What is Agoraphobia

Agoraphobia is the intense fear of situations that may be difficult or embarrassing to leave. People with this phobia worry that they will not be able to get somewhere safe. They often worry about having a panic attack or panic symptoms like dizziness, vomiting, loss of control, or difficulty breathing.

Sufferers usually fear large places like malls, theaters, grocery stores, or parks. They also fear large crowds or places where they feel trapped like traveling on a plane, driving in rush hour traffic, being on a bridge, or visiting the doctor. Usually, a person with agoraphobia can articulate what they fear or where they fear it. Although, sometimes they only know that they have a sense of dread.

The person will begin to avoid the situations where he or she feels uncomfortable. Agoraphobia can worsen without treatment; in some extreme cases, that person can become trapped in his or her own home because he or she is too fearful to leave. Sometimes, the person can participate in activities or travel if a trusted companion goes with him or her.

How common is Agoraphobia?

The National Institute of Mental Health estimates that 5.6% of adults develop agoraphobia and some point in their lives. It is more common among women than men and it usually begins when they are in their twenties or thirties.

Symptoms

The symptoms of agoraphobia can include:

- Fear of what might happen in a situation that is difficult or embarrassing to leave (e.g., Standing in line, being in theaters, and riding a bus)
- Fear of particular places. Elevators, bridges, malls, and expressways are common places.
- Worry about a specific symptom occurrence (e.g., Fainting, diarrhea, vomiting, and difficulty breathing)
- Avoidance of the situations or places.
- Anxiety if placed in the situation or place.
- Many of these symptoms also indicate other disorders. For instance, people may not leave their home because they are depressed and are not interested in the outside world. Professional help can evaluate for agoraphobia or other disorders.

Treatment

The main treatment for agoraphobia is a certain type of Cognitive Therapy called exposure therapy. The goal of this therapy is to get the person to confront the fear directly. With success they learn that they have nothing to fear.

The first step of this therapy is to treat Panic Disorder because most people with agoraphobia also have panic disorder. As the panic attacks disappear, the person becomes more confident about facing the situations they fear. Then the person begins exposure to the places or situations that they fear. Most therapies will start with the least feared and move up to the most feared. The exposure sessions usually last about 2 hours and occur twice a week. Daily practice without the therapist is critical.

About 75% of those treated with exposure therapy report less anxiety, improved morale, a better quality of life at home and work, expanded interests and activities, and more gratifying relationships.

Depending on the situation, some people also find that cognitive therapy, assertiveness training, biofeedback, hypnosis, meditation, relaxation, or couples therapy is helpful.

Medications

The medications used in treating agoraphobia are really for treating Panic Disorder, a common problem for people who have agoraphobia. Medications are usually taken for 6 months, then tapered off, and eventually discontinued. Medications used may include:

Antidepressants

- desipramine (Nopramin, Pertofrane)
- fluoxetine (Prozac)
- imipramine (Tofranil)
- paroxetine (Paxil)
- sertraline (Zoloft)

Bezodiazepines

- alprazolam (Xanax)
- clonazepam (Klonopin)
- larazapam (Ativan