Agoraphobia and Social Phobia
It is common for many people to feel uncomfortable in particular social situations. Although these feelings can be attributed to shyness and social inhibition, it is hard to set the boundaries between the lack of confidence and social impairment. Depending on the character of symptoms, the repeated attacks of panic and a constant fear of social interaction and public activities may be attributed either to the development of agoraphobia or the onset of social anxiety disorder. Each of these conditions affects the lifestyle of people suffering from it and makes them unable to socialize and perform their duties in the educational process, in the workplace, and in the family life. Regardless of the obvious similarity of these conditions, agoraphobia and social anxiety disorder differ in a number of aspects. The examination of these phobias requires the consideration of their general features, the determination of signs and symptoms of each of the disorders, and the discussion of the etiology of these conditions.
The unfounded fear of public settings and experiencing physical symptoms related to panic and anxiety may serve as indicators of the development of either agoraphobia or social phobia. Although these conditions have some similar manifestations, a number of aspects enable the scientists to differentiate between them. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), agoraphobia is characterized by the feeling of anxiety about staying in places or experiencing situations that cause embarrassment and make an individual feel that he will not be able to escape. Besides, people suffering from this phobia try to avoid the situations in which they may not get help in case of having a panic attack or paniclike symptoms. As stated by Buchanan and Coulson, agoraphobia may manifest itself in a fear of being outside the home alone, standing in a queue or a crowd, being on a bridge, or traveling by bus, train, or car. The fact that the majority of agoraphobic patients display paniclike symptoms makes the psychologists suggest that this condition is residual to panic attacks. Social phobia or social anxiety disorder is commonly known as a fear of situations that involve evaluation. A person suffering from this phobia is afraid of social situations that require exposure to unfamiliar people or unwanted attention from others. The fear of interaction with others may be connected not only with public presentations, social events, parties, and workshops, but also everyday activities such as eating, drinking, and writing in the presence of others. The challenges facing people suffering from social phobia include school dropouts, low workplace productivity, a delay in marrying and having children, and overall decreased quality of life. Therefore, agoraphobic patients are afraid to face unescapable, embarrassing, or unfamiliar situations, while people with social phobia try to avoid any social interactions.
Since both agoraphobia and social phobia are closely connected with panic disorder, their symptoms are similar to those experienced by people with panic attacks. The paniclike symptoms experienced by people with agoraphobia include rapid heartbeat, feeling sick, rapid breathing, being hot and sweaty, difficulty swallowing, chest pain, diarrhea, dizziness, and trembling. Agoraphobia is also characterized by some cognitive symptoms, involving the fear of being treated as stupid or embarrassed by other people, a belief in the existing life threat, losing control in front of public, and feeling bad under the steadfast gaze of other people. The behavioral patterns attributed to agoraphobic patients include avoidance of situations that may provoke a panic attack, staying at home for a long time, and the need to be accompanied by someone they trust. The symptoms of social phobia may start in the childhood and become more severe in the adulthood. In children, the manifestations of social anxiety disorder include frequent crying, freezing, experiencing uncontrolled outbursts of anger, as well as being afraid to go to school and participate in classroom activities. In the older age, the patients may be afraid of performing everyday activities, such as communicating via telephone, meeting strangers, talking to authorities, starting conversations, eating or drinking with other people, working, and shopping. Social phobia makes people afraid of being criticized, lowers their selfesteem, makes them avoid eye contact, and leads to the misuse of alcohol and drugs. Thus, the signs of these conditions that may be initially treated as the symptoms of panic can be followed by the lifelong consequences.
Agoraphobia and social anxiety disorder are also characterized by the presence of similar etiological features. In most cases, the development of agoraphobia can be explained by environmental and biological factors. The first category includes family climate and past experiences, such as exposure to traumatic events in the childhood. Apart from this, agoraphobia may develop in people with the family history of this condition. In the same way, social phobia may progress under the influence of environmental and genetic factors. Although the nature of the connection between genetics and social anxiety disorder is not fully studied, it is observed that this condition is often present in close family members. These findings lead to the conclusion that the chances of social phobia development in children can be determined by the behavioral patterns of their parents. Besides, the levels of social anxiety may be determined by the age of the patient and the changes in his life circumstances. For instance, it is reported that the level of social anxiety is lower in older adults while young people seem to experience higher levels of anxiety in particular situations. Therefore, both agoraphobia and social phobia are associated with genetic factors and can develop as a response to negative environmental exposures.
To conclude, both agoraphobia and social phobia affect the social aspects of an individual’s life as well as the state of his mental and physical health. The frequent exposure to physical symptoms of panic attack exhausts the patient and makes him more likely to develop the signs of other healththreatening conditions. Besides, the constant fear of being unable to escape and having no possibility to get help when it is needed makes a person avoid performing even some basic activities that are treated as the ones involving some risk. In the same way, the physical manifestations of social phobia in combination with the avoidance of situations involving the evaluation from other people prevent the patients from performing even some basic everyday activities. The primary distinction between these conditions lies in the nature of the fear. While people with social phobia are afraid of the settings involving many people who can criticize them and evaluate the quality of their participation, agoraphobic patients may experience the fear of being unable to escape even in the absence of other people. Although social phobia may develop even in the childhood, both conditions are associated with the environmental factors as well as family history of the disorder. Although the available data about the etiology of these phobias cannot explain the process of their development in great detail, the future findings in this area may shed some light on this issue.