Eileen Bailey on Agoraphobia

What is Agoraphobia?

Agoraphobia is one type of anxiety disorder that limits the places and situations a person feels comfortable and safe. A person with agoraphobia feels anxiety being in places where they cannot easily escape or where they do not feel they can get help should they experience a panic attack or intense anxiety symptoms. Agoraphobia is thought to develop from the fear of having a panic attack.

Fears from agoraphobia usually center around being outside alone, being in crowds or at a party, standing in line, being in a restaurant or theatre, riding public transportation such as a train or bus, being in a car, or being on a bridge. People with agoraphobia must endure situations with distress and fear or avoid situations that can cause a panic attack altogether. This can severely limit activities or a person's abilities to function on a daily basis. Often, people with agoraphobia will require another person to be with them when leaving their homes.

Agoraphobia differs from social anxiety disorder in that intense anxiety feelings are not limited only to social situations or because they are afraid of being embarrassed in public.

Symptoms

The symptoms of agoraphobia are the same as symptoms of a panic attack. They normally develop suddenly and can last up to ten minutes or longer. According to Helpguide.org, symptoms of a panic attack/agoraphobia include at least four of the following:

  • Shortness of breath
  • Feeling as if you can't breathe
  • Palpitations, rapid heart beat
  • Chest pain
  • Shaking, trembling
  • Sweating
  • Stomachache, nausea
  • Being dizzy, lightheaded or faint
  • Fear of going crazy
  • Fear of dying
  • Numbness
  • Either hot or cold flashes

What Causes Agoraphobia

While it is not known exactly what causes agoraphobia, it is considered to be a combination of genetics, life experiences and individual temperament. Some of the risk factors associated with agoraphobia include:

Genetics - Agoraphobia and panic disorder are considered to be hereditary.

Biological Reasons - Some research suggests people with agoraphobia have increased brain activity in certain portions of the brain as well as the nervous system. It is not clear, however, whether the increased activity causes the panic attack or if the panic attack causes the increased activity.

Being Female - Agoraphobia is more common in females than in males.

Nervous or Anxious Temperament - Some people tend to become more nervous than others in certain situations.

Traumatic Life Events - Extreme or traumatic events can sometimes lead to agoraphobia or panic attacks.

Diagnosis

The diagnosis of agoraphobia is normally made by a mental health professional, however, it is suggested a complete physical examination is done before a diagnosis is made. Many of the symptoms of agoraphobia, such as chest pain, are similar to symptoms of heart disease. A physical exam will rule out physical conditions.

A thorough psychological evaluation should also be conducted. This should include describing:

  • Symptoms of your panic attacks
  • When and how often you have attacks
  • How long attacks last and how intense they are

According to the Diagnostic and Statistical Manual (DSM-IV) the criteria for agoraphobia is:

A) anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.

B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.

C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).

Treatment

Treatment of agoraphobia is usually a combination of medication and behavioral therapy. Medications include anti-depressant medication and anti-anxiety medications.

The most effective type of therapy is cognitive behavioral therapy. This type of therapy includes learning about the disorder, personal triggers for attacks, and dealing with physical symptoms of a panic attack.

In addition, cognitive behavioral therapy also includes exposure therapy. A person is exposed to a trigger, in a safe environment or with a therapist. This is done slowly to help desensitize a person and allow them to be comfortable in different situations. After continually practicing feared situations, the person is able to learn new reactions and understand their fears do not come true. This type of therapy has been highly effective and the anxiety diminishes over time.

Coping Strategies

Although professional help is recommended for the treatment of agoraphobia, there are some strategies people can incorporate into their lives to help them better cope with the symptoms of a panic attack:

Relaxation techniques - Learning deep breathing, yoga, meditation or imagery has been found to be useful in coping with or preventing a panic attack.

Support groups - Many people have found that belonging to a support group helps. Being able to talk with other people that understand your symptoms can help.

Stay away from alcohol and other illicit substances - Alcohol and other illicit drugs can increase anxiety or worsen symptoms.

Take medication - If you have been prescribed medication, take it exactly as prescribed.

For more information:

Panic Disorder

Anxiety Treatment

References:

DSM-IV. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC.

Psychology Today Staff, (2002, Oct 10). Agoraphobia. Psychology Today

Smith, Melinda (2006). Panic Attacks, Panic Disorder and Agoraphobia. Helpguide.org

Frey, PhD, Rebecca (Date Unknown). Agoraphobia. Encyclopedia of Mental Disorders