Agoraphobia

Disease name

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synonym Agoraphobia (agoraphobia) generally refers to agoraphobia

This entry is made by Compilation and application of scientific encyclopedia entries of "Science Popularization China" authentication.

Wang Jianning

(Chief physician)

Department of Psychiatry, Dongcheng District Mental Health Care Hospital, Beijing

Agoraphobia, also known as agoraphobia, is Anxiety disorder One of. Specifically in public occasions Or the extreme fear of staying in an open place, because it is impossible or embarrassing to escape from such a place.

Often spontaneity Panic attack Start, then generate Anticipatory anxiety and Avoidance behavior , indicating the formation of conditionality. Square horror The expansion and persistence of symptoms can be made possible by the recurrence of symptoms Anxiety Conditionalization, and avoidance behavior hinders the regression of conditionalization; In addition, fear of fainting or making a fool in public can increase anxiety and form a vicious circle.

About 5% of people will suffer from agoraphobia in a year, and the incidence of agoraphobia in women is twice that in men. It mostly occurs between 18 and 35 years old. Most of the patients who were afraid of walking unsteadily or falling in an open place started in their 40s, and the course of disease tended to be chronic. Generally speaking, the course of agoraphobia often fluctuates. Many patients can get better in a short time, even complete remission 。

Chinese name: Agoraphobia

Discipline: Psychology

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pathogeny

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Psychologically, agoraphobia is described as severe and Osmotic force Anxiety and agoraphobia psychological factor The analysis is briefly introduced as follows:

1. Personality factors

Patients are generally very sensitive dependence Strong, overreacting to completely normal situations.

2. Lack sense of security

Patients are generally afraid to leave their familiar safe places, as if exposure to the outside will bring danger anytime and anywhere.

3. Hostility

Exaggerate the external environment too much.

four Psychological shadow

It should be said that some traumatic events in the past caused patients to fear.

clinical manifestation

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Based on clinical observation, there are two cases below.

1. Square phobia No Panic attack

This kind of patient Square horror There was no panic attack before and during the onset of symptoms, and its main manifestations are as follows:

(1) Fear of crowded places, such as meeting places and theaters.

(2) Fear of using Public transport 。

(3) Fear of going out alone or staying at home alone.

(4) Afraid of going to an empty place.

When patients enter such places or are in such a state, they feel nervous and uneasy, and obvious dizzy 、 palpitation 、 Chest tightness , sweating, etc Autonomic nerve Reaction; It may occur in serious cases Depersonalization Experience or syncope 。 It often follows Avoidance behavior 。 Often occurs after one or more similar experiences Anticipatory anxiety 。 When accompanied, patients' fears can be alleviated or eliminated.

2. Square phobia has panic attacks

There are three manifestations:

(1) Before the onset of agoraphobia, there was no panic attack, no panic attack in the place of fear, and only extreme fear when experiencing the place or situation of fear to achieve panic attack diagnostic criteria 。

(2) Having experienced one or more panic attacks before onset of agoraphobia, afraid to go out alone or stay at home alone; stay Panic disorder After effective treatment, the square terror will gradually disappear.

(3) Square phobia and panic attacks can be seen in the same patient. Patients feel nervous in crowded situations, and panic attacks also occur in general. This kind of situation often needs to be given appropriate treatment separately, and the two kinds of symptoms will disappear.

diagnosis

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DSM-IV diagnostic criteria for agoraphobia:

1. Feel anxious about being in a certain place, feel difficult to escape, or feel unable to find help when an unexpected panic attack occurs.

2. The patient tried to avoid this situation, or suffered with pain, or worried about the occurrence of panic attacks with anxiety, or asked for company.

3. Social exclusion phobia , phobia of special objects PTSD Or separation Anxiety disorder etc. Mental disorders All kinds of anxiety or terrorist avoidance caused.

treatment

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1. Psychotherapy

(1) General psychotherapy Such as psychological education, Supportive therapy , the purpose of treatment is to reduce the expectation anxiety of patients and encourage patients reenter A place of fear; Reducing avoidance behavior requires targeted Cognitive behavioral therapy 。

(2) Cognitive behavioral therapy Treat agoraphobia without panic attack Exposure therapy First, explain the nature of the disease to the patient, guide the patient to imagine the place or situation of fear, and then encourage the patient to enter the scene for exposure and repeated training until satisfactory results are achieved. simple Cognitive Therapy It helps to alleviate anxiety and panic attacks, but it is ineffective for agoraphobia. Exposure therapy can alleviate agoraphobia, but it is not a panic attack.

（3） medication Patients with panic attacks should be treated with anti panic drugs first.

2. Exposure therapy

Patients with agoraphobia who have shown panic disorder for a long time often use exposure therapy. The purpose of this therapy is not only to make panic attacks disappear, but also to make agoraphobia disappear in the context of the clinic.

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