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Agoraphobia Resources

Overview

What is Agoraphobia?

Agoraphobia is an anxiety disorder where an individual fears situations where they perceive that it may be difficult or embarrassing to escape (feeling trapped), or the fear of situations where they feel that they may not have help in case of a panic attack (anxiety crisis) or symptoms similar to this. Therefore, in this context, the individual avoids such situations or endures them with intense discomfort.

Many people assume agoraphobia is simply a fear of open spaces, but it's actually a more complex condition. Someone with agoraphobia may be scared of:

  • travelling on public transport
  • visiting a shopping centre
  • leaving home

People with agoraphobia often have symptoms of a panic attack. A panic attack is an episode that may involve choking, tachycardia (fast heartbeat), dizziness, restlessness, nausea, a sense of unreality, as well as an intense fear of losing control (going crazy or dying). They may also experience these symptoms before they even enter the situation they dread. In some cases, the condition can be so severe that people avoid doing daily activities and stay inside their homes. The condition is often misunderstood as a fear of open spaces but is, in reality, more complex as agoraphobia may involve a fear of crowds, bridges or of being outside alone.

In the UK, studies suggest that agoraphobia affects between 1.5% and. 3.5% of the UK population.

What Causes Agoraphobia?

The exact cause of agoraphobia is unknown, however, there are several factors that are known to increase your risk of developing agoraphobia. These include:

  • depression
  • other anxiety disorders and/or phobias e.g. social phobia etc.
  • a history of physical or sexual abuse
  • a substance abuse problem
  • a family history of agoraphobia

Agoraphobia usually develops as a complication of panic disorder, an anxiety disorder involving panic attacks and moments of intense fear. It can arise by associating panic attacks with the places or situations where they occurred and then avoiding them.

A minority of people with agoraphobia have no history of panic attacks. In these cases, their fear may be related to issues like a fear of crime, terrorism, illness, or being in an accident.

Traumatic events, such as bereavement, may contribute towards agoraphobia, as well as certain genes inherited from your parents.

Agoraphobia is also more common in women than in men. It usually begins in young adulthood, with 20 years being the average age of onset. However, symptoms of the condition can emerge at any age.

Signs & Symptoms of Agoraphobia

People with agoraphobia are generally:

  • afraid to leave their home for extended periods of time
  • afraid of being enclosed spaces such as places where it would be difficult to escape, such as a car or elevator
  • afraid of being open spaces e.g. a bridge, a park, or a parking lot
  • afraid of being alone in social situations
  • afraid of losing control in a public place
  • detached or estranged from others
  • anxious or agitated

Agoraphobia often coincides with panic attacks. Panic attacks are a series of symptoms that sometimes occur in people with anxiety and other mental health disorders. Panic attacks can include a wide range of severe physical symptoms, such as:

  • chest pain
  • a racing heart
  • shortness of breath
  • dizziness
  • trembling
  • choking
  • sweating
  • hot flashes
  • chills
  • nausea
  • diarrhoea
  • numbness
  • tingling sensations

People with agoraphobia may experience panic attacks whenever they enter a stressful or uncomfortable situation, which further enhances their fear of being in an uncomfortable situation. They will thus begin to avoid them to prevent panic attacks or embarrassing themselves in public (known as avoidance) e.g. they may only leave the house with a friend or partner. They may order groceries online rather than going to the supermarket. When they begin to avoid these spaces, this behaviour reinforces their fears and causes their fears to increase. If they are forced to encounter these situations, they will experience intense anxiety and symptoms as outlined above.

 

 

Diagnosing Agoraphobia

Agoraphobia is diagnosed based on signs (what can be seen) and symptoms (what you subjectively feel). Your GP will ask you about your symptoms, including when they started and how often you experience them. It's very important you tell them how you've been feeling and how your symptoms are affecting you. Your GP may ask you the following questions:

  • Do you find leaving the house stressful?
  • Are there certain places or situations you have to avoid?
  • Do you have any avoidance strategies to help you cope with your symptoms, such as relying on others to shop for you?

They’ll also ask questions related to your medical history and family history as well since having a family member with agoraphobia can be a risk factor. They may also perform blood tests to help rule out physical causes for your symptoms.

In order to be diagnosed with agoraphobia, your symptoms need to meet certain criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or ICD. These are manuals often used by healthcare providers to diagnose mental health conditions.

You must feel intense fear or anxiety in two of more of the following situations to be diagnosed with agoraphobia:

  • using public transportation, such as a train or bus
  • being in open spaces, such as a store or parking lot
  • being in enclosed spaces, such as an elevator or car
  • being in a crowd
  • being away from home alone

There are additional criteria for a diagnosis of panic disorder with agoraphobia. You must have recurrent panic attacks, and at least one panic attack must have been followed by:

  • a fear of having more panic attacks
  • a fear of the consequences of panic attacks, such as having a heart attack or losing control
  • a change in your behavior as a result of the panic attacks

You won’t be diagnosed with agoraphobia if your symptoms are caused by another illness. They also can’t be caused by substance abuse or another disorder.

How Is Agoraphobia Treated?

Agoraphobia is usually treated with therapy, medication, or a combination of the two.

Therapy

Psychotherapy

Psychotherapy, also known as talk therapy, involves meeting with a therapist or other mental health professional on a regular basis. This gives you the opportunity to talk about your fears and any issues that may be contributing to your fears. Psychotherapy is often combined with medications for optimum effectiveness. It’s generally a short-term treatment that can be stopped once you’re able to cope with your fears and anxiety.

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural 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.

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.

Medications

Certain medications can help relieve your agoraphobia or panic attack symptoms. These include:

  • selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) or fluoxetine (Prozac)
  • selective serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) or duloxetine (Cymbalta)
  • tricyclic antidepressants (TCAs), such as amitriptyline (Elavil) or nortriptyline (Pamelor)
  • anti-anxiety medications, such as alprazolam (Xanax) or clonazepam (Klonopin)

Lifestyle Changes

Lifestyle changes won’t necessarily treat agoraphobia, but they may help reduce everyday anxiety. You may want to try:

  • exercising regularly to increase the production of brain chemicals that make you feel happier and more relaxed
  • eating a healthy diet that consists of whole grains, vegetables, and lean protein so you feel better overall
  • practicing daily meditation or deep breathing exercises to reduce anxiety and fight the onset of panic attacks

During treatment, it’s best to avoid taking dietary supplements and herbs. These natural remedies aren’t proven to treat anxiety, and they may interfere with the effectiveness of prescribed medications.

Prognosis of Agoraphobia

It isn’t always possible to prevent agoraphobia. Around a third of people with agoraphobia eventually achieve a complete cure and remain free from symptoms. Around half experience an improvement in symptoms, but they may have periods when their symptoms become more troublesome – for example, if they feel stressed. Despite treatment, about one in five people with agoraphobia continue to experience troublesome symptoms, however, early treatment for anxiety or panic disorders may help. With early treatment, you have a good chance of getting better. This disorder can be quite debilitating since it prevents you from participating in everyday activities. There’s no cure, but treatment can greatly relieve your symptoms and improve your quality of life.