Agoraphobia: Housebound - Literature review Example

235097Agoraphobia: Housebound Introduction Psychological disorders are not always permanent. Some, like agoraphobia, can actually be cured with theproper treatment because they are phobias, or irrational fears. Without treatment, agoraphobia becomes a psychological disorder that takes over one’s life as an irrational fear of new places or situations from which there is no escape, or no exit without embarrassment to the person suffering the condition. In its mildest form, agoraphobia is uncomfortable, accompanied by panic attacks, heart palpitations, and anxiousness in new situations or surroundings. In its more serious form, it causes insurmountable problems in the lives of people who suffer from the disease, including fear of leaving their own homes, severe panic, anxiety, and depression. Lisa Capps and Elinor Ochs (1995) report that a survey in which more than 15,000 people from four major metropolitan areas indicated that four percent of those surveyed had experienced what could actually be diagnosed as agoraphobia (Capps and Ochs, p. 1). The results reflected an increase in the disorder of the previous year survey (Capps and Ochs, p. 1). “Classic” accounts of agoraphobia go back as far as 1871, when medical field began keeping meticulous records of phobias and other conditions, and began arranging that documentation by diagnosis and symptoms. In 1895 Freud weighed in, separating common phobias, those things that are most commonly feared by people, from phobias of things or situations, like agoraphobia (Maj, Mario, Akistal, Hagoop, S., Lopez-Ibor, Juan Josu, and Okasha, Ahmed, 2004, p. 1). In 1947, the International Classification of Diseases (ICD) designated a separate and distinct category to phobias, including agoraphobia (Maj, Akistal, et al, p. 1). This essay explores what is known about the phobia, what can be done to overcome it, and the impact it has on the lives of people who struggle to overcome the disorder. Signs and Symptoms Agoraphobia is a condition, a mental disorder, which more commonly effects women than men (Capps and Ochs, p. 2). A personality “type” has actually been identified as being more susceptible than others, and even men who suffer from the condition fall into the personality “type.” The “type,” is described as submissive, shy, and dependent (Capps and Ochs, p. 2). Although, Capps and Ochs report, there are other studies, too, that suggest there are no “personality type” links associated with the condition (p. 2). Mario Maj, Hagoop S. Akistal, Juan Josu Loopez-Ibor and Ahmed Okasha write that normal fears are not necessarily “phobias,” and that phobias can exist alone, or manifest as a part of a greater problem, and inclusive of other symptoms (p. 2). Examples, say the researchers, are transient darkness terrors, fear of animals, fears of disease that wax and wane with depression or other expressions of mental illness (p. 2). “The varying difference of phobic phenomena is hard to grasp if we posit a unitary origin for all of them instead of recognizing that varied factors may play a role in their genesis (p. 2).” Agoraphobia can be the result of a trigger that does not actually go off in a person’s life before adulthood. One of the consistencies of agoraphobia are panic attacks. Panic attacks can be situational, accompanied by dizziness, and a sense of loss of control (Nutt, David, Feeney, Adrian, and Argyropolous, Spilios, 2002, p. 4). It is a painful condition of fear, self-doubt, and, when left untreated, can close in around the individual suffering from the condition, cutting them off from the world around them. He DSM IV lists 13 conditions with agoraphobia: A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: 1 Palpitations, pounding heart or accelerated heart rate 2 Sweating 3 Trembling or shaking 4 Sensations of shortness of breath or something 5 Feeling of choking 6 Chest pain or discomfort 7 Nausea or abdominal distress 8 Feeling dizzy, unsteady, light-headed or faint 9 Derealization (feelings of unreality) or depersonlization (being detached from oneself) 10 Fear of losing control or going crazy 11 Fear of dying 12 Paraesthesia (numbness or tingling senstations) 13 (Nutt, Feeney, and Argyropolous, 2002, p. 5) Any combination of these symptoms in conjunction with behavior or fears that suggests the condition requires professional help (Nutt, Feeney and Argyropolous, p. 5). The behaviors are presented in the DSM IV too, and they are: Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobia fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and travelling in a bus, train or automobile. A Note: consider the diagnosis of specific phobia if the avoidance is limited to one or only a few specific situations, or social phobia if the avoidance is limited to social situations B The situations are avoided (e.g. travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion. C The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (e.g. avoidance limited to social situations because of fear of embarrassment), specific phobia (e.g. avoidance limited to a single situation such as elevators or lifts), obsessive-compulsive disorder (e.g. avoidance of dirt in someone with an obsession about contamination), post-traumatic stress disorder (e.g. avoidance of stimuli associated with a severe stressor) or separation anxiety disorder (e.g. avoidance of leaving home or relatives). (Nutt, Feeney and Argyroplous, p. 6). Living With Agoraphobia When the condition manifests itself at the worst level, people who suffer from the condition are often unable to leave their homes. The homebound condition is a result of the avoidance of the precipitating factors that trigger the reactions manifest in the condition (Foa, Edna B., and Kozak, Michael J., and Tuma, Hussain A and Maser, Jack (eds), 1985, p. 421). It is only in recent years that successful treatments have been developed, which help free the individual of the symptoms and conditions that caused avoidance and rendering the sufferer homebound (p. 421). Still, the road to recovery can be long, and painful for many of the people who suffer from the condition. Lisa Capps and Elinor Ochs conducted a study that resulted in first-hand stories about individuals’ pains and agony in dealing with their agoraphobic conditions, which varied in intensity. One woman, Meg, was unable to give Capps directions to her home from the freeway, because it had been four years since the patient, Meg, had ventured beyond a two mile radius of her home (p. 2). Capps’ assessment of Meg was this: “. . .while at home Meg spends much of her time ruminating over past experiences of panic and imagining similar experiences in other hypothetical situations. Home is not a safe haven, after all. It does not protect her from being engulfed by reconstructions of past events that channel rising tides of panic into the present (Capps and Ochs, p. 4).” Meg’s ruminations only increased her anxiety, and she was in a pattern of incrementally decreasing her sphere of outside activity towards the home (p. 4). Without intervention, Meg would eventually have become homebound. Throughout the course of time, Lisa was able to work with Meg, and to work through her anxieties and help to resolve her panic attacks (p. 193). While Meg experienced the loss of a parent, her successful course of therapy had enabled her to travel to parent’s home to be with her loved when in his last days of life (p. 193). Part of the process in helping Meg, was to help her understand her own abilities to be independent, as opposed to dependent, most notably on her husband, on help and good will of others (p. 197). What Lisa focused on with Meg was helping Meg’s stronger personality traits emerge (p. 197). Those traits that caused Meg to be unsure of herself, lack confidence in her ability, or to feel inhibited about herself in the presence of others were all issues that Lisa was able to help Meg successfully overcome in a way that freed her from the phobia that was closing in around her (Capps and Ochs). Conclusion The most important aspect of agoraphobia is recognizing the need for intervention. The sooner the person who suffers from the physical and emotional responses to the condition takes steps towards securing professional intervention, the sooner that individual will begin to feel the release of the pressures and anxiety limiting their lives. References Capps, L., & Ochs, E. (1995). Constructing Panic: The Discourse of Agoraphobia. Cambridge, MA: Harvard University Press. Retrieved August 2, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=101578589 Maj, M., Akistal, H. S., Lopez-Ibor, J. J., & Okasha, A. (Eds.). (2004). Phobias. Hoboken, NJ: Wiley. Retrieved August 2, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=113407566 Nutt, D., Feeney, A., & Argyropolous, S. (2002). Anxiety Disorders Comorbid with Depression: Panic Disorder and Agoraphobia. London: Martin Dunitz. Retrieved August 2, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=109117906 Tuma, A. H. & Maser, J. (Eds.). (1985). Anxiety and the Anxiety Disorders. Hillsdale, NJ: Lawrence Erlbaum Associates. Retrieved August 2, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=37096943 Read More