About agoraphobia

What is agoraphobia?

Agoraphobia is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating.

  • Like other phobias, agoraphobia often goes unreported, probably because many phobia sufferers find ways to avoid the situations to which they are phobic.
  • Agoraphobia often occurs in combination with panic disorder.
  • Agoraphobia occurs alone in less than 1% to almost 7% of the population, more often in girls and women compared to boys and men.
  • There are a number of theories about what can cause agoraphobia, including a response to repeated exposure to anxiety-provoking events or a reaction to internal emotional conflicts.
  • As with other mental disorders, a number of factors usually cause agoraphobia, it tends to run in families, and for some people, there may be a clear genetic factor involved in its development.
  • Symptoms of agoraphobia include anxiety and subsequent avoidance of being in a situation in which one will have a panic attack, when in a situation from which escape is not possible, or is difficult or embarrassing.
  • The panic attacks associated with agoraphobia, like all panic attacks, may involve intense fear, disorientation, rapid heartbeat, dizziness, or diarrhea.
  • The situations that people with agoraphobia avoid and the environments that cause people with balance disorders to feel disoriented are sometimes quite similar, leading some cases of agoraphobia to be classified as vestibular function agoraphobia.
  • Agoraphobia tends to begin by adolescence or early adulthood.
  • Suffering from virtually any other anxiety disorder increases the risk of developing agoraphobia.
  • Symptoms of agoraphobia should be treated when the signs and symptoms of the associated anxiety are not easily, quickly, and clearly relieved.
  • Physicians often diagnose and treat agoraphobia when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought.
  • To diagnose agoraphobia, the treating psychiatrist or other physician will usually take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. The presence of any medical condition or other emotional problem will be considered.
  • Cognitive behavioral therapy and exposure therapy are the most effective psychotherapies that treat agoraphobia.
  • Medications like SSRIs, beta-blockers, and benzodiazepines most commonly treat agoraphobia. The risk of overdose, addiction, or need for increasingly higher doses make benzodiazepines a less desirable treatment for agoraphobia.
  • Agoraphobia increases the likelihood that the person will also suffer from another anxiety disorder and that both conditions will be more severe and difficult to treat.
  • Agoraphobia tends to occur more often in individuals who have a number of different physical conditions.
  • If left untreated, agoraphobia may worsen to the point where the person's life is seriously affected by the disease itself and/or by attempts to avoid or conceal it.

What is the definition of agoraphobia?

A phobia is generally defined as the severe, unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. The definition of agoraphobia is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating.

Phobias are largely underreported and underdiagnosed, probably because many phobia sufferers find ways to avoid the situations to which they are phobic. The fact that agoraphobia often occurs in combination with panic disorder makes it even more difficult to track how often it occurs. Other statistics about agoraphobia include that researchers estimate it occurs from less than 1% to almost 7% of the population. Its age of onset is most often during the mid to late 20s.



What are the symptoms for agoraphobia?

Typical agoraphobia symptoms include Fear of:

  • Leaving home alone
  • Crowds or waiting in line
  • Enclosed spaces, such as movie theaters, elevators or small stores
  • Open spaces, such as parking lots, bridges or malls
  • Using public transportation, such as a bus, plane or train

These situations cause Anxiety because you Fear you won't be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

In addition:

  • Fear or Anxiety almost always results from exposure to the situation
  • Your Fear or Anxiety is out of proportion to the actual danger of the situation
  • You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed
  • You experience significant distress or problems with social situations, work or other areas in your life because of the fear, Anxiety or avoidance
  • Your phobia and Avoidance usually lasts six months or longer

Panic disorder and agoraphobia

Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of Anxiety disorder in which you experience sudden attacks of extreme Fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you're totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Signs and symptoms of a panic attack can include:

  • Rapid heart rate
  • Trouble Breathing or a feeling of choking
  • Chest pain or pressure
  • Lightheadedness or dizziness
  • Feeling shaky, numb or tingling
  • Excessive sweating
  • Sudden flushing or chills
  • Upset stomach or diarrhea
  • Feeling a loss of control
  • Fear of dying

When to see a doctor

Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.

Don't let agoraphobia make your world smaller. Call your doctor if you have signs or symptoms listed above.



What are the causes for agoraphobia?

Biology — including health conditions and genetics — temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.



What are the treatments for agoraphobia?

Interestingly, physicians often diagnose and treat agoraphobia, like other phobias, when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought. As with other mental disorders, there is no single, specific test for agoraphobia. The primary-care doctor or psychiatrist will take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. If someone has another medical condition that he or she knows about or there has been exposure to a medication, drug of abuse or other substance, there may be an overlap of signs and symptoms between the old and the new conditions. Just determining that anxiety does not have a physical cause does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, and/or other mental-health professional.

In order to establish the diagnosis of agoraphobia, the professional will likely ask questions to ensure that the anxiety of the sufferer is truly the result of a fear of being in situations that make it impossible, difficult, or embarrassing to escape rather than in the context of another emotional problem (for example, fear of being near people that remind one of an abuser in the case of posttraumatic stress disorder or the fear of hearing voices that have no basis in reality as occurs in schizophrenia). The evaluator will also seek to determine if the symptoms of agoraphobia have occurred most times that the sufferer has been exposed to the previously described anxiety-provoking situations over at least a six-month period.

 



What are the risk factors for agoraphobia?

Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors for agoraphobia include:

  • Having panic disorder or other phobias
  • Responding to panic attacks with excessive fear and avoidance
  • Experiencing stressful life events, such as abuse, the death of a parent or being attacked
  • Having an anxious or nervous temperament
  • Having a blood relative with agoraphobia



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