Anxiety Disorders (Agoraphobia)

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Agoraphobia - Avoidance Behaviour

With early diagnosis of anxiety disorders and early intervention strategies, such as education and basic cognitive skills, the development of Agoraphobia can be prevented.

Agoraphobia, avoidance behaviour, is a secondary condition to anxiety disorders. In the recent past, agoraphobia was known as the fear of open spaces and/or fear of the 'market place'. The prevailing view of the time was that a panic attack and the avoidance behaviour resulting from the attack, was a "phobic" response to the particular situation and/or place. This was incorrect.

Agoraphobia is now recognised, not as a phobic response, but "as anxiety about being in situations and /or places, from which escape may be difficult or embarrassing, or in which help may not be available, in the event of having a panic attack or panic like symptoms". (1)

Not all people who develop an anxiety disorder develop agoraphobia, but many people do. This in turn adds to the stress, anxiety and confusion that people feel. 

Many of the earlier treatment methods for anxiety disorders with agoraphobia, focused on gradual exposure to the avoided situation and/or place and did not directly deal with the panic attack and/or anxiety. As a result, many people had difficulty in recovering, because the primary cause, the fear of a panic attack or panic like symptoms, was never addressed. 

The latest cognitive techniques now treat the cause, panic and anxiety, and not just the 'effect', agoraphobia. 

Agoraphobia, avoidance behaviour, can be categorized in a number of ways:

•  As an overall defence against ongoing panic and anxiety. People may have 'a safety zone of where they can and can't go. Sometimes this safety zone may mean they are not able to leave the house or perhaps even leave one room.
• A person may have had a panic attack or panic like symptoms in a particular situation or place and avoid going back into the situation or place in case they have another panic attack.
• "What if " thinking - anticipatory anxiety. The person may need to go into a certain situation or place but are fearful of having a panic attack or symptoms of anxiety. The 'what if' thinking creates a spiral of anxiety and they may then avoid going because of the spiral of anxiety
• This reason is quite obvious but not generally acknowledged. With ongoing panic attacks and anxiety many people simply do not feel well. Besides the symptoms of anxiety and panic many people develop ongoing sinus and/or ear problems or other 'flu' type symptoms which in turn makes it more difficult for the person to go out. 
  
  (1) Diagnostic and Statistical Manual Number Four, American Psychiatric Association, Washington DC