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Agoraphobia
Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.
The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.
People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.
Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.
Symptoms
Typical agoraphobia symptoms include fear of:
Leaving home alone
Crowds or waiting in line
Enclosed spaces, such as movie theaters, elevators or small stores
Open spaces, such as parking lots, bridges or malls
Using public transportation, such as a bus, plane or train
These situations cause anxiety because you fear you won't be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.
In addition:
Fear or anxiety almost always results from exposure to the situation
Your fear or anxiety is out of proportion to the actual danger of the situation
You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed
You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance
Your phobia and avoidance usually lasts six months or longer
Panic disorder and agoraphobia
Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you're totally losing control, having a heart attack or even dying.
Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.
Signs and symptoms of a panic attack can include:
Rapid heart rate
Trouble breathing or a feeling of choking
Chest pain or pressure
Lightheadedness or dizziness
Feeling shaky, numb or tingling
Excessive sweating
Sudden flushing or chills
Upset stomach or diarrhea
Feeling a loss of control
Fear of dying
When to see a doctor
Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.
Don't let agoraphobia make your world smaller. Call your doctor if you have signs or symptoms listed above.
Causes
Biology — including health conditions and genetics — temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.
Risk factors
Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.
Risk factors for agoraphobia include:
Having panic disorder or other phobias
Responding to panic attacks with excessive fear and avoidance
Experiencing stressful life events, such as abuse, the death of a parent or being attacked
Having an anxious or nervous temperament
Having a blood relative with agoraphobia
Complications
Agoraphobia can greatly limit your life's activities. If your agoraphobia is severe, you may not even be able to leave your home. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, run errands, or take part in other normal daily activities. You may become dependent on others for help.
Agoraphobia can also lead to or be associated with:
Depression
Alcohol or drug abuse
Other mental health disorders, including other anxiety disorders or personality disorders
Diagnosis
Agoraphobia is diagnosed based on:
Signs and symptoms
In-depth interview with your doctor or a mental health professional
Physical exam to rule out other conditions that could be causing your symptoms
Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Treatment
Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.
Psychotherapy
Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.
Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.
You can learn:
What factors may trigger a panic attack or panic-like symptoms and what makes them worse
How to cope with and tolerate symptoms of anxiety
Ways to directly challenge your worries, such as the likelihood of bad things happening in social situations
That your anxiety gradually decreases if you remain in situations and that you can manage these symptoms until they do
How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety
If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia are well aware of this problem.
If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. He or she may offer to see you first in your home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.
If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety.
You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.
Medications
Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications in the treatment of agoraphobia.
Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants may also effectively treat agoraphobia.
Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, your doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren't a good choice if you've had long-term problems with anxiety or problems with alcohol or drug abuse.
It may take weeks for medication to relieve symptoms. And you may have to try several different medications before you find one that works best for you.
Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your doctor likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication.
Alternative medicine
Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your doctor. Although these supplements are available without a prescription, they still pose possible health risks.
For example, the herbal supplement kava, also called kava kava, appeared to be a promising treatment for anxiety, but there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using any product that contains kava until more-rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.
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