Agoraphobia

 

What Is Agoraphobia?

Agoraphobia is a rare type of anxiety disorder. If you have it, your fears keep you from getting out into the world. You avoid certain places and situations because you think you’ll feel trapped and not be able to get help.

For example, you might worry or panic when you are in:

• Public transportation (buses, trains, ships, or planes)
• Large, open spaces (parking lots, bridges)
• Closed-in spaces (stores, movie theaters)
• Crowds or standing in line
• Being outside your home alone
• You may be willing to go just a handful of places, or you may even dread leaving your house. 

Causes - Agoraphobia

Agoraphobia can develop as a complication of panic disorder.

Agoraphobia can sometimes develop if a person has a panic attack in a specific situation or environment.

They begin to worry so much about having another panic attack that they feel the symptoms of a panic attack returning when they're in a similar situation or environment.

This causes the person to avoid that particular situation or environment.

Panic disorder

As with many mental health conditions, the exact cause of panic disorder isn't fully understood.

However, most experts think a combination of biological and psychological factors may be involved.

 Biological factors

'Fight or flight' response

• Panic disorder is closely associated with your body's natural "fight or flight" response – its way of protecting you from stressful and dangerous situations.
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• Anxiety and fear cause your body to release hormones, such as adrenaline, and your breathing and heart rate are increased. This is your body's natural way of preparing itself for a dangerous or stressful situation.
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• In people with panic disorder, it's thought the fight or flight response is more intense, resulting in a panic attack.

Psychological factors

Psychological factors that increase your risk of developing agoraphobia include: 

• a traumatic childhood experience, such as the death of a parent or being sexually abused
• experiencing a stressful event, such as bereavement, divorce, or losing your job
• a previous history of mental illnesses, such as depression, anorexia nervosa or bulimia
• alcohol misuse or drug misuse
• being in an unhappy relationship, or in a relationship where your partner is very controlling

Symptoms of Agoraphobia

Symptoms of agoraphobia may include:

• Being afraid of leaving home
• Being afraid of open spaces, bridges, or shopping centers
• Fear of enclosed spaces or buildings
• Fear of leaving home or being in social situations alone
• Fear of losing control in a public place2
• Fear of places where escape might be difficult
• Fear of public transportation
• These situations almost always trigger an anxiety response that is out of proportion to the actual danger presented by the situation.

Types of Agoraphobia

Although many people with agoraphobia will also have panic disorder, it is possible to be diagnosed with agoraphobia without having a history of panic disorder.3 When this occurs, the person still has a fear of being stuck in a situation where escape would be difficult or humiliating. However, they generally do not fear having full-blown panic attacks.

Rather, they may be afraid of having some other type of distressing anxiety symptom or other intense physical issues, such as vomiting or having a severe migraine. For instance, the person may be afraid that they will lose control of their bladder in public or faint without any help being available.

Approximately one-third to half of those diagnosed with panic disorder will also develop agoraphobia. The National Institute of Mental Health (NIMH) reports that agoraphobia occurs to approximately 0.9% of adults in the U.S. population in any given year.1 This condition typically develops in adulthood, though it can emerge earlier in adolescence.

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. If this happens to you, you may not be able to visit with family and friends, go to school or work, run errands, or take part in other routine daily activities. You may become dependent on others for help.

Agoraphobia also can lead to:

• Depression.
• Alcohol or drug misuse.
• Suicidal thoughts and behavior.

Prevention

There's no sure way to prevent agoraphobia. But 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 over and over again. This can help you feel more comfortable in those places. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

How is agoraphobia diagnosed?

If you think you have agoraphobia, and the anxiety is interfering with your daily life, you should talk to a primary care physician or a mental healthcare provider, like a psychiatrist or psychologist. If you’re afraid to visit a medical office in person, you may be able to schedule a telephone or video appointment.

The healthcare provider may ask you:

• Do you get stressed about leaving your house?
• Are there any places or situations you avoid because you’re afraid? Why does it cause fear?
• Do you rely on others to do your shopping and errands?

A healthcare provider can diagnose agoraphobia based on your symptoms, how often they happen and how severe they are. It’s important to be open and honest with your providers. Your provider may diagnose agoraphobia if you meet specific standards developed by the American Psychiatric Association. 

To have a diagnosis of agoraphobia, a person must feel extreme fear or panic in at least two of the following situations:

• Using public transportation.
• Being in an open space.
• Being in an enclosed space, such as a movie theater, meeting room or small store.
• Standing in a line or being in a crowd.
• Being out of their home alone.

Treatment for Agoraphobia

If a person does develop agoraphobia with panic disorder, symptoms typically begin to occur within the first year that the person starts having recurring and persistent panic attacks. Agoraphobia can get worse if left untreated.

For the best outcomes in managing agoraphobia and panic symptoms, it is important to seek treatment as soon as symptoms arise. Treatment options typically include a combination of both medication and psychotherapy.

1.Psychotherapy

The therapeutic approach may include some systematic desensitization, in which the person gradually confronts avoided situations with the support and guidance of their therapist. Some research has shown that integrating exposure therapy with psychodynamic treatment has been beneficial in panic disorder with agoraphobia.9 Many times, the person will fare better in facing their fears if accompanied by a trusted friend.

2.Medications

Your healthcare provider also may suggest medications called selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications can treat depression and anxiety disorders.

3. Lifestyle changes

The following lifestyle changes may also help you manage agoraphobia:

• Avoid alcohol, caffeine and other substances.
• Eat a healthy, well-balanced diet.
• Exercise regularly.
• Practice breathing exercises.

4. Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is the most common form of psychotherapy used to treat people with agoraphobia. CBT can help you understand the distorted feelings and views associated with agoraphobia. It can also teach you how to work through stressful situations by replacing the distorted thoughts with healthy thoughts, allowing you to regain a sense of control in your life.

5. Exposure Therapy

Exposure therapy can also help you overcome your fears. In this type of therapy, you’re gently and slowly exposed to the situations or places you fear. This may make your fear diminish over time.

How can I learn to cope with agoraphobia?

Take good care of yourself, take your medications as prescribed and practice techniques you learn from your therapist. And don’t allow yourself to avoid situations and places that spark anxiety. The combination can help you do things you enjoy with less fear.