Agoraphobia is a type of anxiety disorder related to fear. With agoraphobia, you fear being in places where it may be difficult or embarrassing to get out quickly or where you may have a panic attack and can't get help. Because of your fears, you avoid places where you think you may have a panic attack or panic-like symptoms. People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. Commonly feared places and situations are elevators, sporting events, lines, bridges, public transportation, driving, shopping malls and airplanes. The fears can be so overwhelming that some people are essentially trapped in their own homes - it's the only place they feel truly safe, so they don't venture out into public at all. Agoraphobia treatment can be challenging because it usually means confronting your fears. A combination of medications and psychotherapy can help you escape the trap of agoraphobia and live a more enjoyable life.
Complications of Agoraphobia
Agoraphobia can greatly limit your life's activities. In severe cases, you may not even be able to leave your house. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, walk your dog, run errands, or take part in other normal daily activities. You may become dependent on others for help, such as grocery shopping.
Agoraphobia can also lead to depression and anxiety. And people with agoraphobia may turn to alcohol or substance abuse to help cope with the fear, guilt, hopelessness, isolation and loneliness.
Causes of Agoraphobia
Many experts consider agoraphobia to be a complication of panic disorder. Panic disorder is a type of anxiety disorder characterized by frequent episodes of intense fear (panic attacks) that for no apparent reason trigger severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
You may develop agoraphobia when you begin to associate your panic attacks with one or more situations in which those attacks have occurred. You may avoid similar situations in an attempt to prevent future panic attacks. People with agoraphobia are especially likely to avoid circumstances in which it would be difficult or embarrassing to escape if a panic attack occurred, such as in a crowded stadium or an airplane.
In some cases, fear of having a panic attack may be so great that you may not be able to leave the safety of your home. In other cases, you may be able to overcome your fear and tolerate most situations as long as you're accompanied by a trusted companion.
Rarely, agoraphobia may develop without an accompanying panic disorder. In these cases, the cause of agoraphobia isn't known.
Signs & Symptoms of Agoraphobia
A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place. Typical agoraphobia symptoms include:
Fear of being alone
Fear of being in crowded places, such as in a shopping mall or sports stadium
Fear of losing control in a public place
Fear of being in places where it may be hard to leave, such as an elevator or train
Inability to leave your house for long periods (housebound)
Sense of helplessness
Overdependence on others
A sense that your body is unreal
In addition, you may also have signs and symptoms similar to a panic attack, including:
Rapid heart rate
Upset stomach or diarrhea
Feeling a loss of control
Diagnosis of Agoraphobia
Agoraphobia is diagnosed based on signs and symptoms, as well as a thorough psychological interview with your doctor. You may also have a physical exam. A physical exam is important because some of the signs and symptoms of a panic attack are similar to those of other conditions. To be diagnosed with agoraphobia, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
For agoraphobia to be diagnosed, you must meet these criteria:
Anxiety about being in places or situations that it may be difficult or embarrassing to get out of, or in which you may not be able to get help if you develop panic-like symptoms
Avoiding places or situations where you fear you may have a panic attack, or having great distress and anxiety in those situations
In addition, your mental health provider will try to determine if you might have panic disorder, social phobia or another specific type of phobia, rather than agoraphobia, since these all can resemble one another.
Treatments of Agoraphobia
As with many other mental disorders, agoraphobia treatment typically includes a combination of medication and psychotherapy. Treatment of agoraphobia is often successful, and you can overcome agoraphobia and learn to keep it under control.
Antidepressant and anti-anxiety medications are commonly used to treat agoraphobia and panic symptoms. You may have to try several different medications before you find one that works best for you.
Your doctor is likely to prescribe one or both of the following:
A selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are commonly used to treat agoraphobia include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) or sertraline (Zoloft).
Another type of antidepressants, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.
An anti-anxiety medication. Also called benzodiazepines, these drugs — including alprazolam (Xanax), clonazepam (Klonopin) and others — can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. Your doctor will weigh this risk against the potential benefit of this class of drugs. Both starting and ending a course of antidepressants can cause side effects that mimic the symptoms of a panic attack. For this reason, your doctor likely will gradually increase your dose at the beginning of your treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication — often over the course of a year or more after your agoraphobia symptoms are controlled.
Several types of psychotherapy or counseling can help agoraphobia. One common therapy used is cognitive behavioral therapy. Cognitive behavioral therapy has two parts. The cognitive portion involves learning more about agoraphobia and panic attacks and how to control them. You learn what factors may trigger a panic attack or panic-like symptoms, and what makes them worse. You also learn how to cope with these distressing symptoms, such as using breathing and relaxation techniques. The behavioral portion of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely confront the places and situations that cause fear and anxiety. A therapist may accompany you on excursions to help you remain safe and comfortable, such as trips to the mall or driving your car. Through gradually practicing going to feared places, people with agoraphobia learn that the fears don't come true and that their anxiety goes away with time. If you have trouble leaving your home, you may wonder how you can possibly venture out to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer initial appointments in your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through e-mail. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed.
Prevention of Agoraphobia
There's no sure way to prevent agoraphobia. However, anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you or seek professional help.
Also, if you've experienced panic attacks or have panic disorder, get treatment as soon as possible. Because panic disorder and agoraphobia are closely related, getting treatment for panic disorder may prevent the development of agoraphobia.
In addition, if you take medication or are already in therapy or counseling for panic disorder, continue to follow your treatment plan. If you develop any symptoms of agoraphobia, get treatment as soon as possible, which will help prevent symptoms from getting worse over time.
When to seek Medical Advice
Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.
Some people with agoraphobia have "safe zones," or places they can go without severe worry, especially if accompanied by a trusted friend or relative. Sometimes they may muster up the courage to go somewhere, but they still feel severely distressed and anxious.
Often, however, agoraphobia can make you feel like a prisoner in your own home. If you anticipate having a panic attack when you venture out in public, you may indeed have one - causing a vicious cycle. The number of places you're able to go may become fewer and fewer.
Don't let agoraphobia make your world smaller. Call your doctor if you have symptoms of agoraphobia.