Monday, February 26, 2007

Agora-what? I said, AGORAPHOBIA!

Agoraphobia, that’s scary, right? Most people think this psychological fear of being in crowds or sometimes being in open spaces is always accompanied by extreme panic attacks that often lead the afflicted seeking medical treatment. However, a new study published in Behavior Modification dares to defy this long-held belief. According to the article, many people experience agoraphobia without panic attacks and often the triggers are unknown. For the most part, the disorder is still a mystery.

The real debate brought up is that some psychologists believe there can be panic-free agoraphobia while others do not believe this. It’s a tough call because most people who experience agoraphobia without panic attacks do not seek medical treatment. The results are somewhat inconclusive and therefore it becomes debatable and diluted with speculation.

Ever felt like you were about to have some sort of panic attack and therefore you stayed in your house all day? Probably not; however, if you did stay in and have never actually experienced a panic attack nor did you have one that day, you could have agoraphobia. Some other symptoms of agoraphobia include becoming so incapacitated by one’s own fear of going out of their “comfort zones” and becoming a hermit. In the Behavior Modification article, one phrase caught my attention, “fear of fear.” Literally, people who have agoraphobia could have never experienced a panic attack and just the fear of the chance of having a panic attack caused by fear disables the person and they are incapacitated. The article looked at various studies done on people who either had agoraphobia with panic attacks or had never had a panic attack and yet suffered from agoraphobia and the results were astounding.

It seems like people often times have periods where they are so scared of having an attack that has never occurred before in their life that they cannot even do anything besides stay at home. However, since they never actually have an attack they never feel the need to seek medical treatment so the numbers of people who do have agoraphobia are not accurate because they do not incorporate all those who suffer in silence because of their lack of knowledge about the illness. A specific statement within the article articulated that anxiety sensitivity can lead to agoraphobia without the presence of panic attacks. It is an interesting claim because most would assume that a well-documented illness such as agoraphobia would have all its symptoms written out by now, but this research has given a whole new perspective to the disorder.

The avoidance of situations seems to intensify the feelings of fear that are already enhanced because the afflicted do not usually seek treatment. The people who have agoraphobia without panic attacks have unusually strong fears of embarrassment or of some sort of catastrophic event occurring while they are out and about. We all have fears about our houses burning down if we left things plugged in or maybe vomiting when we get nervous, but the fear these agoraphobics are stricken with is so serious that they grow to avoid all instances where they may be presented with having a panic attack. It’s an odd phenomenon and explaining it has proven to be a tough challenge.
The best explanation for the fear has nothing to do with the “severity or frequency of panic attacks” and instead with events that caused arousal in the subjects.

It appears that subjects were prone to fearing events as opposed to what actually happens when they are really in situation. The people come to fear the symptoms of panic attacks without having ever experienced a panic attack and the fear is crippling to the extent that they are unable to go about daily tasks. A formulated Anxiety Sensitivity Index was used to gauge different peoples’ anxiety levels and how they interpreted fear. Apparently, agoraphobics with panic attacks scored very high on this index prior to treatment but lower afterward, whereas the plain avoidant subjects scored about the same and since they did not have panic attacks, they had not had treatment so they performed the same the second time. Anxiety sensitivity is present in other anxiety disorders, yet it is key to developing agoraphobia even without the panic attacks.

You’re probably wondering how on earth this can be relevant to you or people around you. To make a connection with myself, I have a friend that has never had a panic attack and yet is extremely fearful of having one at an inappropriate time and you would never guess this from just hanging out with her. She often avoids leaving her room and instead offers her dorm room for people to hang out in. I didn’t think anything was really wrong with her until I read this article and understood that someone can have a fear of having a panic attack and yet never have had one. It’s a weird concept that still stumps psychologists and scientists alike. Studies like this help my friend and probably people you know overcome their fear and get help even if there is no evidence that they need help.

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