• Agoraphobia

    Definition

    Agoraphobia is an anxiety disorder. It is an irrational fear of being trapped in places or situations where escape is difficult. People with agoraphobia may not be able to leave the house.

    Causes

    The exact cause of anxiety disorders is not known. Factors that may contribute to the development of agoraphobia include:
    • Genetics
    • Changes in brain chemistry or activity
    • Having a nervous system that reacts excessively, even to normal stimuli
    • Increased awareness of physical changes, such as increased heart rate
    • Distorted thinking, which may start a cycle of fear
    Agoraphobia often develops in people with panic disorders. These disorders are associated with frequent and severe panic attacks. Agoraphobia may develop when people begin to avoid certain places or situations to prevent these panic attacks.
    Nervous System
    female nervous system 3D
    Changes or genetic problems in the nervous system (brain and nerves) may contribute to agoraphobia.
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    Agoraphobia is nearly twice as common in women than in men. Other factors that may increase your chance of agoraphobia include:
    • History of panic attacks or panic disorder
    • A tendency to be nervous or anxious
    • Stressful situations
    • Family members with panic disorder or phobias
    • History of exposure to traumatic events
    • Other psychiatric disorders

    Symptoms

    Symptoms include:
    • Fear of open spaces, crowds, bridges, or standing in line
    • Fear of enclosed spaces, such as cars, buses, trains, or airplanes, or being in a small theater or shop
    • Fear that escape may be difficult when feelings of anxiety occur
    • Creation of a safe zone
    • Feelings of anxiety when outside the safe zone
    • Fear of being alone outside of the home
    • Avoidance of situations that might cause a panic attack
    • Restriction of activities outside the home
    • Feeling of being safer with a trusted friend or family member
    Feared situations may trigger a panic attack. Attacks start quickly and peak in about 10 minutes. A panic attack usually includes four or more of the following:
    • Intense fear
    • Shaking
    • Rapid heartbeat
    • Pounding or racing feeling in the chest
    • Sweating
    • Blushing
    • Shortness of breath
    • Chest pain
    • Lightheadedness
    • Hot flashes or chills
    • Numbness or tingling
    • Nausea
    • Feeling of loss of control or "going crazy"
    • Fear of having a heart attack or dying
    Agoraphobia is also commonly associated with the following conditions:

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. Agoraphobia will be diagnosed by the type and duration of symptoms.
    You may be asked questions about your:
    • Use of alcohol and drugs
    • Mental health history
    • Family's mental health history
    There are no tests for agoraphobia or panic disorder. Your doctor may order heart or blood tests done to look for an underlying cause.

    Treatment

    Treatment aims to help you overcome irrational fears and live more independently. Goals include:
    • Reducing the number and severity of panic attacks
    • Learning to manage panic attacks that do occur
    Treatment of agoraphobia is similar to the treatment of panic disorder. Treatments may include:

    Lifestyle Changes

    Lifestyle changes may include:
    • Regular exercise
    • Getting enough sleep every night
    • Relaxation techniques, such as deep breathing, meditation, and yoga
    • Avoiding anxiety triggers, such as tobacco, caffeine, and drugs
    • Drinking alcohol in moderation
    • Awareness of stressful situations and learning how to manage it

    Social Support

    • Have a strong support system of family and friends
    • Consider family therapy to help with understanding and coping skills
    • Join a support group

    Cognitive-Behavioral Therapy

    Cognitive behavioral therapy (CBT) can help to change troublesome thought patterns. It will help you learn how you can alter your actions. The combination therapy will help you:
    • Identify and change anxious thoughts
    • Use relaxation techniques to decrease feelings of anxiety
    • Control breathing by taking slower, deeper breaths
    • Cope with physical changes associated with anxiety
    • Confront feared situations

    Exposure Therapy

    Exposure therapy exposes you to the factor causing the fear while in a safe environment. The sessions often include repeated, detailed imagining of the traumatic experience. The therapy will help people face their fear and gain control of it while it is happening. Exposure therapy methods range anywhere from a gradual approach to the fear to complete confrontation all at once.
    Exposure therapy may be done alone or in combination with other treatments.

    Medications

    Your doctor may prescribe medication as well as therapy. Medication options may include:
    • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)
    • Benzodiazepines—may cause dependence
    • Other anti-anxiety medications
    It is important to take all medications as instructed by the doctor.

    Prevention

    Agoraphobia often develops as a response to panic attacks. If you have had a panic attack, instead of avoiding the place or situation, seek medical care. Early treatment for panic attacks can help prevent agoraphobia.

    RESOURCES

    American Psychiatric Association http://www.psychiatry.org

    Mental Health America http://www.mentalhealthamerica.net

    CANADIAN RESOURCES

    Canadian Psychiatric Association http://www.cpa-apc.org

    Canadian Psychological Association http://cpa.ca

    References

    Agoraphobia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116901/Agoraphobia. Updated October 17, 2014. Accessed September 30, 2016.

    Lenders JW, Eisenhofer G, et al. Phaeochromocytoma. Lancet. 2005;20-26;366:665-675.

    Panic disorder & agoraphobia. Anxiety and Depression Association of America website. Available at: http://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia. Accessed January 26, 2016.

    Phobias. Mental Health America website. Available at: http://www.mentalhealthamerica.net/conditions/phobias. Accessed January 26, 2016.

    Symptoms. Anxiety and Depression Association of America website. Available at: http://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia/symptoms. Accessed January 26, 2016.

    What are anxiety disorders? American Psychiatric Association website. Available at: http://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. Accessed January 26, 2016.

    What is posttraumatic stress disorder? American Psychiatric Association website. Available at: http://www.psychiatry.org/patients-families/ptsd/what-is-ptsd. Accessed January 26, 2016.

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