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Agoraphobia

Agoraphobia is a fear of public situations, particularly public situations that could be difficult to exit quickly or escape from. People with agoraphobia worry excessively about having a panic attack in such a situation and in extreme cases, this fear of public spaces can lead to a person becoming housebound at all times, too afraid to venture beyond the safety of the home. All people with agoraphobia limit their exposure to feared public/social situations, avoiding them completely if possible, enduring them with anxiety when absolutely necessary.

People with agoraphobia often feel less anxiety about facing a feared public situation if they can be accompanied by a trusted friend or family member.

Agoraphobia With/Without Panic Disorder

The American Psychiatric Association distinguishes between agoraphobia with and without panic disorder.

In most cases, panic disorder causes agoraphobic symptoms and the feared event is a panic attack in public. Some people with agoraphobia do not have panic disorder, and do not fear having a full blown panic attack in public, but rather fear having some symptoms of a panic attack in a public place. Examples of feared symptoms could include a loss of bladder control, dizziness or diarrhea, in public; or an excessive and unreasonable fear having a medical emergency, such as a heart attack, in a situation without medical help, such as an airplane.

What Causes Agoraphobia?

Most cases of agoraphobia begin after the experience of panic attacks. The experience of panic attacks leads to a fear of future panic attacks and to an avoidance of places or situations that are associated with panic, or that are perceived to be difficult to escape from in the event of an attack. For many agoraphobics, the world becomes a gradually smaller and more restrictive place as more and more places become “off limits”.

Who Gets Agoraphobia?

Women are twice as often afflicted with agoraphobia and the most common age of onset is during the teens or twenties, although it can develop at any age.

People who experience panic attacks or panic disorder are at a greater risk of agoraphobia, as are people who abuse drugs or alcohol.

Agoraphobia and Other Disorders

People with agoraphobia frequently endure one or more additional mental health issues. A fear of public or social events can lead to social isolation and poor performance at work or in school. Agoraphobia’s impact on quality of life can lead to other anxiety disorders, mood disorders (such as depression) and an increased risk of substance abuse.

How is Agoraphobia Treated?

Treatment for agoraphobia most typically combines medication and psychotherapy.

Medications often used include:

  • SSRIs – a class of anti depressant that are frequently a first-line choice in the treatment of agoraphobia. Examples include Paxil, Prozac and Zoloft.
  • Anti-Anxiety Medications – such as benzodiazepines, can work very well to reduce anxiety symptoms quickly, but these medications are addictive and are not often recommended for long term use.

Psychotherapy

The most frequently used psychotherapeutic technique for the treatment of agoraphobia is cognitive behavioral therapy (CBT).

Although without treatment, symptoms of agoraphobia can endure for years, the disorder is very treatable and most people show significant symptoms improvement after treatment initiation.

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