Agoraphobia

What is agoraphobia?

Agoraphobia is an anxiety disorder. If you have agoraphobia, you avoid going places or doing things because you are afraid you will have no way to escape or will panic and have no help. For example, you might have an intense fear of driving, crossing bridges, or being in shopping malls. You fear the reactions, called panic attacks, that you might have in these situations. The fears can disable you. Fear can prevent you from leaving your home.

A person who has agoraphobia may also have panic disorder.

How does it occur?

The exact cause of this disorder is not known. There are several theories about why people develop this problem. It may result from having a bad experience. Scientists know that certain parts of the brain and nervous system cause the emotional and physical surge of fear. People usually develop agoraphobia sometime between their teens and mid-thirties.

About 5% of people in the US have agoraphobia sometime during their lives. Women have it 2 to 4 times more often than men. When it occurs with panic disorder, the condition tends to run in families.

What are the symptoms?

You may have agoraphobia if you often avoid going places or doing things because you are afraid that:

• you will have no way to escape
• you will have symptoms of panic such as:
  • a suddenly fast heartbeat
  • a lot of sweating
  • trembling or shaking
  • shortness of breath or a feeling that you are choking
  • chest pain
  • nausea or diarrhea
  • dizziness
  • a feeling of being detached
  • fear of going crazy, losing control, or dying
  • numbness
  • chills or hot flashes.

These feelings start suddenly and become very strong, usually within 10 minutes. The attacks are often unpredictable.

A panic attack often includes symptoms such as chest pain and shortness of breath. You may think a panic attack is actually a heart attack. If you have severe chest pain or trouble breathing, get medical treatment right away to find out the cause.

How is it diagnosed?

Your health care provider or therapist will ask about your symptoms. He or she will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

It may be hard for people with this disorder to go to see their health care provider or therapist. Some people with agoraphobia will use alcohol or drugs to try to control the anxiety. There are effective ways to treat agoraphobia.

How is it treated?

Psychotherapy

Seeing a therapist is helpful. Several types of therapy can help treat agoraphobia:

• cognitive-behavioral therapy (learning to change your response to situations that cause anxiety)
• relaxation therapy
• desensitization (practicing facing increasingly frightening situations)
• visual imagery (practicing facing a situation that causes anxiety by picturing it in your mind)
• support groups.

The treatment your provider or therapist uses may depend on how much the disorder interferes with your day-to-day life.

Medicine

Several medicines can help. Your provider will work with you to carefully select the best one for you. Some medicines are:

• antianxiety medicines such as lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and buspirone (BuSpar)
• newer antidepressant medicines such as mirtazapine (Remeron) and venlafaxine (Effexor)
• selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), escitalopram (Lexapro) and citalopram (Celexa)
• tricyclic antidepressants such as imipramine (Tofranil), desipramine (Norpramin), and clomipramine (Anafranil).

Natural and Alternative Treatments

• Herbs and Supplements. Claims have been made that certain herbal and dietary products (kava root, lemon balm, lavender, passion flower, valerian) help control anxiety problems. No herb or dietary supplement has been proven to help agoraphobia.
• Biofeedback. With biofeedback you learn to control body functions such as heart rate, blood pressure, muscle tension, or brain wave patterns. Biofeedback can help with tension and anxiety.
• Relaxation Therapies. Learning ways to relax can help make panic attacks less severe. Yoga and meditation may be helpful.
• Hypnotherapy. Hypnosis can help you learn to control anxiety symptoms and things that trigger panic attacks.

How long will the effects last?

Without treatment, agoraphobia can last many years. Sometimes it lasts a lifetime.

What can I do for myself?

• Talk about your concerns with your health care provider or therapist.
• Tell your provider about any medicine you are taking.
• Realize you are not alone and that your anxiety can be overcome. You may be able to face situations that make you anxious if someone you trust is with you.
• Join a local support group. Set up a "phone buddy" relationship with someone from your group.
• Do not use alcohol or other drugs not prescribed by your provider to try to manage anxiety.
• Avoid caffeine.
• Eat a healthy diet.
• Get regular exercise.
• Avoid the kind of shallow or rapid breathing that can be caused by anxiety. Exhale slowly and completely and breathe regularly.