Agoraphobia is a type of anxiety disorder in which you avoid situations that you're afraid might cause you to panic. You might avoid being alone, leaving your home or any situation where you could feel trapped, embarrassed or helpless if you do panic.
People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. The fears can be so overwhelming that you may be essentially trapped in your own home.
Agoraphobia treatment can be tough because it usually means confronting your fears. But with medications and psychotherapy, you can escape the trap of agoraphobia and live a more enjoyable life.
Agoraphobia is a type of phobia. 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. Commonly feared places and situations are elevators, sporting events, bridges, public transportation, shopping malls, airplanes, crowds or lines of people.
Typical agoraphobia symptoms include:
In addition, you may also have signs and symptoms similar to a panic attack, including:
When to see a doctor
Some people with agoraphobia have "safe zones," or places they can go without severe worry, especially if accompanied by a trusted friend or relative. Sometimes they may muster up the courage to go somewhere, but they still feel extremely uncomfortable.
Often, however, agoraphobia can make you feel like a prisoner in your own home. If you believe you're going to have a panic attack when you go out in public, you may indeed have one — causing a vicious cycle. The number of places you're able to go may become fewer and fewer.
Don't let agoraphobia make your world smaller. Call your doctor if you have symptoms of agoraphobia.
Agoraphobia is usually a complication of panic disorder. Panic disorder is a type of anxiety disorder in which you experience attacks of intense fear (panic attacks) that for no apparent reason trigger intense physical symptoms. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
You may develop agoraphobia when you begin to make a connection between your panic attacks and one or more situations in which those attacks have occurred. You may avoid similar situations in an attempt to prevent future panic attacks. People with agoraphobia are especially likely to avoid circumstances in which it would be difficult or embarrassing to escape if a panic attack were to occur, such as in a crowded stadium or an airplane.
In some cases, fear of having a panic attack may be so great that you may not be able to leave the safety of your home. In other cases, you may be able to overcome your fear and tolerate most situations as long as you're accompanied by a trusted companion.
Rarely, agoraphobia may occur without an accompanying panic disorder.
Agoraphobia usually starts in your late teens or early 20s, but younger children and older adults also can develop agoraphobia. Women are diagnosed with agoraphobia more often than are men.
Possible agoraphobia risk factors include:
Agoraphobia can greatly limit your life's activities. In severe cases, you may not even be able to leave your house. 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 become 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.
Preparing for your appointment
If you have agoraphobia, you may be too afraid or embarrassed to go to your doctor's office. Consider starting, instead, with a phone call to your doctor. Some health care professionals, particularly mental health experts who specialize in agoraphobia and anxiety disorders, may be able to start by meeting with you in your own home.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
For agoraphobia, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Tests and diagnosis
Agoraphobia is diagnosed based on signs and symptoms, as well as an in-depth interview with your doctor. 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 other conditions.
To be diagnosed with agoraphobia, you 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 providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
For agoraphobia to be diagnosed, you must meet these criteria:
In addition, your mental health provider will try to determine if you might have panic disorder, social phobia or another specific type of phobia, rather than agoraphobia, since these conditions have a lot in common.
Treatments and drugs
Agoraphobia treatment usually includes both medication and psychotherapy. It may take some time, but treatments can help you get better.
Your doctor is likely to prescribe one or both of the following:
Both starting and ending a course of antidepressants can cause side effects that seem just like a panic attack. For this reason, your doctor likely will gradually increase your dose at the beginning of your treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication — often over the course of a year or more after your agoraphobia symptoms are controlled.
Cognitive behavioral therapy has two parts. The cognitive part 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 symptoms, such as using breathing and relaxation techniques.
The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely face the places and situations that cause fear and anxiety. A therapist may join you on outings to help you stay safe and comfortable, such as trips to the mall or driving your car. The more you go to feared places and realize you're okay, the more your anxiety will lessen.
If you have trouble leaving your home, you may wonder how you can possibly go to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer to see you first 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 email. 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.
Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your health care professional. Although these supplements are available over-the-counter, they still pose possible health risks in some people.
For example, the herbal treatment called kava is marketed as a treatment for anxiety. Kava may reduce anxiety, but the supplement has been linked to multiple cases of severe liver damage. Several countries have banned the sale of kava due to safety concerns. The Food and Drug Administration has issued warnings about kava but hasn't banned the sale of kava in the United States.
Coping and support
Living with fear of panic attacks 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:
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.
Last Updated: 2011-04-21
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