Very crowded places closed or on the contrary large desert areas... The agoraphobic panics at the idea of being confronted with an uncontrollable situation from which he cannot escape.

   Professor Antoine Pelissolo, a psychiatrist specializing in anxiety disorders, explains this phobia, which affects nearly 3% of the population, and gives us some tips on how to get out of it.

define agoraphobia

   Fear of overcrowded or confined places but also of vast and deserted places... The agoraphobe fears above all to lose control of a situation, not to be able to escape easily in case of attack or malaise.

   A kind of "fear of being afraid", agoraphobia may only affect certain places (public places or busy places such as demonstrations or public transportation) or may extend to anything outside the home.

   The resulting physical reactions - wobbly legs, dizziness, sweating, palpitations, stomach aches - can be likened to real panic attacks, accompanied by unreasonable fears such as dying of a heart attack, for example.

   Sometimes a source of social isolation, agoraphobia can be effectively treated by cognitive-behavioral therapy.

   "I started by avoiding public transport at rush hour and then avoided it altogether," recalls 34-year-old Catherine. "I also left the car because of the traffic jams.

   Today, I do my shopping at the opening of shops to get things done faster and I don't get out of my neighborhood much anymore.

   "Like Catherine, 2 to 3 percent of the population suffers from agoraphobia at some point in their lives, to varying degrees.

   Difficulties often begin between the ages of 20 and 30, but older people are also affected. Women are twice as affected as men.

Agoraphobia, not just a phobia of crowds

   If agoraphobia is often assimilated to a fear of public places, and by extension of crowds, it covers a more complex reality as explained by Pr Antoine Pelissolo, a psychiatrist at the Pitié-Salpêtrière in Paris: "The agoraphobic person is not afraid "of the crowd" but "in the crowd".

   And more broadly of what could happen to them if they feel ill, in the crowd or any other place from which they cannot escape or be rescued quickly because of the environment".

   The situations that crystallize the fears of agoraphobes are therefore extremely varied.

   They correspond to very crowded and/or enclosed places (demonstrations, traffic jams, lifts, department stores, public transport, work meetings in "closed spaces"...) but also, what may seem paradoxical, to large spaces without the human presence (desert plains, snowy landscapes, very long bridges, tunnels...).

   Professor Pelissolo notes: "Claustrophobia, fear of confined spaces, is a form of agoraphobia. Acrophobia, fear of emptiness and height, too.

   Conversely, agoraphobia must be distinguished from a social phobia which, although it can generate the same type of behavior (avoiding crowds, withdrawing at home...), corresponds to a fear of the gaze of others.

   "However, some agoraphobes may suffer from a form of social anxiety in addition to this.

   When it starts, agoraphobia is limited to certain circumstances: long journeys in the subway, queuing at the supermarket checkout... However, the dreaded situations can multiply and agoraphobia can become truly disabling, forcing the person to isolate himself socially.

   "I can't leave my house without feeling suffocated and I run home because I'm terrified," says 22-year-old Lyly. "My fiancé offers me a place to stay, but he lives 40 km away and I don't think I can bear the trip."

Frequent but safe panic attacks

   Lyly feels like she's suffocating. Other agoraphobes have wobbly legs, dizziness, sweating, palpitations, stomach aches... They fear to fall, having a heart attack, a stroke, or even going "crazy". In short, of "losing control".

   When physical reactions get out of control, they can lead to real panic attacks. Often, this is even how agoraphobia begins.

   "Symptoms occur for no apparent reason. Often, the person consults their doctor and says they have a physical problem, but the doctor doesn't find anything organically wrong," says Pelissolo.

   Finally, the agoraphobic who has panic attacks is "afraid to be afraid".

Agoraphobia is the fear of

   Fear of the crisis itself, since he feels he is dying, and fear of conditions that could aggravate his situation, such as overcrowded or closed places if he feels he is suffocating.

   "Sometimes I try to brave my fears," says Catherine. But I feel terrible and I tell myself that my heart will stop beating so fast".

   Professor Pelissolo insists: "You think you're dying but there's no real threat.

   A panic attack is not physically dangerous and the person manages to control their behavior. Seizures always end well".

   However, phobias are not "reasonable" fears. While identifying panic attacks and agoraphobia is a prerequisite for stopping them, often more needs to be done.

Treating Agoraphobia: Cognitive and Behavioural Therapies

   The first step in the case of agoraphobia is to consult your doctor, especially if there are panic attacks, because some pathologies can cause the same symptoms or promote their appearances, such as inner ear disorders (dizziness...) or hyperthyroidism (palpitations, nervousness...). If agoraphobia is confirmed, he will pass the baton to a psychiatrist or psychologist.

   Dr. Pelissolo recommends more particularly cognitive and behavioral therapies (CBT): "The objective is to work on the behaviours themselves, the "false beliefs" and what one says to oneself.

   But you have to have a real desire to get involved." More "classical" therapies, which aim to get to know oneself better in order to explain one's fears, can help "with more uncertain results".

overcoming agoraphobia

   Some agoraphobes cope on their own by setting up their own "CBT program" thanks to certain books and Internet sites.

   In practice, it is necessary to identify the dreaded situations, to classify them from the simplest to the most difficult and to find the means to confront them progressively.

   "In the beginning, you can be accompanied by a relative, reassure yourself by keeping your mobile phone or a box of anxiolytics close at hand.

   The idea is to proceed gradually while maintaining a certain level of discomfort but avoiding major attacks," explains Professor Pelissolo.

Any other possible treatments for agoraphobia?

What about medication? "They don't have much interest," replies Professor Pelissolo.

   "Anxiolytics, mainly represented by benzodiazepines (Lexomil, Lysanxia, Temesta, Xanax...), can be useful to relieve the crises but not in the long term, because of the risk of dependence and their side effects.

   They should not become a reflex because the seizures can pass alone. "

   Antidepressants that reduce the intensity of emotions (Seroplex, Deroxat...) are sometimes prescribed as part of a background treatment.

   "They only work if there is an underlying depression and/or panic attacks," says the specialist.

   Hospitalization is not helpful unless there is a real depression or risk of dependency, as alcohol or other drugs are sometimes used to cope with fears.

   However, some facilities do offer day hospital follow-up as part of intensive CBT. A few specialists agree to travel to the home when agoraphobia prevents them from going to consultations.