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In the last section, we discussed three other social avoidant behaviors that are more extreme than agoraphobia. These are social phobia; social skills deficit; and dysmorphophobia.
As you are aware, agoraphobia is defined as "fear of being in places or situations from which escape might be difficult or in which help might be unavailable in the event of suddenly developing a symptom that could be incapacitating or embarrassing." In simpler terms, agoraphobia is the fear of public and social situations during which a client might undergo a panic attack that could be embarrassing or leave the client unable to reach help.
The client becomes increasingly avoidant of social situations and prefers to seclude him or herself from the rest of the world. A consensus on the origins of agoraphobia has not yet been reached. For instance, do panic attacks incite a client to avoid certain situations, or does the disorder bring on the panic attack? Of course, this question is extremely debatable, but significant links from childhood to adult agoraphobia have been found.
In this section, we will examine three characteristics of childhood agoraphobia, which are development of agoraphobia in childhood and adolescence; separation anxiety; and early exposure.
Three Characteristics of Childhood Agoraphobia
♦ Characteristic #1 - Development in Childhood and Adolescence
Separation anxiety, which we will discuss later on in this section, becomes more prevalent at this age as the child becomes more attached to the home. This mainly comes as a result of the home being a symbol of security and privacy. While all children and early adolescents have some anxiety of adjusting to social atmospheres, those clients with separation anxiety experience a much more severe and urgent reluctance to going to school and being in a place in which safety is not necessarily guaranteed.
The adolescent, on the other hand, deals with much more emotional and social factors than the latent child. Mainly, during adolescent years, the client must learn to balance dependence and independence. While manifesting a mature façade, the teenage client is merely imitating those adults around him or her and is in fact teetering between adulthood and childhood.
Inwardly, the adolescent resists the shouldering of responsibility through emotional outbursts, moodiness, and signs of depression. In adolescents suffering from agoraphobia, the anxiety resulting from new responsibility is met with increased seclusion and isolation.
♦ Characteristic #2 - Separation Anxiety
Those adults with agoraphobia that includes panic attacks have an increased rate of childhood separation anxiety while those adult clients who report panic attacks alone do not report increased rates of separation anxiety in childhood. However, the severity of the attacks do not differ. Dr. G.L. Klerman lists the following three ways that separation anxiety is linked to panic and agoraphobia in adults:
Dr. Klerman also states that "Separation anxiety may be the childhood antecedent of adult panic attacks." Think of your agoraphobic client. Could he or she have had a history of separation anxiety in his or her childhood? Could he or she still have a minor case of separation anxiety?
♦ Case Study
However, I asked if it would be financially possible to put Sam in a smaller, private school. Dave and Eve researched small schools in the city and found a small, Christian school whose average class number was around 11 children per grade. Not only were the social demands of the school lessened, but also the teachers were much more attentive to the children. Dave and Eve explained to Sam’s teacher about her condition and her teacher made the extra effort to make Sam feel more at home and in a safe and secure environment.
Think of your child client who is experiencing agoraphobia related to school. Could he or she benefit from being put in a smaller class?
♦ Characteristic #3 - Early Exposure
On the other hand, instigating fear in a child is a practice that many parents resist. They would much rather avoid the situation altogether which may in fact worsen the child’s condition. Laura was a nine year old client of mine who experienced extreme symptoms of panic when exposed to large crowds. Her parents, Michael and Diane, were reluctant to try exposure therapy because the site of their daughter in pain was one they wished to avoid at all costs.
However, eventually, they developed a system of exposure steps, along with my assistance, that would, hopefully, gradually reduce Laura’s anxiety. Exposure degrees came in the following order:
The intensity of Laura’s anxiety would be carefully monitored to ensure she would not be overwhelmed. When the time came for a visit to a friend’s house without her parents, the overseeing adult was informed to watch Laura carefully and to encourage her a great deal. Eventually, Laura became less and less anxious around social groups as she became more and more exposed to social situations. Replay section 6 for more information on exposure therapy.
In this section, we discussed three characteristics of childhood agoraphobia, which are development in childhood and adolescence; separation anxiety; and early exposure.
In the next section, we will examine three aspects of panic disorder, namely typical manifestations; irritable bowel syndrome, and loss of significant person.