Feeling anxious, worrying or feeling apprehensive is an experience common for a lot of us within our daily lives, which could be in association with specific situations. Agoraphobia is a type of anxiety disorder which is characterised by a marked fear or anxiety about two or more of the following five situations: (a) using public transport; (b) being in open spaces; (c) being in closed spaces; (d) standing in a line or crowd; and (e) being outside of the home alone.
Further, because of such anxiety, the individual fears or avoids the situation, which almost always provokes fear and anxiety. Therefore, these situations are actively avoided, and the individual typically tends to require the presence of a companion to reduce the anxiety when confronted by such a situation. In addition, it is important to understand that the anxiety experienced is out of proportion to the actual threat posed by the situation and to the socio-cultural context. The fear anxiety and avoidance is persistent typically lasting for 6 months, and contributes to significant interference in the individual’s personal, social as well as occupational functioning.
Dr Samir Parikh, Director, Department of Mental Health and Behavioral Sciences, Fortis Healthcare explains the causes, risks and treatment for the condition.
As is the case in most other anxiety disorders, multiple theories and contributing factors have been suggested for contributing towards the development of agoraphobia. However, no single causative factor has been fully implicated. The etiology of agoraphobia involves an interaction between genetic, biological, and psychosocial factors.
*Biological Factors: The role of neurotransmitters has been clearly established in the causation of anxiety disorders. Specifically, lower levels of serotonin have been found to be associated with agoraphobia as well.
*Genetic Factors: Most anxiety disorders have a tendency to run in the family. Children with at least one parent having any anxiety disorder have higher chances of being diagnosed with agoraphobia.
*Psychosocial Factors: Besides the biological and genetic factors, many psychological and social stressors like trauma, loss of a dear one, difficulties in relationships, work-stress, change in environment, and other life-challenges can be a trigger for symptoms of anxiety.
In addition to the above-mentioned factors, there are certain other factors that tend to increase the risk of an individual developing an agoraphobia:
• Parental history of shyness, social inhibition or any anxiety disorder.
• Anxious or insecure disposition.
• Difficult and challenging family circumstances.
• History of childhood abuse – verbal, physical or sexual.
• Low sense of self.
• Low peer-group support and other support mechanisms.
• Over-protective, controlling or detached parenting.
Mounting evidence indicates the effectiveness of using psychological approaches in significantly reducing the symptoms of anxiety disorders. Aiming at providing relaxation techniques, such approaches also help the individual boost his/her confidence and self-esteem and encourage the person to face the feared situations.
Social Skills and Assertiveness Training are the essential components of the interventions directed at helping individuals with such anxiety disorders. Further, a combination of medications and psychological approaches could help regulate the production of ‘serotonin’, the neurotransmitter in the brain which contributes to anxiety, while also developing more adaptive coping mechanisms.
Agoraphobia is treatable, and professional help is irreplaceable. The person suffering is often ridiculed for a lack of confidence and courage and may even be snubbed by others. Often people may choose to hide their symptoms, in fear of embarrassment or stigma. It is imperative to encourage a supportive environment for the earliest identification and adequate psychiatric and psychological intervention.