Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Interestingly, agoraphobia, like other phobias, is
often diagnosed and treated when patients seek treatment for other medical or
emotional problems rather than as the primary reason that care is sought. As with other mental disorders, there is no
single, specific test for agoraphobia. The primary-care doctor or psychiatrist
will take a careful history, perform or refer to another doctor for a physical
examination, and order laboratory tests as needed. If you have another medical
condition that you know about, there may be an overlap of signs and symptoms
between the old and the new conditions. Just determining that anxiety does not
have a physical cause does not immediately identify the ultimate cause. Often,
determining the cause requires the involvement of a psychiatrist, clinical
psychologist, and/or other mental-health professional.
In order to diagnose
agoraphobia, the professional will likely ask questions to ensure that the
anxiety of the sufferer is truly the result of a fear of being in situations
that make it impossible, difficult, or embarrassing to escape rather than in the
context of another emotional problem (for example, fear of being near people that remind
one of an abuser in the case of posttraumatic stress disorder or the fear of
hearing voices that have no basis in reality as occurs in schizophrenia).
How is agoraphobia treated?
There are a variety of treatments available for agoraphobia, including
specific kinds of psychotherapy as well as several effective medications. A
specific form of psychotherapy that focuses on decreasing negative,
anxiety-provoking, or other self-defeating thoughts and behaviors (called
cognitive behavioral therapy) has been found to be highly effective in treating
agoraphobia. In fact, when agoraphobia occurs along with panic disorder,
cognitive behavioral therapy, with or without treatment with medications, is
considered to be the most effective way to both relieve symptoms and prevent
their return. In fact, sometimes patients respond equally as well when treated
with group cognitive behavioral therapy or a brief course of cognitive
behavioral therapy as they do when treated with traditional cognitive therapy. Psychotherapy for agoraphobia has even been found to be effective for
many people when they receive it over the Internet, which is optimistic news for
people who live in areas that are hundreds of miles from the nearest mental-health
professional.
Another form of therapy that has been found effective in managing agoraphobia
includes self-exposure. In that intervention, the person either imagines or puts
him or herself into situations that cause increasing levels of agoraphobic
anxiety, using relaxation techniques in each situation in order to master their
anxiety. As people gain access to the Internet, there is increasing evidence
that exposure therapy can also be done effectively through that medium.
Regarding medical therapy,
agoraphobia is usually treated in connection with panic disorder. Commonly,
members of the serotonin selective reuptake inhibitor (SSRI) and the minor
tranquilizer (benzodiazepine) groups of medications are used in treatment. Examples of SSRI medications include sertraline (Zoloft),
paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of SSRI
medications can vary greatly from person to person and depend on which
medication is being used. Common side effects of this group of medications
include dry mouth, sexual dysfunction, nausea, tremors, trouble sleeping,
blurred vision, constipation or soft stools, and dizziness. In very rare cases,
some people have been thought to become acutely more anxious or depressed once
on the medication, even trying to or completing suicide or homicide. Children
and teens are thought to be particularly vulnerable to this rare possibility.
Phobias are also sometimes treated using beta-blocker
medications, which block the effects of adrenaline on the body. An example of a
beta-blocker medication is propranolol.
Panic disorder and phobias are less
commonly treated with drugs in a medication class known as benzodiazepines. This
class of medications causes relaxation but is used much less often these days to
treat anxiety due to the possibility of addiction, increasing need for higher
doses, and overdose. The risk of overdose is especially heightened if taken when
alcohol is also being consumed. Examples of medications from that group include
diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam
(Klonopin).
As anything that is ingested carries the risk of possible side
effects, it is important to work closely with your doctor to decide whether
medication is appropriate, and if so, which medication would be best for you.
Further, the treating doctor will likely closely monitor for the possibility of
side effects that can vary from the minor to the severe and in rare cases may
even be life-threatening.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
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