Agoraphobia
ARTICLE SECTIONS
Introduction
Signs and symptoms
Causes
Risk factors
When to seek medical advice
Screening and diagnosis
Complications
Treatment
Prevention
Coping skills
Introduction
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 places 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. Both medications and psychotherapy have been found to be helpful. With treatment, you can escape the trap of agoraphobia and live a more enjoyable life.
Signs and symptoms
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 in crowded places, such as 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 get out of, such as an elevator or train
- Inability to leave your house for long periods (housebound)
- A sense that your body is unreal
In addition, you may also have signs and symptoms similar to a panic attack, including:
- Upset stomach or diarrhea
- Feeling a loss of control
Causes
Researchers are still trying to better understand what causes someone to have agoraphobia. As with most mental illnesses, agoraphobia is probably caused by a complex mix of:
- Your temperament and traits
Risk factors
Agoraphobia usually starts during late adolescence or early adulthood, but younger children and older adults also can develop agoraphobia. About 5 percent of people in the United States have agoraphobia. Women are diagnosed with agoraphobia more often than men are.
Although researchers don't know exactly what causes agoraphobia, they do know several risk factors involved, or the things that make you more likely to get agoraphobia. These risk factors may include:
- Experiencing stressful life events
- Having a tendency to be nervous or anxious
- Alcohol and substance use disorders
When to seek medical advice
Agoraphobia can make you feel like a prisoner in your own home. You may be so fearful of having a panic attack that you can't venture into public. Some people with agoraphobia have "safe zones," or places, areas or situations they can go without severe worry. For instance, you may be able to walk around your neighborhood, but no farther. Or, you may be able to go places as long as a trusted relative or friend is with you. Sometimes you may muster up the courage to go somewhere but feel severely distressed and anxious.
Agoraphobia, whether extreme or not, can severely limit your life. You may not be able to socialize as you'd like. You may not be able to go to school or work. You may not be able to run errands for your family, attend your child's soccer game or go shopping with friends. If you anticipate having a panic attack, you may indeed have one, and you may constantly worry about the next one — causing a vicious cycle. The number of places you're able to go may become fewer and fewer.
At the same time, these fears, as well as embarrassment, can make it extremely difficult to visit your health care professional. Consider starting, instead, with a phone call to your health care professional. Some health care professionals, particularly mental health experts who specialize in agoraphobia and anxiety disorders, may initially be able to meet with you in your own home. Don't let agoraphobia make your world smaller than you'd like it to be.
Screening and diagnosis
Agoraphobia is diagnosed based on signs and symptoms, as well as a thorough psychological evaluation. Your doctor or mental health professional will ask you to describe the signs and symptoms you're experiencing — what they are, when they occur, how intense they are and how long they last, for example. You also might discuss how your life is affected or limited by your symptoms, such as places or situations you avoid.
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 heart, lung or 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 professionals 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 professional 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.
Complications
Agoraphobia can greatly limit your life's activities, depending on how severe it is. In severe cases, you may not be able to leave your house at all. 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 have to become extremely 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.
Treatment
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. Among antidepressants, the selective serotonin reuptake inhibitors (SSRIs) fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft) are approved by the Food and Drug Administration to treat panic disorder and also may help agoraphobia. Other types of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) also are sometimes used to treat agoraphobia. But TCAs and MAOIs tend to have more side effects and more serious side effects than do SSRIs.
Anti-anxiety medications, also called benzodiazepines, also can help control symptoms of anxiety and panic attacks, and are often used in agoraphobia treatment. These may include alprazolam (Xanax), clonazepam (Klonopin) and others.
Anti-anxiety medications often work immediately to reduce symptoms, while antidepressants may take a couple of weeks before you start getting effective relief. Your doctor may suggest taking both since the effectiveness may be increased. You may have to try several different medications before you find one that works best for you.
All medications have possible side effects, but these usually can be controlled by self-care measures or lifestyle changes. Be sure to let your health care professionals know about any side effects you may have. In addition, anti-anxiety medications can be habit-forming, which means they may cause you to feel physically or mentally dependent on them. Discuss such concerns with your health care professionals.
Some research studies show that you may benefit from taking medication for a year or more, even after your agoraphobia symptoms are controlled. This maintenance treatment may help prevent the unexpected return of your symptoms, especially as you venture beyond your home more frequently and face potentially stressful situations.
Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, consult your health care professionals. Although these supplements are available over-the-counter, they still pose possible health risks in some people.
Several types of psychotherapy or counseling can help agoraphobia. Several research studies have shown that cognitive behavior therapy may offer the most benefits for agoraphobia. Cognitive behavior therapy has two components. 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 component 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
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.
Coping skills
Living in fear of anxiety can make life difficult for anyone with agoraphobia, no matter how severe it is. Professional treatment of agoraphobia can help you overcome this disorder or manage it effectively so that you don't become a prisoner to your fears.
You can also take some steps on your own to cope and care for yourself when you have agoraphobia:
- Try not to avoid feared situations. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places does make them less frightening and anxiety-provoking. Family, friends and your therapist can help you work on this.
- Learn calming skills. People with agoraphobia worry excessively about losing control or having a panic attack. Working with your health care professional, you can learn skills to help calm and soothe yourself. You can practice these skills on your own, especially at the first hint of anxiety.
- Practice relaxation techniques. Meditation, yoga and imagery are among the simple relaxation techniques that may help — and you can do them in the comfort of your own home. Practice these techniques when you aren't anxious or worried and then put them into action during stressful situations.
- Reach out. Consider joining a self-help or support group, where you can connect with others who understand what you're going through.
- Avoid alcohol and illicit drugs. These can worsen your panic or anxiety symptoms.
- Take medications as directed. It may take a couple of weeks to start seeing benefits when you first start a medication, but stick it out. Also, don't stop a medication without first consulting your health care professional, as some medications can cause withdrawal-like symptoms.
- Take care of yourself. Get enough rest, eat a balanced diet and try to exercise every day.
Mayo Clinic
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