Shallow breathing, palpitationssweat, nauseafeeling of strangulation… No doubt, this is a panic disorder. But it gets complicated when the panic arises from the fear of feeling these symptoms, in anticipation. This “fear of fear” is the definition given to agoraphobia in 1871 by Carl Westphal, German neurologist and psychiatrist. “Today, we speak rather of ‘fear of’to fear‘ and ‘anxious anticipation’ “explains Doctor Franck Peyré, a psychiatrist in Bordeaux, specializing in depressive and anxiety disorders. Often likened to the fear of crowds or closed spaces, agoraphobia is not limited to this type of context. More broadly, this disorder corresponds to the fear of experiencinganxietyor a panic, in a given situation for which fleeing or calling for help may be difficult (e.g. taking public transport, being in the middle of a crowd, in a store or in a queue.. .).
The agoraphobe is afraid of the symptoms of anxiety
The agoraphobic person dreads these situations permanently, because his sense of danger is disproportionate to the real danger. She may also fear a specific negative outcome (for example, a panic attack or embarrassing or disabling physical symptoms). “Agoraphobia occurs when you feel that you will not be able to cope with the manifestations of anxiety“explains Franck Peyré. These dreaded manifestations are the classic symptoms of panic attacks, which the agoraphobic may fear without even having already experienced them: “vertiginous floating, feeling of imminent death, feeling of falling, feeling of going crazy…“, describes the psychiatrist. It is therefore an interoceptive phobia, that is to say centered on bodily manifestations.
Fearing his own physical sensations, the agoraphobe will adapt his behavior so as not to feel them, most often avoiding situations that are sources of panic. She may also accept these situations under certain circumstances, for example by being accompanied by a trusted person, or will undergo them with intense fear or anxiety.
No clearly identified causes for agoraphobia
But what are the origins of this phobia? “There are no identified risk factors, or personal history history“, deplores Franck Peyré. “For a long time agoraphobia was thought to be linked to a childhood attachment or addiction problem, but this turned out to be incorrect.“, He adds. Similarly, the situation causing the symptoms may have been associated with an experience of panic in the past, but this is not systematic.
In fact, agoraphobia affects women more than men and can depend on a context that suddenly accentuates the sensitivity to inner feelings. “Agoraphobia, for example, is a frequent complication of a depressive episode bipolar disorders“says the psychiatrist.
Behavioral and cognitive therapy for agoraphobia
These disorders are recognized and described in international classifications, which allows psychiatrists and psychologists to diagnose them reliably. But once the diagnosis has been made, how can this phobia be treated? “For pure agoraphobia, when it is not associated with another disorder, there is no drug treatment. Medications can provide relief but will not eliminate symptoms“explains Doctor Peyré. The only effective treatment for agoraphobia is then the behavioral and cognitive therapy(CCT). It is a brief therapy (from a few months to two or three years) which aims to replace negative ideas and inappropriate behaviors with thoughts and reactions in line with reality. “The important thing in this therapy is the functional analysis: understanding how the disorder works and why it persists despite the patient’s best efforts.“, supports Franck Peyré.
With CBT, the patient does a real learning process to become aware of his inner resources. He will identify the tricks he has put in place to manage his fear or alleviate the symptoms (such as never going out without being accompanied, putting on dark glasses to isolate himself, etc.) Once these behaviors have been identified, they will have to be fought because “it is precautionary or reassuring behaviors that fuel vicious circles” warns the psychiatrist. CBT will help to learn to “tame” anxiety, to “make the patient understand that anxiety does not mean disaster“.
“The agoraphobe should not judge himself as a weak person”
When the symptoms persist for several months, they may turn out to be severe enough to deteriorate the state of the phobic’s personal, family, social, educational or professional life.
If the latter does not tame his fear, the risk is that he will become dependent on others. “This is often the case for an agoraphobe in a relationship who will totally depend on his spouse.” notes Franck Peyré. For the spouse as for the relatives of the phobic, “there is a form of common suffering, misunderstanding, harassment, which sometimes requires consulting a specialist for help” recommends the psychiatrist. And for the agoraphobic person himself, “the sooner she consults after the first symptoms, the easier it will be to learn new resources. In any case, she must not judge herself as a weak person.“, advises the psychiatrist.
Dr. Franck Peyré is the author of two books on generalized anxiety disorders and agoraphobia.
Dealing with GADs (generalized anxiety disorder), Retz editions, 2014.
Coping with agoraphobiaRetz editions, 2006.
Sources:
– Interview with Doctor Franck Peyré, psychiatrist in Bordeaux, specialist in depressive and anxiety disorders.
– French Association of Behavioral and Cognitive Therapy (AFTCC)
– Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Edition Masson 2011
– International Classification of Diseases (ICD) of the World Health Organization (WHO)
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