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.
Agoraphobia increases the likelihood that the person will also suffer from
another anxiety disorder and that both conditions will be more severe and
difficult to treat. Also, agoraphobia tends to occur more
often in individuals who have a number of different physical conditions,
including irritable bowel syndrome (IBS) and asthma. If left untreated,
agoraphobia may worsen to the point at which the person's life is seriously
affected by the disease itself and/or by attempts to avoid or conceal it. In
fact, some people have had problems with friends and family, failed in school,
and/or lost jobs while struggling to cope with severe agoraphobia or another
severe phobia. There may be periods of spontaneous improvement, but the
condition does not usually go away unless the person receives treatments
designed specifically to help phobia sufferers. Further, alcoholics can be up to
10 times more likely to suffer from a phobia than those who are not alcoholics,
and phobic individuals can be twice as likely to be addicted to alcohol as are
people who have never been phobic.
Is there coping and support information for both agoraphobia
patients and their family members and loved ones?
The following organizations can provide information, self-help tips, and/or
support for individuals experiencing agoraphobia as well as their families.
ABIL (Agoraphobics Building Independent Lives), Inc.
3805 Cutshaw Ave., Suite 415
Richmond, VA 23230
Phone: 804-353-3964
Fax: 804-353-3687 abil1996@aol.com
Agoraphobia is defined as a fear of being outside or otherwise being in a
situation from which one either cannot escape or from which escaping would be
difficult or humiliating.
Like other phobias, agoraphobia is largely
underreported, probably because many phobia sufferers find ways to avoid the
situations to which they are phobic.
Agoraphobia often occurs in combination
with panic disorder.
Agoraphobia occurs alone in less than 1 percent to almost 7 percent of the population.
There are a number of theories about
what can cause agoraphobia, including a response to repeated exposure to
anxiety-provoking events or a reaction to internal emotional conflicts.
As
with other mental disorders, agoraphobia is usually caused by a number of
factors, tends to run in families, and for some people, may have a clear genetic
factor involved in its development.
Symptoms of agoraphobia include anxiety
and subsequent avoidance of being in a situation in which one will have a panic
attack, when in a situation from which escape is not possible, or is difficult
or embarrassing.
The panic attacks associated with agoraphobia, like all panic
attacks, may involve intense fear, disorientation, rapid heart beat, dizziness,
or diarrhea.
The situations that are often avoided by people with agoraphobia
and the environments which cause people with balance disorders to feel
disoriented are sometimes quite similar, leading some cases of agoraphobia to be
classified as vestibular function agoraphobia.
Agoraphobia tends to begin by
adolescence or early adulthood.
Girls and women, Native Americans, middle-aged
individuals, low-income populations, and individuals who are either widowed,
separated, or divorced are at increased risk of developing agoraphobia.
Suffering from virtually any other anxiety disorder increases the risk of
developing agoraphobia.
Symptoms of agoraphobia should be treated when the
signs and symptoms of the associated anxiety are not easily, quickly, and
clearly relieved.
Agoraphobia 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.
To diagnose agoraphobia, the treating
psychiatrist or other physician will usually take a careful history, perform or
refer to another doctor for a physical examination, and order laboratory tests
as needed. Any medical condition or other emotional problem will be considered.
Cognitive behavioral therapy and exposure therapy are the most effective
psychotherapies used to treat agoraphobia.
Medications like SSRIs, beta
blockers, and benzodiazepines are most commonly used to treat agoraphobia. The
risk of overdose, addiction, or need for increasingly higher doses make
benzodiazepines a less desirable treatment for agoraphobia.
Agoraphobia
increases the likelihood that the person will also suffer from another anxiety
disorder and that both conditions will be more severe and difficult to treat.
Agoraphobia tends to occur more often in individuals who have a number of
different physical conditions.
If left untreated, agoraphobia may worsen to
the point where the person's life is seriously affected by the disease itself
and/or by attempts to avoid or conceal it.
References:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Treatment Revision. Washington, D.C., 2000.
Bienvenu, O.J., Onyike, C.U., Stein, M.B., Chen, L., Samuels, J., Nestadt, G.,
and Eaton, W.W.
Agoraphobia in adults: incidence and longitudinal relationship with panic. The
British Journal of Psychiatry 188: 432-438, 2006.
Biondi, M. and Picardi, A. Increased probability of remaining in remission from
panic disorder with agoraphobia after drug treatment in patients who received
concurrent cognitive-behavioural therapy: a follow-up study. Psychotherapeutic
Psychosomatics 72(1): 34-42, 2003.
Bruce, S.E., Vasile, R.G., Goisman, R.M., Salzman, C., Spencer, M., Machan, J.T., Keller,
and M.B.
Are benzodiazepines still the medication of choice for patients with panic
disorder with our without agoraphobia? American Journal of Psychiatry 160:
1432-1438, August 2003.
Bruce, S.E., Yonkers, K.A., Otto, M.W., Eisen, J.L., Weisberg, R.B., Pagano, M., Shea, T.,
and Keller, M.B. Influence of psychiatric comorbidity on recovery and recurrence in
generalized anxiety disorder, social phobia and panic disorder: a 12-year
prospective study. American Journal of Psychiatry 162: 1179-1187, 2005.
Collier, D.A. FISH, flexible joints and panic: are anxiety disorders really
expressions of instability in the human genome? The British Journal of
Psychiatry 181: 457-459, 2002.
Fava, G.A., Ruini, C., Rafanelli, C., and Grandi, S. Cognitive behavior approach to loss
of clinical effect during long-term antidepressant treatment: A pilot study.
American Journal of Psychiatry 159: 2094-2095, December 2002.
Furukawa, T.A. and Watanabe, N. Psychotherapy plus antidepressant for panic disorder
with or without agoraphobia. The British Journal of Psychiatry 188: 305-312,
2006.
Gersley, E. Phobias: Causes and treatments. All Psych Journal, http://www.allpsych.com, 11/17/01.
Godemann, F., Ahrens, B., Behrens, S., Berthold, R., Gandor, C., Lampe, F., and Linden, M.
Classic conditioning and dysfunctional cognitions in patients with panic
disorder and agoraphobia treated with an implantable cardioverter/defibrillator.
Psychosomatic Medicine 63: 231-238, 2001.
Goodwin, R., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R.,
and Wittchen, H.U. The
epidemiology of panic disorder and agoraphobia in Europe. European Neuropsychopharmacology 15(4): 435-443, 2003.
Grant, B.F. The epidemiology of DSM-IV panic disorder and agoraphobia in the
United States: results from the national epidemiologic survey on alcohol and
related conditions. Journal of Clinical Psychiatry 67(3): 363-374, 2006.
Ito, L.M., de Araujo, L.A., Tess, V.L.C., de Barros-Neto, T.P., Asbahr, F.R.,
and Marks, I.
Self-exposure therapy for panic disorder with agoraphobia: randomized controlled
study of external v. interoceptive self-exposure. The British Journal of
Psychiatry 178: 331-336, 2001.
Kenwright, M., Liness, S., and Marks, I. Reducing demands on clinicians by offering
computer-aided self-help for phobia/panic. The British Journal of Psychiatry
179: 456-459, 2001.
Kessler, R.C. The epidemiology of panic attacks, panic disorder and agoraphobia
in the National Comorbidity Survey Replication. Archives of General Psychiatry
63(4): 415-424, 2006.
Kikuchi, M., Komuro, R., Oka, H., Kidani, T., Hanaoka, A., and Koshino, Y. Panic disorder
with and without agoraphobia: comorbidity within a half-year of the onset of
panic disorder. Psychiatry and Clinical Neurosciences 59(6): 639-643, 2005.
Kumano, H., Kaiya, H., Yoshiuchi, K., Yamanaka, G., Sasaki, T., and Kuboki, T. Comorbidity
of irritable bowel syndrome, panic disorder and agoraphobia in a Japanese
representative sample. The American Journal of Gastroenterology 99(2): 370-376,
2004.
Leinonen, E., Lepola, U., Koponen, H., Turtonen, J., Wade, A., and Lehto, H. Citalopram
controls phobic symptoms in patients with panic disorder: randomized controlled
trial. Journal of Psychiatry Neuroscience, 25(1): 25-32, 2000.
Magee, W.J., Eaton, W.W., Wittchen, H.U., McGonagle, K.A., and Kessler, R.C. Agoraphobia,
simple phobia and social phobia in the National Comorbidity Survey. Archives of
General Psychiatry 53(2): 159-168, 1996.
Milrod, B. Emptiness in agoraphobia patients. Journal of the American
Psychoanalytic Association 55(3): 1007-1026, 2007.
Nascimento, I. Psychiatric disorders in asthmatic outpatients. Psychiatry
Research 110(1): 73-80, 2002.
Roberge, P., Marchand, A., Reinharz, D., and Savard, P. Cognitive-behavioral treatment
for panic disorder with agoraphobia: A randomized, controlled trial and
cost-effectiveness analysis. Behavior Modification 32(3): 333-351, 2008.
Schuckit, M.A., and Hesselbrock, V. Alcohol dependence and anxiety disorders: what is
the relationship? Focus 2: 440-453, 2004.
Shandley, K., Austin, D.W., Klein, B., Pier, C., Schattner, P., Pierce, D., and Wade, V.
Therapist-assisted, internet-based treatment for panic disorder: can general
practitioners achieve comparable patient outcomes to psychologists? Journal of
Medical Internet Research 10(2), 2008.
Thomas, S.E., Thevos, A.K., and Randall, C.L. Alcoholics with and without social phobia:
a comparison of substance use and psychiatric variables. Journal of Studies on
Alcohol, vol. 60, 1999.
Wittchen, H.U., Nocon, A., Beesdo, K., Pine, D.S., Hofler, M., Lieb, R., and Gloster, A.T.
Agoraphobia and panic: Prospective-longitudinal relations suggest a rethinking
of diagnostic concepts. Psychotherapy and Psychosomatics 77(3), 2008.
Yardley, L., Britton, J., Lear, S., Bird, J., and Luxon, L.M. Relationship between balance
system function and agoraphobic avoidance. Behavior Research Theory 33(4):
435-439, 1995.
Zimmerman, M. and Mattia, J. Principal and additional DSM-IV disorders for which
outpatients seek treatment. Psychiatric Services 51:1299-1304, October 2000.
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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