Agoraphobia

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Classification according to ICD-10
F40.0 Agoraphobia
F40.01 Agoraphobia with panic disorder
ICD-10 online (WHO version 2019)

As agoraphobia or claustrophobia refers to a particular form of anxiety disorder . The fear is triggered by certain places and situations such as wide spaces or crowds. Those affected avoid the triggering situations and in extreme cases can no longer leave their own home. Agoraphobia also occurs when people avoid wide open spaces or travel alone or in general because of fear.

Common to all of these situations is a fear of losing control. Those affected then fear, for example, that in the event of panic or potentially threatening physical conditions, they would not be able to flee quickly enough, that help would not be available quickly enough or that they could get into embarrassing situations. Agoraphobia often occurs with panic disorder .

To the subject

Agoraphobia is a compound term from the ancient Greek words ἀγορά agorá (market place) and φόβος phóbos ( fear ). It was described under this name in 1871 by the Berlin neurologist and psychiatrist Carl Westphal . More rarely, multiple situation phobia is also used synonymously .

The fear of wide open spaces is called claustrophobia in psychology . However, this technical term is used in everyday language for the opposite state of fear, namely claustrophobia (fear of confined spaces). Claustrophobia is again referred to in technical terms as space anxiety (isolated phobia according to the ICD-10 F40.2 standard).

Symptoms

The main characteristic of agoraphobia is an unfounded or unrealistically strong fear of certain places or travel. This fear eludes voluntary control and cannot be eliminated even with rational arguments. Those affected usually show strong avoidance behavior , as panic attacks can occur to varying degrees . The fear can be limited to going into public places or shops, often specifically avoiding crowds. In pronounced cases, fear already sets in in the apartment, so that it is no longer left.

Diagnosis and classification

The first diagnostic step is to clarify whether the agoraphobia exists in an affected patient as an independent clinical picture or is a symptom of another underlying psychological or organic disease.

In the past, the term agoraphobia was used exclusively for fear of large public spaces. It now also includes fear of other situations, so that, according to ICD-10, at least two of the following fear triggers must be detectable:

  1. Crowds
  2. public places
  3. Travel far from home
  4. Travel alone

The last internationally valid ICD-10 2006 does not differentiate between the presence or absence of panic attacks. The ICD-10 2010 GM (German Modification) , which is only valid in Germany, specifies the occurrence or absence of panic attacks within the diagnosis of agoraphobia (F40.0). Agoraphobia is assumed to be superordinate and can be classified without specifying a panic disorder (F40.00) or with panic disorder (F40.01). In contrast, agoraphobia in DSM-IV is subordinate to panic disorder. The panic disorder is primary and can be specified with or without agoraphobia. The diagnosis “agoraphobia” without a history of panic disorder exists separately.

The ICD-10 also subsumes ochlophobia (from Greek: ochlos = "crowd" and phobos = "fear, fear"), enochlophobia (Greek en-, "within") and demophobia (Greek: demos = "people") ) under agoraphobia.

frequency

According to a 2006 study, agoraphobia was found in 0.61% of a study population of 12,792 (55 years or older). This means that the frequency of the disorder was lower here than is otherwise reported.

Based on the "National Comorbidity Survey Replication" survey in the USA, figures on the relationship between agoraphobia, panic attacks and panic disorder (according to the definition of the DSM-IV) were also published in 2006. Accordingly, the lifetime prevalence in 9282 subjects who were at least 18 years old was in the possible combinations:

  1. 22.7% for isolated panic attacks
  2. 0.8% for panic attacks combined with agoraphobia
  3. 3.7% for panic disorder without agoraphobia
  4. 1.1% for panic disorder with agoraphobia

It could be shown that from the 1st to the 4th group there was a continuous increase in the individual examined characteristics such as persistence of the symptoms, number of attacks, number of years of illness, severity of the individual episodes and accompanying diseases .

In 2005 Kituchi et al. from Kanazawa University in Japan 233 outpatients with panic disorder (99 men, 134 women), 63 without and 170 with agoraphobia. The latter group had on average a long-standing panic disorder and a higher prevalence of generalized anxiety disorder . There were no differences in terms of pronounced depressive episodes, the severity of the individual panic attacks, or the gender distribution. It was also shown that just over 40% of those study participants who had developed a panic disorder also developed agoraphobia within 24 weeks and that this group did not differ in terms of age or gender either.

A possible trauma must always be considered as a possible cause. Agoraphobia is one of the possible psychological disorders that can develop in addition to the classic symptoms of post-traumatic stress disorder (PTSD) and also to the symptoms of complex PTSD (comorbidity).

treatment

If agoraphobia is a symptom of an underlying condition, it is primarily that condition that is treated accordingly. If agoraphobia is present as an independent disorder, both psychotherapeutic measures and psychotropic drugs are part of the standard treatment.

psychotherapy

Talk therapies are usually not very effective for pure agoraphobia. A proven treatment for agoraphobia is exposure therapy , which is carried out as part of behavioral therapy . The person affected and their therapist go to the respective place that triggers fear and is therefore avoided. With the help of the therapist, the person concerned confronts their fears and allows them to be in full force in order to be able to experience that the fear is unfounded and that it subsides by itself over time. The therapist supports the patient in approaching the situation, remaining in the situation and not using avoidance strategies. Avoidance behaviors can alleviate anxiety in the short term, but in the long term it will maintain anxiety. There are at least two types of exposure therapy. On the one hand, there is systematic desensitization , which takes place gradually. On the other hand, there is also what is known as “ flooding ”, in which the client immediately confronts a particularly fear-inducing situation. However, forced flooding, to which the client does not voluntarily consent, can have the opposite effect and make the problem worse.

Medication

Like other anxiety disorders , agoraphobia can be treated with medication. As a rule, however, these drugs do not have a curative effect, only relieve symptoms while you are taking them. Above all, anxiolytics , tricyclic antidepressants and selective serotonin reuptake inhibitors are used . The use of benzodiazepines is viewed critically in long-term use.

literature

  • Agoraphobia. In: Rosalyn Deutsche: Evictions - Art and spatial politics. Massachusetts Institute of Technology Press, 1996, ISBN 0-262-04158-8 , p. 269.
  • Kathleen A. Brehony: Women and agoraphobia. In: The stereotyping of women. New York 1983.
  • Sigmund Freud : Inhibition, Symptom and Anxiety. In: Freud: study edition. Volume 6: Hysteria and Fear. Frankfurt am Main 1970, pp. 253 and 284.
  • Gerda Lazarus-Mainka, Stefanie Siebeneick: fear and anxiety . Hogrefe, Göttingen 2000, ISBN 3-8017-0969-8 .
  • Pschyrembel - Clinical Dictionary. 261st edition. Walter de Gruyter, p. 32.
  • Heinz-Peter Schmiedebach : Agoraphobia. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 17 f.
  • Silvia Schneider, Jürgen Margraf: Agoraphobia and Panic Disorder. Hogrefe, Göttingen 1998, ISBN 3-8017-1011-4 (= progress in psychotherapy ).

Web links

Wiktionary: Agoraphobia  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. H. Hinterhuber: Ethics in Psychiatry. In: HJ. Möller, G. Laux, HP. Kapfhammer (Ed.): Psychiatry, Psychosomatics, Psychotherapy. Volume 1: General Psychiatry. 4th ext. and completely revised edition. Springer, Berlin 2011.
  2. Phobia. In: Werner D. Fröhlich: Dictionary Psychology. 26th edition. Deutscher Taschenbuch Verlag, Munich 2008, ISBN 978-3-423-34231-5 .
  3. a b Andrew Mathews, Michael G. Gelder, Derek W. Johnston: Agoraphobie . Springer, London 1988.
  4. Michael Zaudig et al. a .: Therapy glossary for psychiatry, psychosomatics, psychotherapy . Springer, Berlin 2006, ISBN 978-3-540-30986-4 , pp. 23 ( limited preview in Google Book search).
  5. Eugen Bleuler: Textbook of Psychiatry. Springer, 1983.
  6. Gökce Ipeklioglu: Panic Disorder and Agoraphobia. Norderstedt 2000.
  7. ^ Frank Schneider: Specialist knowledge of psychiatry and psychotherapy. Springer, 2012.
  8. L. McCabe, J. Cairney, S. Veldhuizen, N. Herrmann, DL Streiner: Prevalence and correlates of agoraphobia in older adults. In: American Journal of Geriatric Psychiatry. June 2006; 14 (6), pp. 515-522.
  9. Willi Butollo et al. a .: Creativity and destruction of post-traumatic coping. Research results and theses on life after trauma . 2., ext. Edition. Stuttgart 2003, p. 61.
  10. Nina Heinrichs, Georg W Alpers, Alexander L. Gerlach: Evidence-based guidelines for the psychotherapy of panic disorder and agoraphobia. Göttingen 2009.
  11. Sigrun Schmidt-Traub: Overcoming fear: Self-help with panic and agoraphobia. Berlin 2008.
  12. ^ Faust: Psychiatrie - A textbook for clinics, practice and advice. ISBN 3-437-00759-9 .
  13. Thomas Lang, Sylvia Helbig-Lang, Dorte Westphal: Exposure-based therapy of panic disorder with agoraphobia: A treatment manual. Göttingen 2012.
  14. ^ T. Poehlke: Psychiatry. 17th edition. 2009.
  15. Drugs Commission of the German Medical Association: Evidence-based therapy guidelines. 2nd Edition. Cologne, 2004.
  16. Michael Elze: Agoraphobia. In: dr-elze.com ; accessed on May 7, 2015