Agoraphobia

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Definition

Agoraphobia is an anxiety disorder. It is an irrational fear of being trapped in places or situations where escape is difficult. People with agoraphobia may not leave the house.

Causes

The exact cause of anxiety disorders is not known. Agoraphobia often occurs with panic disorders. People with a panic disorder may having a panic attack and not having anyone around to help them. This can lead them to avoid certain places or situations. Other factors that may contribute to the development of agoraphobia 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

Changes or genetic problems in the nervous system (brain and nerves) may contribute to agoraphobia.

Risk Factors

Factors that may increase your chance of agoraphobia include:

History of panic attacks or panic disorder
A tendency to be nervous or anxious
Stressful situations
Family members with panic disorder or phobias
Other psychiatric disorders

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

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

Agoraphobia is also commonly associated with the following conditions:

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. You may be asked questions about your:

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

There are no tests for agoraphobia or panic disorder. Your doctor may order 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

Cognitive therapy can help to change troublesome thought patterns. Behavioral therapy will help you learn how you can alter your actions. The combination therapy will help you:

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

Exposure Therapy

Exposure therapy exposes you to the factor causing the fear while in a safe environment. The sessions often include repeated, detailed imagining of the traumatic experience. The therapy will help people face their fear and gain control of it while it is happening. Exposure therapy methods range anywhere from a gradual approach to the fear to complete confrontation all at once.

Exposure therapy may be done alone or in combination with other treatments.

Medications

Your doctor may prescribe medication as well as therapy. Medication options may include:

Antidepressants
Benzodiazepines—may cause dependence
Other anti-anxiety medicines

It is important to take all medications as instructed by the doctor.

Lifestyle Changes

Stress management may also help. Lifestyle changes to manage stress include:

Get some exercise every day
Get adequate sleep
Avoid caffeine, alcohol and nicotine

Prevention

Agoraphobia often develops as a response to panic attacks. If you have had a panic attack, instead of avoiding the place or situation, seek medical care. Early treatment for panic attacks can help prevent agoraphobia.

RESOURCES

American Psychiatric Association http://www.psych.org

Anxiety Disorders Association of America http://www.adaa.org

Mental Health America http://www.nmha.org

CANADIAN RESOURCES

Canadian Mental Health Association http://www.ontario.cmha.ca/

Mental Health Canada http://www.mentalhealthcanada.com

References

Agoraphobia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated November 8, 2012. Accessed March 4, 2013.

Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005;20-26;366:665-675.

Panic Disorder & Agoraphobia. Anxiety and Depression Association of America website. Available at: http://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia. Accessed March 4, 2013.

Phobias. American Psychiatric Association website. Available at: http://www.psychiatry.org/phobias. Accessed March 4, 2013.

Phobias. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/phobias. Accessed March 4, 2013.

PTSD. American Psychiatric Association website. Available at: http://www.psychiatry.org/ptsd. Accessed March 4, 2013.

Symptoms. Anxiety and Depression Association of America website. Available at: http://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia/symptoms. Accessed March 4, 2013.

Revision Information

Reviewer: Brian Randall, MD
Review Date: 02/2013 -
Update Date: 03/04/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Kendall Regional Medical Center

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