Surely each of us at least once has seen a person who literally moves through the area or is afraid to leave the open door. We are familiar to consider such people with cranks, but the problem is much deeper than it may seem at first glance.
What it is?
Agorafobia is a multi-storey phobia that manifests itself In the form of fear of open spaces, large clusters of people. The fear of open space can manifest in horror before the prospect of Go through a wide street or area or leave the door indoor. This phobia is known for a long time. Her name happened from the ancient Greek words, translated by the “market” and “fear”. Therefore, the fear of open space is often called a “market disease” or “disease of large areas”.
Agorafobia is a concept that includes many fears, one way or another related to the open space. Fears are unconscious and often irrational. In essence, the fear is a hypertrophied manifestation of a protective mechanism – a person feels danger, and physiological, mental and biochemical processes start in his body, which include “protection”, suggest that in this situation you need to escape, to escape.
The first surprisingly accurately described this mental violation. German psychiatrist and neuropathologist Karl Westphal, who lived in the XIX century. His work dedicated to the “Market Film” was published in 1872, and he was the first to use the term “agoraphobia” himself. In his work, Westphal described mostly only the fear of being in an open place, but then the lanted science did not know about the subway at the rush hour, did not imagine large demonstrations and rallies for several hundred thousand people.
Surely many will be surprised by learning that Agorafobia at one time suffered by Sigmund Freud. The disease manifested itself especially strongly in his youth, and for this reason, a world-famous doctor was very difficult to perform independent walks in old age. He himself told about this one of his students to theodore district. Raik described this conversation in his writings, and at the same time concluded that Freud for the study of human psychology and its deep-seated secrets did not have anything other than his own problems with the psyche. And, indeed, Freud has managed much.
Before him, psychiatrists tried to treat fears with morphines, hypnosis and electricity. As a last resort, we sent a patient with phobias on therapeutic water or resort. And it was Freud first offered to talk, talk with patients, discuss their problem to minimize the manifestations of agoraphobia. The best medical minds of the world were shocked by such a sentence, it did not fit into any reasonable framework, but they could not offer anything better, and therefore Freud largely determined the principles of psychotherapy fear of open spaces and large clusters of people.
Today, medicine looks at agoraphobia wider. It includes not so much fear of open places, but also fear of similar situations (finding outside the house, the need to move somewhere outside the house, finding in the crowd, public places, in transport and subway). The fear of agoraphobia is ranked before the need to go without accompanying a deserted street, the park, fear of going to the road or a trip alone. This also includes fear to attend markets, large shops, restaurants, cinemas, go to rallies. For agoraphoba, fear of any place, which he, in the case of which, can not leave, being unnoticed, not attracting attention to others.
At the same time, people suffering from such a disorder are perfectly aware that their fears and panic attacks do not have grounds and are very afraid that such attacks will occur in public, that is, they will become public. As a result, the person finds the only reasonable, in his opinion, the exit – he closes in his “fortress” (at home) and leave it can not make any power.
On its territory Agorafob feels safe. Most can communicate perfectly, receive guests, to be welcoming owners, to work, lead telephone negotiations, solve very complex creative tasks, but solely on their territory. While they understand that the space around them is controlled, they behave adequately. They can live for years without leaving at home. Trying to avoid panic attacks, people with such a disorder Consciously limit their movements, narrow the area of activity, try to avoid any situations in which they may be too far from their safe space. It is important for them to know that If necessary, they can return to it quickly.
Quite often, agoraphobia is a concomitant symptom of other disturbances of the disturbing type, panic syndrome, sociophobia. Agorafobia is called psychiatrists of one of the most difficult phobias, it often leads to disability. So, to consider agoraphobes just eccentrics – erroneously. The state should observe and treat a psychiatrist or psychotherapist.
Marilyn Monroe suffered from agoraphobia, she was very afraid of open places and large clusters of people and attended them only, accompanied by loved ones or friends, which she trusted. A similar problem was the actress Barbara Streisand.
Causes of occurrence
If you ask any agoorefob, what it is he who is afraid why he can not get to the middle of the square and tell everyone that he thinks about them, or just leave the limits of his own apartment, it is unlikely that he will find an answer. In 95% of cases, patients with such a phobia consider their fears completely inexplicable. They do not see any connections of panic with the former shocks and psychological injuries. Only about 5% of the agoraphobes can, feel firmly, remember that The very first time experienced wild horror and panic in a situation where they felt bad in some specific circumstances: They hurt the flu, tired, it was very stuffy and hot, worried before the interview or surrender.
They, the doctor, of course, will believe. But the circumstances and situations in which fear arises, cannot explain the reason for its appearance. And on this account, psychiatrists and neurophysiologists know what the agoran themselves are not aware – the disorder is closely related to the critical level of sense of personal safety in humans. Quite often it is laid in childhood. If a person at a gentle age began to perceive himself as a creature vulnerable, weak and helpless, not able to confront the evil, aggressive and living world, then the probability that agoraphobia will appear at a later age, very high.
Why a child can feel like that? For three reasons:
- Parents are overcome without leaving spaces for their own solutions and actions, passing inspiring that the world is full of nightmares and dangers, “you need to be careful and always alert”+
- Parents do not pay attention to the child, are not interested in his experiences and fears, it does not feel support and safety near adults+
- Parents are too demanding, despotic, authoritarian, and the child is constantly tense, waiting for his actions, words, actions will cause disapproval and even punishment.
In all these situations, fear becomes the usual satellite of life from childhood, to some extent he is constantly present. But it would be unfair to accuse the parents. There are individual prerequisites for the emergence of a mental disturbance. Most often, agoraphobia develops in people with a certain type of nervous system – in very sensitive, impressionable personalities, disturbing, inclined to dig in their feelings, secretly, not ready to show their weaknesses to the world.
Sometimes the first attack of agoraphobia occurs after severe traumatic situations – severe illness, physical torture, sexual violence, the death of a very close and expensive person, after transferred to the natural disaster, staying in the combat zone. In an adult man with such a psychotic, the development of the ailment is possible after the loss of the work important for him, the partner’s care.
But all this is only external circumstances. What happens inside a person? In essence, his own brain begins to deceive it – that is why many patients with agoraphobic develop problems with the vestibular apparatus. A healthy person manages to maintain equilibrium due to three types of signals – proprioceptive, tactile and visual. These landmarks are enough to understand where you are and what is your position at the point of space at the current time.
Agorafobov may have perception of only two types of signals – tactile and visual. Due to this, a pronounced disorientation occurs when a person turns out to be inside a hoarse crowd, on inclined surfaces and large open spaces with a minimum number of visual landmarks. The brain sends them erroneous signals, as a result, an equilibrium disorder is possible.
note that on such “tricks” the brain is not able to itself, but with the active support of hormones. Anxiety occurs as a protective mechanism, and then instantly released in the blood of stress hormones (for example, adrenaline). Hormone immediately causes a “run or defend” in the brain.
But the world for Agorafoba is too big and terrible, he will not come to his head, and he himself (in his personal perception) is small and weak, and therefore the only probable brain reaction – a signal run.
In some congenital and acquired pathologies associated with a violation of a hormonal background, the development of agoraphobia may have exactly endocrine causes (pathological processes in the brain launches hormone imbalances). This is possible with neurocirculatory dystonia, alcoholism, drug addiction, coarse pathologies of the thyroid gland.
It is noteworthy that large coffee amateurs and everything that contains caffeine (strong tea and dark chocolate), also risk replenishing the friendly rows of agorafobov – caffeine stimulates the production of stress hormones and with the coincidence of the predisposing factors, the start of the “Market Disease” is quite possible. According to statistics, Agorafobia to one degree or another occurs in 5% of the population of the Earth, the men are subject to her less than women about 2 times.
Agorafoba just just know. He is afraid to get out of the house, do something outside of its usual territory controlled territory. Go out into the street, go on the road, go down in the subway and sit in a crowded morning bus for classic agorafoba – complex tasks, and sometimes generally unrealized. At the same time, one is afraid to visit the stores, and the second is not able to attend the hairdresser. Public transport is a common fear with such a disorder, because while the bus is going, a person can not stand and leave him if he feels in danger.
But the agoraphob is afraid not so much area, park, open door or deserted street. He is afraid to become a laugh in the eyes of others, if suddenly he becomes scary, because in most cases the panic attack starts. He is afraid of “losing a face”, to become the object of bullying, ridicule, because it perfectly understands that he is hard to control the attacks of panic.
At the same time, accompanied by loved ones or someone who the patient completely trusts, the level of anxiety decreases, and the person is able to do what one cannot do. There are agophobes that have only one fear, for example, fear crossing the area on foot or fear. There are people who suffer immediately with several fears at the same time until the full inability to leave their apartment, move away somewhere, and in the most difficult cases and in their native walls alone they cannot remain.
Typically, agolariflections act on ahead – plan their daily events in such a way as not to face under any turns of fate with situations in which they are scary: Looking for work in step accessibility, if you are afraid of transport, start working remotely at home, if you are afraid to leave the house, order products to the house, if you are afraid to go to the store, put closers on the door to do not accidentally forget to close the door behind you. And in their measures they are very consistent, punctual and attentive to small things.
If nevertheless Agorafob, despite all precautions, it turns out in alarming circumstances, it can be noted the following signs of the disease:
- Breathing is expelled and becomes shallow, superficial+
- Heartbeat is steadwork+
- Pot is enhanced, the face and hand sweat especially+
- Dizziness occurs, it is possible to loss of orientation in space, drop+
- There is a feeling of “coma in throat”, it becomes difficult to swallow+
- Feeling nausea and compresses in the stomach.
At the same time, a person is afraid that those surrounding will notice what now he is experiencing that strengthens physical manifestations. Many patients at the time of attack are afraid to lose their mind or die.
If cautious and prudent Agorafob knows that he will soon have to deal with the situation of a terrible, dangerous (for example, it is very necessary to visit the passport desk and get a document, because no one will do it for him), then in anticipation, he begins to experience fear in a few days. Anxiety is growing gradually.
True Agoraforts have a low self-esteem, they are almost certain in advance that nothing can be released from their clauses and ideas. They are afraid of loneliness, because they simply do not understand how to survive without support, care, protection from. They are painful about parting, can fall with severe depression.
All life Agorafoba – One incessant battle for extra safe space under the sun. And it happens that the patients can be able to win the extra lands to their “fortress”, they expand the space in which they feel calm. But after the emergence of unforeseen traumatic circumstances (the wife gone, threw her husband, betrayed each other, fired from work, did not go to work) Progress usually goes to no, and the person returns back to his “Islet of Security”.
Psychiatrists noticed that The first signs of the disease usually manifest themselves when a person reaches the age of 20-25 years. And in this – the main difference between this fear of other phobias, which are usually manifested in adolescence or in childhood. According to the analysis of people’s diseases with agoraphobia, experts noticed that the first attack of horror usually arises in certain situations – when a person stands at the stop and waiting for his tram or at the moment when he walks through the shopping center or bazaar, choosing a purchase.
Usually disorder has persistent chronic character. Periods of exacerbations are replaced by remission, and then exacerbations come again. Seven of the ten patients develop classical clinical depression, and almost half – phobic disorders. If a person is gradually developing a panic syndrome, the disease has the most difficult course and is becoming more difficult.
The corresponding diagnosis can be installed only after the conclusion of a psychiatrist, which listens to the complaints, compare the symptoms and determine the level of anxiety using a special test and series of questionnaires (Mi-questionnaire Mobility of Hartman). As a result, it establishes a certain form of a disease – without panic disorder or with panic disorder.
Unfortunately, science and medicine unknown “Magic Tablet”, which helped to help a person get rid of such a disease like agoraphobia. Therefore, the therapy will be long, complex, sometimes it continues throughout the life of Agorafoba.
Much depends on what form of violation is established – with a panic disorder or without it. If the attacks of panic as such are not, to treat a person accepted with psychotherapy. This is the most effective way to deal with the fear of open space, crowd or transport. The use of drugs in the case of non-aeronautical agoraphobia was recognized in an ineffective, Tablets from this disease can not be cured, you can only temporarily reduce the symptoms. But in particularly persistent cases, the ailment is still recommended by short periods of tranquilizers simultaneously with a psychotherapeutic course of treatment.
If the agorafoba has other mental disorders, then the treatment of them occurs simultaneously with the treatment of “market fear”. Consider the main methods that help to overcome this phobia.
The main method, which in psychiatry and psychology is estimated today as the most efficient – Cognitive behavioral therapy. At the very beginning, the doctor reveals the degree and frequency of anxiety and fears, the circumstances in which the person is experiencing them. Next, connections with certain memoirs, emotions and experiences of the patient. And then the doctor starts together with a patient a change in thoughts and beliefs that provoke fear in certain circumstances.
At the second stage, when a person begins to realize all the absurdity of his nightmares, he is beginning to gradually immerse in the situation, which he was still afraid of the most in life. At first it happens with the help of a specialist, and then – on your own. As a result, situations that have been recently scared, become familiar, at the calibration is not completely terrible, anxiety is quite naturally starting to decline.
If the agoraphobia in man is heavy, psychotherapy proceeds against the background of medication reception. It can be long. Often, experts use techniques such as Gestalt therapy, psychoanalysis, psychodrama, existential therapy.
Psychotherapist and psychiatrist do not set goals to destroy fear as such. They pursue another goal – remove those psychological attitudes and prerequisites, unhealthy perception of themselves and the world around, which lead to fear. Thus, treatment is aimed at improving self-esteem, to establish a more friendly relationship with the outside world and inhabiting it. Without this, the psychotherapy will be a sense of at least, and soon phobia will return. In particularly difficult cases, hypnosis are used.
For treatment use different drugs. They can be divided into several groups.
Trucks and dietary supplements
This includes funds that are essentially treating anything, but they have a general fascination effect on the body. Separately, they cannot be used because of the uselessness of such drugs in mental violation. But in comprehensive treatment can be appointed. These include “Glycine”, “Afobazol”, “Fesame”, “CerebroLizin”, “Magna B6”
Provide basically symptomatic effect, do not treat the root cause in principle. Cause braking signals in the brain, due to which anxiety is reduced. Most often apply Benzodiazepines “Fenazepam”, “Diazepam”. Preparations have side effects, With long-term use cause drug addiction, and therefore for long-term treatment are not suitable.
Preparations of this group are considered more effective in agoraphobia therapy than the above funds. Almost 80% of patients decrease the level of anxiety. Funds do not cause addiction. The effect is achieved by normalizing the number of neurotransmitters in the cells of the brain (the content of serotonin in particular) increases. The best result is possible to achieve while using Antidepressant and psychotherapy. More often use “PAROKSETHIN”, “SERTRALIN”, “Fluoksetin”.
General rules say that All medicines a person must take, being absolutely sober and sane. That is, the admission of alcohol, coffee, drugs for the treatment is excluded. The patient should not exceed the recommended dosage doctor. In this case, the refusal of psychotherapy does not guarantee any effect from treatment in general. On themselves pills if they “work”, then only in relation to certain symptoms and not long.
Forecasts for agoraphobia depends on how deep and hard is the disorder, as well as from the personal interest of a person in healing from phobia. If the patient is not quite well motivated, then all the efforts of a psychiatrist or psychotherapist will go as shock.
It is almost impossible to cope with agoraphobia on their own, since fear quickly becomes an integral part of a person’s life, part of his own personality. And the fight against him reminds the notorious struggle bee against honey. Therefore appeal to a specialist – be sure. The following recommendations will help to speed up the positive results and defeat the fears:
- Learn to relax – Practice meditation, do yoga (this can be done on video times), pay relaxation time daily, better when it happens in the morning and in the evening+
- Believe me that you are on the way to recovery, you have enough strength in order to go through this way to the end+
- Color the breathing gymnastics – a series of breaths and exhalations of a certain depth and intensity helps to cope with a panic faster if the attack will repeat+
- Drive diary, In which every day, specify in the details, which part of your fears have already managed to win, it will help to see progress and will motivate you for further treatment.
As you do try to enlist the support of the person you trust. Share with him with your new feelings, achievements. But gradually acquire more independence: if you could not go to the store without accompanying, do not be afraid to try it yourself, but first make half the way to the store and return, and then overcome the whole way. In the next “approach” go to the store and keep there a little. Gradually succeed and make purchases.
According to the results of the latest studies, it helps a lot of responsibility for someone who is weaker than you. Therefore, if you have the opportunity, get a pet with whom you need to walk, for example, a dog. With her, you will not feel lonely on the street, and go there will have to go there at least 2-3 times a day, which gradually turn the hostile environment into the usual.
The prevention of agoraphobia does not exist, since triggers (provoking factors) have not yet been studied. And the prevention is wiserfully take care of parents who want to grow children’s mentally healthy. For this, mom and dad should not adhere to an authoritarian style of upbringing, in which the child is constantly intimidated. Hyperex should be deleted – The child must have enough personal space and independence, he must have the right to choose. At first it will be a choice that it is to eat for an afternoon school, and later – the choice of profession, university, friends.
If you are a sensitive person, anxious and very worried about what others think about you, if you are often afraid not to cope with the case, which you have to do on your own, without the help of others, if in the subway or bus you are extremely uncomfortable (but it is not yet It is about panic), you need to seek help to a psychologist. This will help to reconsider some beliefs that in adverse circumstances may well result in the development of agoraphobia.
First of all it is important to understand that you are strong enough to live in the world without fear. Yes, and the world itself is not so angry and unfriendly, as it seems. Try to see in it good, and then the street behind your window will never become a “mine field”, step on which you do not agree in any kind of rugs.
On how to get rid of agoraphobia, see the following video.