Question

What b is Agoraphobia. The etiology and pathophysiology of Agoraphobia

Answer 1

Phobia is defined as an irrational fear of a specific object, situation or activity, often leading to persistent avoidance of the feared object, situation or activity.

Agoraphobia is one of the common varieties of phobia. It is characterised by an irrational fear of being in places away from the familiar setting of home. Although it was earlier thought to be a fear of open spaces only, now it includes fear of open spaces, pub lic places, crowded places, and any other place from where there is no easy escape to a safe place.

The patient is afraid of all the places or situations from where escape may be perceived to be difficult or help may not be available, if he suddenly develops embarrassing or incapacitating symptoms. These embarrassing or incapacitating symptoms are the classical symptoms of panic.

A full-blown panic attack may occur (Agoraphobia with panic disorder) or only a few symptoms (such as dizziness or tachycardia) may occur (Agoraphobia without panic disorder). As the agoraphobia increases in severity, there is a gradual restriction in the normal day-to-day activities. The activities may become so severely restricted that the person becomes self-imprisoned at his home. One or two persons (usually close relations or friends) may be relied upon, with whom the patient can leave home. Hence, the patient becomes severely dependent on these phobic companion(s).

Etiology & Pathogenesis.

In phobia, the secondary defense mechanism is displacement. By using displacement, anxiety is transferred from a really dangerous or frightening object to a neutral object. These two objects are often connected by symbolic associations.

The neutral object chosen unconsciously is the one which can be easily avoided in day-to-day life, in contrast to the frightening object (frightening to the patient only, due to oedipal genital drives). In agoraphobia, loss of parents in childhood and separation anxiety have been theorised to contribute to causation.

The behavioural theories explain phobia as a conditioned reflex. Initially, the anxiety provoked by a naturally frightening or dangerous object occurs in contiguity with a second neutral object. If this happens often enough, the neutral object becomes a conditioned stimulus for causing anxiety.

All phobias, especially agoraphobia, are closely linked to panic disorders. It has been suggested that probably the biological models of panic apply to phobias too.