Agoraphobia

by Debra Wood, RN

Definition

Agoraphobia is an irrational fear of being trapped in places or situations where escape could be difficult or impossible. People with agoraphobia often will not leave the house. It often occurs in association with panic disorder. In this case, the affected people may fear that help will not be available in certain places in case a panic attack occurs.

Causes

The exact cause is unknown. Most people develop agoraphobia after having panic attacks. Afraid of having another attack, an agoraphobic avoids places and situations that have triggered an attack. Factors that may contribute to the development of this phobia 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

Nervous System

Risk Factors

These factors increase your chance of developing agoraphobia. Tell your doctor if you have any of these risk factors:

A tendency to be nervous or anxious
Stressful situations
Family members with panic disorder or phobias
Age: 18-35
Sex: female
Other psychiatric disorders
Personality disorder

Symptoms

Symptoms include:

Fear of being in a crowd, shopping, standing in line, or similar activities
Fear of riding in a car, bus, or train
Creation of a safe zone
Feelings of anxiety when outside the safe zone
Fear of being alone
Avoidance of situations that might cause a panic attack
Restriction of activities outside the home
Feeling of being safer with a trusted friend
Lack of interest in normal activities
Becoming homebound

Agoraphobia is commonly associated with the following:

Panic disorder
Depression
Eating disorders ( anorexia nervosa, bulimia nervosa )
Alcohol or drug abuse

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
Dizziness or 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

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may also look for a medical condition, drug, or other substance that may be causing your symptoms.

You may be asked questions about your:

Use of alcohol and drugs
Mental health
Family's mental health

There are no tests for agoraphobia or panic disorder. However, you may have 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

Treatments may include:

Cognitive-Behavioral Therapy

This therapy combines:

Cognitive therapy to change troublesome thought patterns
Behavioral therapy to help learn how you can alter your actions

This therapy helps you learn to:

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

Medications

Commonly used drugs include:

Antidepressants
Benzodiazepines or other anti-anxiety medicines
- Benzodiazepines may cause dependence. This means that withdrawal symptoms occur once the medication is stopped.

Lifestyle Changes

Avoid caffeine and nicotine. They can increase anxiety.

Prevention

Agoraphobia often develops as a response to panic attacks. Instead of avoiding places where you have had a panic attack, it is better to seek medical care. Early treatment for panic attacks can help prevent agoraphobia.