of a person that shape an individual’s attitude to a certain stress factor and reaction to it. Thus, the risk of developing “fear of spaces” exists in people with increased anxiety, developed imagination, and a tendency to isolate. In the event of some “cataclysm” that the other person will not even notice, they may develop PTSD, turning into panic and agoraphobia.
6. Accented personality type. In this case, the individual’s character traits become sharper and begin to manifest themselves very clearly - the anxious and suspicious person develops excessive anxiety, the schizoid person develops suspicion, etc.
7. Poor physical health.

In addition to the above, people with chronic fatigue, little rest, poor nutrition, and uncontrolled use of medications such as sleeping pills and tranquilizers may be susceptible to agoraphobia.

Who is more susceptible to the disease? Some statistics

Agoraphobia most often occurs at a young age. The range is in the region from 15 to 25 years. During this period, powerful hormonal and physiological changes occur in the body.

It is during this transitional period that a not yet fully formed person faces many difficulties: misunderstanding of academic disciplines, rejection of himself and his body, first unsuccessful love, conflicts with parents and teachers, inability to self-determinate, the desire to stand out from others, difficulties communicating with peers, bad company, taking psychoactive substances (drugs and alcohol). Thus, the stress factor when agoraphobia occurs is in the external and sometimes hostile world.

Most often, residents of large cities are susceptible to neurotic disorders. Difficult working conditions, conflicts in the family, lack of proper rest, lack of sleep, poor nutrition and daily routine are a serious negative background for the occurrence of agoraphobia.

At-risk groups

As a rule, agoraphobia develops in a person at the age of 20–30 and extremely rarely can appear after 40. For many people, it “gets along” with panic disorder, uncertainty, dependent nature, and dissatisfaction with life.

Rural residents, unlike those who live in big cities, do not develop agoraphobia. Among those suffering from this disease, more females than males are in the highest risk group: ladies without children, girls not in a permanent relationship, with low income and low social status. Also vulnerable:

• epileptics;
• people with a rich imagination;
• neurotics;
• suffering from diseases of the central nervous system;
• manic-depressive individuals;
• weak somatically;
• asthenics;
• people with respiratory problems;
• those who have suffered a traumatic brain injury;
• having tumors;
• with malfunctions of the endocrine system.

The peculiarity of the fear of open space is that until the age of twenty a person lives a completely calm, full life, but at a certain moment, when the first attack of panic hits him, everything changes radically.
This usually happens when he begins to live independently and may be afraid of change, traveling alone, or crowds. If treatment is neglected, the disease can lead to deep depression, the inability of the patient to appear anywhere unaccompanied, and disability.

Sources

1. Melnikova M.V. Agoraphobia // Innovative science. 202 No. 6.
2. Statsenko Oleg Aleksandrovich, Drozdovsky Yuri Vikentievich, Kralya Oleg Viktorovich Sulpiride in the complex therapy of agoraphobia with panic disorder // Russian Psychiatric Journal. 2011. No.
3. Moor L.V., Rakhmazova L.D. Clinical and psychopathological features of agoraphobia with panic disorder in patients of the department of non-psychotic mental disorders // Omsk Psychiatric Journal. 2021. No. 1 (7).
4. Pavlichenko A.V. Stages of development of panic disorder and differentiated therapy // BMIK. 2015. No. 2.
5. Shukil L.V., Statsenko O.A., Kuznetsova I.G. The influence of stress on the formation and dynamics of the symptom complex of agoraphobia with panic disorder // Omsk Psychiatric Journal. 201 No. 1 (3).
6. Burno A.M., Nekrasova S.V., Zuikova N.L. Experience in using the technique of inversion of possibilities for psychotherapy of agoraphobia in the structure of panic disorder // Archives of Internal Medicine. 201 No. S1.

Tips for those who want to avoid recurrent attacks

1. Seek qualified medical help from a psychiatrist. Don't neglect your health! Timely attention to the problem will help prevent complications of the disease.
2. Take the necessary medications prescribed by your doctor. If a psychiatrist has prescribed you therapy with tranquilizers or antidepressants, do not adjust the dosage of the medications and do not stop taking the medications at the first improvement. Psychotropic drugs have a cumulative effect. This means that the longer you take the medicine and gradually stop taking it, the longer the stable state of remission of the disease will remain.
3. Carry a tranquilizer with you in case you have an attack in a public place.
4. Learn techniques to relax and help yourself. Breathing techniques are the most effective. When an attack is imminent, it is important to breathe slowly, deeply and measuredly. This will prevent the development of a vegetative crisis and brain hypoxia.
5. If you feel anxious about an impending attack, find a quiet place, breathe deeply, close your eyes and think about something distracting.
6. If you cannot calm down on your own, approach any person and briefly explain your condition. They will definitely help you!