Agoraphobia

Agoraphobia is an intense fear and anxiety of being in places where it is hard to escape, or where help might not be available. Agoraphobia usually involves fear of crowds, bridges, or of being outside alone.

Causes

The exact cause of agoraphobia is unknown. Agoraphobia sometimes occurs when a person has had a panic attack and begins to fear situations that might lead to another panic attack.

Symptoms

With agoraphobia, you avoid places or situations because you do not feel safe in public places. The fear is worse when the place is crowded.

Symptoms of agoraphobia include:

• Being afraid of spending time alone
• Being afraid of places where escape might be hard
• Being afraid of losing control in a public place
• Depending on others
• Feeling detached or separated from others
• Feeling helpless
• Feeling that the body is not real
• Feeling that the environment is not real
• Having an unusual temper or agitation

  Agitation

  Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.

  

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• Staying in the house for long periods

Physical symptoms can include:

• Chest pain or discomfort

  Chest pain

  Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

  

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• Choking
• Dizziness or fainting

  Dizziness

  Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...

  

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  Fainting

  Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...

   

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• Nausea or other stomach distress
• Racing heart
• Short of breath

  Short of breath

  Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air

  

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• Sweating

  Sweating

  Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...

  

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• Trembling

  Trembling

  A tremor is a type of shaking movement. A tremor is most often noticed in the hands and arms. It may affect any body part, including the head or vo...

  

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Exams and Tests

The health care provider will look at your history of agoraphobia, and will get a description of the behavior from you, your family, or friends.

Treatment

The goal of treatment is to help you feel and function better. The success of treatment usually depends in part on how severe the agoraphobia is. Treatment most often combines talk therapy with a medicine. Certain medicines usually used to treat depression may be helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. DO NOT stop taking them or change the dosage without talking with your provider.

• Selective serotonin reuptake inhibitors (SSRIs) are most often the first choice of antidepressant.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice.

Other medicines used to treat depression or medicines used to treat seizures may also be tried.

Medicines called sedatives or hypnotics may also be prescribed.

• These medicines should only be taken under a doctor's direction.
• Your doctor will prescribe a limited amount of these drugs. They should not to be used everyday.
• They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.

Cognitive-behavioral therapy (CBT) is a type of talk therapy. It involves 10 to 20 visits with a mental health professional over several weeks. CBT helps you change the thoughts that cause your condition. It may involve:

• Understanding and controlling distorted feelings or views of stressful events or situations
• Learning stress management and relaxation techniques
• Relaxing, then imagining the things that cause the anxiety, working from the least fearful to the most fearful (called systematic desensitization and exposure therapy)

You may also be slowly exposed to the real-life situation that causes the fear to help you overcome it.

A healthy lifestyle that includes exercise, enough rest, and good nutrition can also be helpful.

Support Groups

You can ease the stress of having agoraphobia by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.

Resources for more information include:

Anxiety and Depression Association of America: www.adaa.org

Freedom from Fear: www.freedomfromfear.org

Outlook (Prognosis)

Most people can get better with medicines and CBT. Without early and effective help, the disorder may become harder to treat.

Possible Complications

Some people with agoraphobia may:

• Use alcohol or other drugs while trying to self-medicate.
• Be unable to function at work or in social situations.
• Feel isolated, lonely, depressed, or suicidal.

When to Contact a Medical Professional

Call for an appointment with your provider if you have symptoms of agoraphobia.

Prevention

Early treatment of panic disorder can often prevent agoraphobia.