Agoraphobia is an anxiety disorder related to fear of being in places that might be embarrassing or difficult to leave quickly, get help, or where you might experience a panic attack.
Persons with Agoraphobia often avoid places they believe they might have a panic attack or symptoms of one.
They have a difficult time feeling safe in public places, often where there are crowds of people. Public places where there are lines, sporting events, elevators, driving, public transportation, airplanes or shopping malls are places commonly feared by persons with Agoraphobia.
For persons with this disorder, the fear can become overwhelming to the point where they feel trapped at home because it is the only safe place. They feel as if they don't want to go out into public at all.
Treatment of Agoraphobia involves confronting fears like these and can be challenging because of it. Treatment involves both psychotherapy and medications. Persons who pursue treatment can get away from the trap that Agoraphobia presents and live more fulfilling and enjoyable lives.
Symptoms of Agoraphobia
Fear of a specific circumstance, situation, or objects is a, 'Phobia.' Worries over experiencing a panic attack in public places and settings involve a condition known as, 'Agoraphobia.' The symptoms of Agoraphobia include:
The fear of being alone
The fear of being in crowded places
The fear of loss of control in public
The fear of places which are difficult to get out of
The fear of being isolated in one's home
The fear of over-dependence
A sense of the body being unreal
Other symptoms of Agoraphobia are similar to a panic attack, and may include:
Rapid heart rate
A sense of loss of control
Causes of Agoraphobia
Medical science does not yet understand what causes Agoraphobia; although they believe it is a mixture of different things. These things include:
A person's biological and genetic background
Their life experiences
Their traits and temperaments
Risk Factors for Agoraphobia
Most people who develop Agoraphobia do so during late adolescence or early adulthood. Children and older adults can also develop it; approximately five percent of Americans have Agoraphobia. More women are diagnosed with Agoraphobia than men. The risk factors for Agoraphobia include:
Already having a panic disorder
Having experienced stressful events in life
The tendency to be anxious or nervous
Substance or alcohol abuse
Female in gender
The Time to Find Medical Assistance
Some persons with Agoraphobia feel imprisoned in their own homes, fearful of experiencing a panic attack and unable to go out in public. Others have places that they consider to be safe or situations, and they feel that they can be approached without worry. Some persons with Agoraphobia are able to walk around their neighborhood, for example, yet cannot go any further than that. At times they are able to gather enough courage to go someplace but are anxious and distressed when they do.
Agoraphobia can place serious limits on a person's life, restricting their ability to socialize to the degree they would like to. They may not be able to go to work or school, or out with family members. Shopping with friends, attending events associated with a child's activities and many other social situations, to include shopping at the grocery store may present incredible challenges. Anticipation of a panic attack and the experience of one can lead to consistent worry of another one, and cause a cycle that leads to a self-restriction of limiting social excursions.
Embarrassment and the fears themselves might make it very hard to get out and see a medical professional in order to get help for Agoraphobia. A first step is to pick up the phone and call a medical professional. There may be one who understands and specializes in Agoraphobia and anxiety disorders who might be able to initially meet with you in your own home.
Testing and Diagnosis of Agoraphobia
A diagnosis of Agoraphobia is based on symptoms and signs of it through psychological evaluation done by a doctor or mental health professional. They will ask you to describe the symptoms and signs you are experiencing, when they happen, what they are, their intensity and how long they last. You may also talk about the effects these symptoms and signs are having on your daily life, as well as the situations and places that you avoid. Physical examination is part of the testing for Agoraphobia because some of the symptoms and signs of panic attacks are similar to those experienced by persons with lung, heart, or other conditions.
The criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) must be met in order to be diagnosed with Agoraphobia. The DSM is a manual used by mental health professionals in order to diagnose a number of different mental health conditions, as well as by insurance companies for the purpose of reimbursing others for treatments received. In order for a diagnosis of Agoraphobia to be reached a person has to meet the following criteria:
Avoidance of places where fear of a panic attack or distress and anxiety in those situations is present
Anxiety over being in situations or places where it might be embarrassing or difficult to get out, or where the person might not be able to receive assistance should they develop panic-like symptoms
A mental health professional may also try to determine if you have social phobia, panic disorder or another form of phobia instead of Agoraphobia; they can all resemble each other.
Complications of Agoraphobia
There is great potential for Agoraphobia to limit a person's life activities depending on its severity. In the most severe cases of Agoraphobia, a person might not be able to leave their home at all, and without medical treatment will stay at home for years at a time. They will not be able to go to work, school, visit with friends or family members or go to the mail box out of fear. Seemingly simple things such as taking the dog for a walk or going to the grocery store can leave a person with Agoraphobia highly dependent on others for assistance. Further anxiety and guilt are sometimes results of Agoraphobia, and people with it might turn to substance abuse or alcohol in an effort to cope with hopelessness, guilt, isolation, fear and loneliness.
Agoraphobia, Treatments and Medications
Treatment for Agoraphobia usually involves both psychotherapy and medication, and is oftentimes successful. There is great reason to hope that you can learn to keep Agoraphobia under control with treatment.
Medications for Agoraphobia
There are a number of antidepressants and anti-anxiety medications that are used in order to treat Agoraphobia and associated panic symptoms. Antidepressants from the Serotonin Reuptake Inhibitor group (SSRI's), such as Prozac, Paxil, and Zoloft, have been approved by the Food and Drug Administration for use in treating panic disorder. These medications may also help in treating Agoraphobia. Tricyclic antidepressants (TCA's) are another form of antidepressant medication that may be used to treat Agoraphobia, as well as Monoamine Oxidase Inhibitors (MAOI's). It is important to note that MAOI's and TCA's usually have more and serious side effects than SSRI's.
Benzodiazepines are a form of anti-anxiety medication that can be used to assist in controlling panic and anxiety attacks. They are many times used in treating Agoraphobia as well. Medications such as Klonopin, Xanax and others are among the ones commonly prescribed from the anti-anxiety group of medications in order to treat Agoraphobia. One of the benefits of anti-anxiety medications is that they usually work immediately, reducing symptoms. Antidepressants can take two weeks in order to begin taking effects and provide a level of relief. Doctors may suggest taking both to increase effectiveness of treatment, and different medications may have to be tried before finding out what works for a particular person.
Every medication has the potential for side-effects. Lifestyle changes and self-care can help to control the side effects of medications, as well as working with your doctor by telling them about any side-effects you experience. Anti-anxiety medications may be habit forming, leading to feelings of mental and physical dependence, so it is very important to talk about any concerns that you may have with your doctor.
Taking medications for Agoraphobia can be beneficial over a year or more of time, despite easing symptoms, according to research. Maintenance treatment helps to prevent an unexpected return of symptoms as you go out into wider areas in society and face different and possibly more stressful situations in daily life. There are some herbal and dietary supplements that may have anti-anxiety and calming benefits which are available on an over-the-counter basis. A healthcare professional can discuss them and any potential health risks associated with these supplements with you.
Psychotherapy and Agoraphobia
Counseling and Psychotherapy of different types is available to help treat Agoraphobia, and research studies show that Cognitive Behavior Therapy is perhaps the most beneficial form of therapy for Agoraphobia. There are two components to Cognitive Behavior Therapy; the, 'cognitive,' part involves educating the person about panic attacks and Agoraphobia, as well as methods of controlling them. The person learns about factors which may trigger panic symptoms or attacks and make them worse, how to deal with these symptoms, and how to use relaxation and breathing techniques.
The, 'behavioral,' part involves desensitization of undesired, unhealthy, unwanted behaviors through exposure therapy. A technique is used that helps the person to confront situations and places safely that might cause anxiety and fear. For example; a therapist might accompany a person on trips to keep them comfortable and safe; places like the grocery store or the mall, or for a drive in a car. By gradually going to places that a person has feared, the person who has Agoraphobia is exposed to those fears and learns that their fears do not come true, helping their anxieties to go away over time.
Therapists who work with persons who have Agoraphobia are aware that those who have it might wonder how they could ever leave home to attend an appointment at a therapist's office. A therapist might offer some initial appointments at a person's home or in their, 'safe-zone,' or offer sessions over the telephone or through e-mail in order to start helping them. To get help, search for a therapist who can help you to find an alternative to appointments that are, 'in-office,' in the early part of treatment. You might take a friend or relative to an appointment with a therapist so they can provide you with help and comfort.
At this time there is no known way to prevent Agoraphobia. The more a person fears different situations, the greater the amount of anxiety they will experience. If you have some fear about going to a place that is safe, go there before your fear magnifies and becomes overwhelming. If you cannot, bring a friend or family member with you, or look for professional assistance.
Panic disorder and Agoraphobia are closely related, and getting treated for panic disorder might prevent the onset of Agoraphobia. If you have had a panic attack, or if you have panic disorder, it is important to seek treatment as quickly as possible. It is equally important to seek medical attention if you develop signs of Agoraphobia. Following the treatment plan you are on, if you already have a diagnosis of panic disorder or Agoraphobia, is crucial, and helps to prevent worsening symptoms over time.
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