Reviewed by Lauren Guilbeault
Agoraphobia is a form of anxiety disorder. In Greek, the word agora means "fear of the marketplace," and someone dealing with the condition will often feel extremely nervous about being trapped in certain states (like public places or areas where crowds gather) where escape may be challenging, or help would be impossible if they suffer panic.
People often think agoraphobia is a fear of open spaces, but the condition is far more convoluted. Movie theaters, long queues in banks and stores, and buses or subways are instances of situations that may trigger anxiety in people with agoraphobia. Eventually, they avoid those situations altogether or only visit with someone they feel safe and comfortable with. In extreme cases, the person stays at home all the time, afraid to go anywhere in public.
It is normal for people to be concerned about their safety when using public transportation or getting through a crowded grocery store. However, some people suffer extreme anxiety and worry when they get caught in public spaces where escape is nearly impossible. They may dread having to stand in a queue or experience unrest when they sit in a crowded movie theater. This fear of open places or fear of crowns makes the person agoraphobic. Consequently, they put restrictions around their lives as they start to avoid the places that induce panic. They resort to isolation from others and shun experiences they previously enjoyed.
Agoraphobia often starts after someone experiences a panic attack or extreme anxiety in a particular situation. Even if they got through the attack, they might eventually become overwhelmed with concern that the event will reoccur. Agoraphobia is more prevalent in women than men and is more common with middle-aged, divorced or widowed, or financially challenged individuals. It affects about 7 percent of women ad 4 percent of men. It also tends to affect people with panic disorder – 50 percent of people with panic disorder also have agoraphobia.
Essentially, agoraphobia causes people to avoid places and situations that might make them feel helpless, trapped, embarrassed, panicked, and scared. People with agoraphobia usually experience signs of a panic attack, such as rapid heartbeat and nausea when they get into stressful conditions. They may even start noticing the symptoms even before they experience the conditions they fear. Sometimes, it gets so bad that the person may avoid performing their daily tasks.
According to the National Institute of Mental Health (NIMH), an estimated 0.8 percent of people in the united states have agoraphobia. About 40 percent of such cases are categorized as severe. When the condition gets more severe, agoraphobia can be quite incapacitating. People with agoraphobia sometimes understand that their fear is irrational, but they cannot help the situation. This may adversely affect their personal relationships and output at work or in school.
Diagnosing The Types Of Agoraphobia
Diagnosing agoraphobia is primarily based on symptoms. At first, the mental health professional will perform a comprehensive evaluation of the signs and symptoms by having the patient complete questionnaires or interviews. A physical exam or other related lab tests may be required sometimes to eliminate the chances of panic-related symptoms (including substance use or hyperthyroidism). Some of the types of agoraphobia include
- Fear of using public transportation
- Fear of open spaces
- Fear of enclosed places
- Fear of being outside the house alone
- Fear of crowds or standing in line
Patients need to experience at least two or more of these situations for an accurate diagnosis of agoraphobia. Also, the symptoms need to have been present for at least six months for the diagnosis.
Causes Of Agoraphobia
While the precise cause of agoraphobia is not completely known, experts' opinion is that certain brain centers that are linked with a fear response may play a great part. Furthermore, genetic factors may be a contributor because people who have a family member with agoraphobia are at increased risk of developing the condition.
People who suffer from phobias like panic disorder (a form of anxiety disorder) are also more likely to develop agoraphobia. However, the information from the diagnostic and statistical manual of mental disorders, panic disorder, and agoraphobia are distinct and are no longer related. This adjustment was necessary because many people with agoraphobia do not experience signs of panic.
Agoraphobia may happen after a certain stressful life event, such as the death of a family member or loved one, a relationship breakup, attack, or abuse. Also, people with anxious or nervous personalities are more prone to becoming agoraphobic.
Signs And Symptoms Of Agoraphobia
As mentioned earlier, getting a diagnosis for agoraphobia requires experience at least two or more forms of the condition. People tend to avoid certain places or conditions where they have experienced panic attacks before. The fear is usually blown out of proportion compared to the actual nature of the adverse condition. It persists for six months or more, causing a decline in quality of life and the person's ability to undertake day-to-day tasks.
In situations where a person suffers both agoraphobia and panic disorder, they may experience abrupt, highly severe panic attacks for a brief period. The fear of experiencing another panic attack stops the person from being caught in the same situation or place where the attack occurred before.
Agoraphobic patients who suffer panic attacks often experience rapid heart rate, chest pain, breathing difficulties, diarrhea, excessive sweating, or dizziness. They may also feel like they have lost control and become afraid of death. In most situations, patients are wary of leaving their places of comfort due to anticipation of anxiety. For those with severe anxiety, patients may suffer low confidence levels, low self-esteem, and depression.
Treatment Of Agoraphobia
There are different forms of treatments for agoraphobia. Patients will often require a combination of treatment methods:
Psychotherapy: also called talk therapy, psychotherapy entails talking to a therapist or a mental health professional regularly. This presents patients the chance to discuss their fears and other problems that may be contributing to anxiety. The therapist will work with patients to help them learn effective and practical skills to manage anxiety-related signs. Psychotherapy is usually recommended with medications for maximum effectiveness. It is often a short-term treatment that can stop after the patient learns how to cope with their fears and anxiety.
Cognitive Behavioral Therapy (CBT): This is the most popular type of psychotherapy used to treat those dealing with agoraphobia. CBT can help patients make sense of the convoluted feelings and outlook related to agoraphobia. It can also help them learn to handle stressful situations by substituting distorted thoughts with healthy ones, helping them regain control of their lives. Short-term therapy helps patients learn skills to improve thought patterns, behavioral patterns, and the ability to surmount the challenge presented by places or situations that cause agoraphobia. They can also learn social skills to help their social interactions.
There are two forms of CBT – cognitive and exposure therapy. Cognitive therapy aims to recognize, challenge, and eventually overcome the underlying factors responsible for agoraphobia; on the other hand, exposure therapy helps patients learn to slowly lower their anxiety level by staying in stressful places or situations. It helps patients adjust the activities that they used to avoid due to anxiety. Patients are gently and gradually exposed to their fear until the fear reduces significantly over time. Exposure therapy is sometimes done with relaxation exercises, self-esteem therapy, and counseling for more efficiency. CBT may be provided to a patient or a set of patients experiencing the same condition. A therapist may also give patients tasks to attempt between the training sessions.
Medications for Agoraphobia
Aside from psychotherapy, mental health professionals recommend medications to lower the severity of symptoms. However, the medications may interact with some substances such as caffeine, over-the-counter cold and flu drugs, and some herbal solutions. Some medications are linked to dependence, so they should only be considered for short-term use to manage anxiety and optimize psychotherapy treatment. Therefore, before using the medications, patients should have a conversation with their doctor about their health history and the current routine medicines they may use for other medical conditions.
To get the best effect from medicines, physicians need to work with their patients to select the proper medicine, dosage, and treatment length. Because drugs' efficacy varies from patient to patient, physicians may prescribe multiple drugs before choosing the correct one. Due to certain medications' adverse effects, doctors usually opt to begin with a low drug dose and slowly increase it until they reach the optimal dose. An alternating treatment plan is typically more effective than a continuous plan to decrease the risk of drug resistance.
The psychiatric medications that are usually recommended include anti-anxiety and antidepressant meds and beta-blockers. Anti-anxiety drugs are often prescribed to lower anxiety-related signs, severe fear, and panic attacks. However, overuse of these medications can cause the body to develop resistance or tolerance; drug dependency may also occur. In such situations, a noteworthy increase in drug dose will be necessary to achieve a significant effect. Beta-blockers are primarily used to treat the physical signs of a panic attack such as breathing difficulties, rapid heart rate, or choking.
Antidepressant meds such as serotonin-norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors are prescribed to treat anxiety-related symptoms and depression. These drugs help regulate the level and activity of specific brain chemicals that play a major role in regulating emotional behaviors. Patients below the age of 25 years may develop suicidal thoughts when they start using antidepressants. Therefore, the patient needs to be observed closely, especially in the first few weeks of treatment.
Lifestyle changes are not exactly agoraphobia treatments but may effectively reduce anxiety in day-to-day routines. Besides medical intervention, certain self-help techniques can reduce the severity of the symptoms and improve treatment effectiveness. Lifestyle adjustment tips include:
- Regular exercises help to increase the release of brain chemicals that induce happy feelings and relaxation.
- Getting good sleep and eating a healthy diet that includes whole grains, lean protein, vegetables to improve wellness
- Relaxation methods such as daily meditation, yoga, hypnotherapy, and breathing exercises can help lower anxiety and control panic attacks.
- During treatment, it is better to stay off dietary supplements and herbs. These natural solutions are not scientifically proven as treatments for anxiety and may inhibit prescribed drugs' effectiveness.
When treatment is ongoing, patients must adhere to the treatment routine and avoid the places or situations that cause panic. It is advisable to stay off alcohol, caffeine, or other illicit substance that can aggravate anxiety symptoms. Because hyperventilation or rapid breathing often occurs with a panic attack, making attempts to slow down breathing can reduce the signs of a panic attack. Different in-person and online support groups can help connect patients with similar conditions. These groups can be a platform to discuss personal experiences and coping methods.
To improve exposure therapy's efficiency, a person should begin to face the fearful condition, slowly in a controlled manner. It is better to start with situations that cause the least fear and be accompanied by a trusted person or a professional until the fear wanes. This technique is known as desensitization. Practicing this regularly can help patients cope with the condition and restore confidence.
The Bottom Line
If you think you have agoraphobia, you should take an assessment test and receive treatment as soon as possible. Treatment can help to control the symptoms and help to handle situations better. Depending on the extent of the condition, treatment may include therapy, medications, and lifestyle adjustments.
Preventing agoraphobia may not always be practical. However, early intervention for anxiety or panic disorders may be helpful. Patients have a better chance of getting better with treatment. Also, treatment is convenient and quicker when it begins early. Therefore, if you think you have agoraphobia, ensure you seek help immediately. The disorder can be quite disturbing since it may stop you from living an active lifestyle. There is no cure, but treatment can significantly reduce the symptoms and improve the quality of life.