What Is Agoraphobia?
Agoraphobia is a type of anxiety disorder that involves a pathological fear of being put into situations that cause panic. This fear of panic resulting in the sufferer becoming housebound. People who have agoraphobia may attempt to avoid being alone, leaving the house, or any other situations in which they feel trapped, shamed or helpless if a panic attack arises.
Agoraphobia is an extreme anxiety about - or avoidance of - places or situations from which escape may be difficult or embarrassing; and cause avoidance in such situations in which help may not be available in the event of a panic attack or panic-like symptoms.
Often, people who have agoraphobia have trouble feeling safe in a public situation, especially if there are crowds, which leads to many people with agoraphobia becoming housebound.
Agoraphobia is comprised of two types of anxiety disorders: a panic disorder and a phobia. While depression isn't technically a symptom of agoraphobia, 50% of those suffering agoraphobia also suffer from depression.
Often, people report suffering from agoraphobia after a stressful and/or traumatic event.
The severity of agoraphobia is variable: some people with agoraphobia lead mostly normal lives and simply avoid anxiety-provoking situations. In severe cases of agoraphobia, people are housebound, avoiding any and all situations that may produce anxiety.
Treatment for agoraphobia can be tough - it generally involves conquering fears, but with proper medications and therapy, people with agoraphobia can go on to lead healthy, productive lives.
What Are The Causes of Agoraphobia?
Agoraphobia is often a complication of a panic disorder. Panic disorder is an anxiety disorder in which panic attacks trigger intensely frightening physical symptoms.
Agoraphobia may develop after a panic attack occurs in a certain type of situation. A person with agoraphobia may try to combat panic attacks by avoiding the specific type of situation that triggered a panic attack. Rarely does agoraphobia occur without some type of panic disorder.
There's no one cause that leads people to develop agoraphobia, most experts believe that agoraphobia are caused by a combination of physical and psychological factors.
Stressful and/or traumatic event occurring in childhood or adulthood, such as the loss of a loved one, a natural disaster, or other traumas.
Substances - certain types of medications have been linked to agoraphobia.
Problems with spacial orientation, especially as it relates to balance, which can be overwhelming in crowds.
What Are The Risks for Developing Agoraphobia?
Estimates from the National Institute of Mental Health say that approximately 3.2 million Americans live with agoraphobia. Typical age of onset for agoraphobia is late teens to early twenties, but this is not a hard-set rule or predictable time table. Other risk factors for developing agoraphobia include:
- Sex: Women are more likely than men to develop agoraphobia.
- Other Mental Illness: Preexisting diagnosis of Panic Disorder
- Personality: Nervous disposition
- Addiction: Alcoholism or substance abuse
What Are The Symptoms Of Agoraphobia?
Agoraphobia can manifest itself in a number of ways, broken down into types of symptoms:
Physical Symptoms of Agoraphobia - these symptoms will usually appear when a person with agoraphobia finds themselves in a situation in which become anxious. Because people with agoraphobia often avoid triggering situations, these symptoms may not always be experienced:
- Rapid heart rate
- Feeling hot and/or flushing
- Difficulty swallowing
- Feeling dizzy
- Stomach upset and/or diarrhea
Psychological Symptoms of Agoraphobia:
The following psychological symptoms of agoraphobia may be related in part to the physical symptoms that are experienced:
- Fear that people will see a panic attack, which will lead to shame and humiliation
- Fear that a panic attack will lead to death
- Fear that the person is going "crazy"
Other Psychological Symptoms of Agoraphobia may include:
- Low self-esteem
- Low self-confidence
- Feeling dread and anxiety
- Fear of being left alone
- The belief that the person with agoraphobia cannot function or survive without the help of other people.
Behavioral Symptoms of Agoraphobia:
Frequent panic attacks - a panic attack is a period of intense fear that lasts at least ten minutes.
Avoidance Behavior - those with agoraphobia avoid places or situations in which making a quick exit due to panic attacks would be embarrassing, or those in which no one would be around to help if they had a panic attack. Those with agoraphobia avoid going places unless it's with a "safe" person or a "safe" place.
Common situations that people with agoraphobia avoid can include:
- Driving a car
- Being outside
- Being away from home
- Sitting in the middle row at a theatre or stadium
- Using public transportation
- Crossing a bridge
- Taking an elevator
- Standing in lines
Fear of Being Alone and/or Scanning - thanks to the physical sensations of panic attacks, some people with agoraphobia engage in obsessive scanning, or the constant monitoring of their own bodies for any unusual symptoms. People with agoraphobia are often afraid to be alone, even in a safe place, because they're afraid no one will be around to help them.
Safe People and Safe Places - to cope with the fear, people with agoraphobia establish safe people and places.
- A safe person is someone with whom the person feels emotionally close. Safe people are generally parents, children, close friends, relatives and spouses. While a safe person is around, people with agoraphobia can travel farther from home and enter feared places and situations.
- A safe place is a place in which a person with agoraphobia feels psychologically comfortable and is generally their home. A safe place can also be the homes of safe people, therapists' offices, and other established places. Some people with agoraphobia can feel safe in many places whereas others may be confined to their beds.
Reassurance - a person with agoraphobia may need to be reassured by another person.
Escape - leaving a stressful place and/or situation and going back to their safe place.
How Is Agoraphobia Diagnosed?
A psychiatrist will take a complete medical history of a person who presents with agoraphobia-like symptoms. In order to receive a diagnosis of agoraphobia, the DSM-IV requires the following:
- The person is anxious about being in a place or situation where escape is difficult in the event of a panic attack.
- Person avoids situations that may trigger a panic attack.
- Person only can endure panic inducing situations with the help of a friend.
- No other pathology explains the symptoms.
How Is Agoraphobia Treated?
Behavioral Therapy - a person with agoraphobia learns to face feared situations in small steps or all at once, rather than practice avoidance.
- Flooding - technique used to overcome fears by forcing the individual into a feared situation long enough for the fear to subside.
- Systematic Desensitization - a step-by-step technique used to teach the individual to relax in a previously feared situation. This can be experienced in real situations or through guided visualizations.
- Cue-Controlled Relaxation - A person with agoraphobia learns to achieve a state of relaxation any time, anywhere and on cue.
Cognitive Therapy - identifies and corrects habitual, irrational thought patterns at the root of anxiety, panic and fear.
- Focusing - teaches the individual to willfully focus their attention on something in the immediate environment whenever an irrational thought arises.
- Thought Replacing (also called Cognitive Restructuring) - the individual learns to become aware of thoughts, identify the irrational thoughts that lead to agoraphobia, and complete a step-by-step procedure for replacing irrational thoughts with more constructive thoughts.
- Thought Stopping - A person with agoraphobia identifies irrational thought and thinks (or says) the word "stop," or does a distracting activity to distract themselves from the thought before it leads to panic.
Medications Used To Treat Agoraphobia:
A number of types of medications have been proved to be helpful for those suffering agoraphobia. These medications may include:
- Anti-anxiety medications - these can help reduce the incidence of panic attacks.
- SSRI's - these antidepressants are used to stabilize moods and stop panic attacks.
- Additional antidepressant like an MAOI or tricyclic antidepressant.
What Is The Prognosis For Someone With Agoraphobia?
Approximately a third of people who have agoraphobia eventually become asymptomatic. Half of the people who have agoraphobia may have some decrease in symptoms, although symptoms reemerge during stressful and/or traumatic situations.
One in every five people who have agoraphobia will continue to have persistent symptoms despite treatment.
Living With Agoraphobia:
Living in constant fear of panic attacks, the outside world, and unsafe situations can make life very miserable. Proper treatment of agoraphobia can help make the disorder more manageable so that you do not become a prisoner to your fears. Here are some tips for coping with agoraphobia:
Don't shy away from feared situations - it's really hard to try something new when you're afraid of getting a panic attack. Instead, take small baby steps toward doing the things you fear most. From these experiences, you can gain the confidence to do more and more.
Relaxation techniques - many people who have agoraphobia find that certain meditation techniques can help them to handle their fears and worries. These may include meditation, yoga, guided imagery, usage of an acupressure mat in your own home. Practice these at home, then use them when you're in a stressful situation.
Calming down when you're feeling overwhelmed with worry about losing control or having a panic attack. Have your therapist teach you some ways you can calm yourself down, and implement them at the first hint of panic.
Don't Self-Medicate - while the urge of having something make the fear more bearable is a strong feeling, unfortunately, drugs and alcohol can worsen panic attacks and anxiety.
Take ALL medications as directed - don't stop taking your medication because you feel like you "don't need it" or before you talk to your doctor.
Be good to YOU - sleep well, eat well, eat balanced diet, and get some exercise each day.
Ask for help - reach out to support groups and other people who have agoraphobia in order to connect with other people who truly
Additional Resources for Agoraphobia:
Anxiety Disorders Association of America - leader in advocacy, education, training, and research for anxiety and stress-related disorders.
Therapist Locator, searchable by city or zip code.
Canadian Mental Health Association has a section on anxiety, including Agoraphobia, and offers resources for getting help in Canada.
Agoraphobia Support UK offers online support for sufferers, caregiver, friends and family.
Anxiety Care UK offers some great tips on how to treat Agoraphobia, including things you can do on your own, outside of tradition therapies.
This Agoraphobia Help site has a free newsletter and 7 part video course.