Agoraphobia – Symptoms and causes



Agoraphobia is Greek for “fear of the marketplace.” The disorder is characterized by anxiety over finding oneself in places or situations from which escape might be difficult or embarrassing should a panic attack or panic-like symptoms occur. Agoraphobia commonly accompanies panic disorders.

People with agoraphobia typically avoid any situations in which they might experience panic. As a result, many patients spend increasing amounts of time at home and in other sheltered situations, significantly hampering their ability to work, travel, perform daily tasks and maintain interpersonal relationships. Agoraphobia tends to begin in a person’s 20s. Women are affected more often than men. The cause of this phobia remains unclear. However, genetics, biochemical factors and stress are believed to play a role in the development of agoraphobia.

Patients with agoraphobia have several treatment options. In the majority of cases, a combination of psychotherapy and anti-anxiety and antidepressant medications is the most effective treatment.

About agoraphobia

Agoraphobia is an anxiety disorder characterized by an abnormal, debilitating fear of being caught in a place or situation from which escape might be difficult or embarrassing during a panic attack. It also refers to fear of being trapped in circumstances in which medical help might not be available during such episodes. Like other phobias, agoraphobia involves irrational, involuntary fears of ordinary situations and things.

People with agoraphobia frequently avoid any situations or places in which they might experience these feelings. Examples of such scenarios might include:

  • Being outside of the home alone
  • Being in a crowd of people, or standing in a line
  • Traveling in cars, buses, trains or airplanes
  • Being on a bridge
  • Being in an elevator

Agoraphobia is closely linked with panic disorder, another type of anxiety disorder in which a person regularly experiences panic attacks – sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause symptoms such as racing heartbeat, heavy sweating, chest discomfort, shortness of breath, nausea and fear of dying. In many cases, panic disorder is actually the cause of agoraphobia. In other cases, people have agoraphobia without the presence of panic disorder, although they usually experience some panic-related symptoms (e.g., excessive sweating or racing heartbeat).

The hallmark of agoraphobia is avoidance. A person with agoraphobia avoids any potentially threatening circumstance that could cause a panic attack or other panic-inducing symptoms. For example, if a panic attack occurred in a shopping mall, the person avoids malls and perhaps other crowded areas as well.

Agoraphobia should be differentiated from several other phobia categories. A specific phobia refers to fear of a certain object or situation (e.g., a person who fears dogs avoids all dogs). Social phobia involves fear of social situations because of embarrassment or humiliation, not because of panic symptoms.

Agoraphobia tends to begin in a person’s 20s. Women are affected more often than men. The condition can substantially hamper a person’s quality of life. Some patients are able to endure certain potentially threatening situations (e.g., traveling) if they are accompanied by another person. Others may not be able to withstand threatening situations under any circumstances. Patients may find it difficult to work, socialize, travel or perform important daily tasks such as grocery shopping. People with agoraphobia may eventually experience much less anxiety by limiting their exposure to potentially threatening situations.

The term “agoraphobia” includes the Greek word “agora,” which referred to the open spaces of the ancient marketplace. Today, it can refer to any place in which anxiety or panic symptoms occurred and the person now tries to avoid. The cause of agoraphobia remains unclear. However, genetics, biochemical factors and stress are believed to play a role in the development of agoraphobia.

Signs and symptoms of agoraphobia

Symptoms of agoraphobia are often both psychological and physical in nature. Patients who have experienced a panic attack or other panic symptoms in the past may fear being trapped in similar situations where escape is difficult or where they may lose control in a public place. Psychological symptoms of agoraphobia can include:

  • Feeling agitated or short-tempered
  • Remaining homebound for long periods of time
  • State of being detached or estranged from others
  • Sense of helplessness and feeling dependent on others
  • Sense that the body and environment are unreal
  • Confused or disordered thoughts

Typically, patients will experience anxiety or panic attacks and the physical symptoms that often accompany them, such as rapid heartbeat, excessive sweating and breathing problems. Other physical symptoms include:

  • Abdominal distress
  • Chest pain
  • Dizziness
  • Trembling or twitching
  • Lightheadedness
  • Nausea and vomiting
  • Numbness and tingling
  • Skin flushing

People with agoraphobia often become frustrated and ashamed of their behavior. As a result, they are at risk for developing many other related conditions, including depression and substance abuse problems.

Diagnosis methods for agoraphobia

Before diagnosing agoraphobia, a physician should perform a complete physical examination and compile a thorough medical history to rule out any potential physical cause. If a mental disorder is suspected, the patient will be referred to a psychiatrist, psychologist or other mental health professional.

Agoraphobia will be diagnosed if the patient has symptoms consistent with agoraphobia that are not caused by another mental condition. Other mental conditions that may present with symptoms similar to those of agoraphobia include:

  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Separation anxiety disorder
  • Social phobia
  • Specific phobia

Agoraphobia frequently occurs with another condition called panic disorder. Many patients share at least some of the symptoms of both of these conditions. Patients may be diagnosed as having either panic disorder with agoraphobia or agoraphobia without history of panic disorder.

The criteria used to diagnose these two conditions are virtually identical. However there is one key exception: agoraphobia without history of panic disorder is diagnosed if the patient’s fear is focused on the potential for experiencing incapacitating or embarrassing, panic-like symptoms or attacks with limited symptoms. For example, the patient may fear having heart-related symptoms and not being able to get help. This differs from panic disorder with agoraphobia, in which the patient’s fear is centered on the possibility of full-blown panic attacks, after experiencing panic attacks. In essence, patients who are diagnosed with agoraphobia without history of panic disorder do not have a history of recurrent panic attacks. Finally, agoraphobia will not be diagnosed for conditions in which a patient’s fears are reasonable given certain medical conditions. For example, a patient who has Crohn’s disease (a chronic autoimmune disease) may fear being struck with an episode of diarrhea at an inconvenient time. This fear is normal given the patient’s circumstances.

Treatment and prevention of agoraphobia

Patients diagnosed with agoraphobia have several treatment options. In the majority of cases, a combination of psychotherapy and anti-anxiety and antidepressant medications is the most effective treatment.

Psychotherapy is likely to take the form of cognitive behavior therapy (CBT). CBT involves learning new skills to react differently to situations that typically trigger anxiety. The patient also learns to change specific actions and to use different techniques to stop harmful behavior. The patient may learn relaxation techniques, such as deep breathing, and may be gradually exposed to situations that are frightening and in which the patient can test new coping skills. Patients also learn more about negative thought patterns that increase anxiety and ways to redirect such thinking.

The use of antidepressant and anti-anxiety medications should be closely monitored. The U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in children and adolescents and all people being treated with them should be monitored closely for unusual changes in behavior. However, the benefits of such medications typically outweigh the risks. In some cases, agoraphobia may not be prevented. However, if these treatment methods are used for panic attacks or panic disorder, it may prevent or reduce the severity of agoraphobia.

Questions for your doctor about agoraphobia

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding agoraphobia:

  1. Are my symptoms indicative of agoraphobia?
  2. How is agoraphobia typically diagnosed?
  3. What is causing my agoraphobia?
  4. How is agoraphobia related to panic disorder?
  5. Do I have panic disorder?
  6. Is my agoraphobia medically dangerous?
  7. Will my agoraphobia become worse if I don’t treat it?
  8. What are my treatment options? How effective are treatments?
  9. Will I ever be able to overcome my agoraphobia?
  10. Are my children at risk of developing agoraphobia since I have the condition?
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