Agoraphobia

We all have our safe places…our home, our street, our town, our favorite shops and restaurants, the homes of our close friends and family.  These are the places we’re most familiar with, where we feel most comfortable.  Leaving these safe places to go to work, to travel, or to explore new activities takes a little effort and maybe some planning but, it's usually accomplished without significant discomfort.

But, what happens when our safe places start to shrink?  What happens when the locations in which we feel comfortable narrow, either gradually or abruptly, and our sense of being "ok" becomes limited to just a few nearby places.  Venturing outside just a few locations we’re most familiar with or maybe even just leaving our home becomes a source of stress or even panic.  This is agoraphobia, an anxiety disorder characterized by intense emotional and even physical symptoms of discomfort outside one’s range of perceived safety.  Untreated, agoraphobia typically leads to increased fear and avoidance and a severe limiting of one’s lifestyle and social relationships.

What is Agoraphobia?

In ancient Greece, “agora” meant “the marketplace,” so agoraphobia has been thought of as a fear of being in a large, open, public space.  More accurately, agoraphobia is a clinical diagnosis applied to individuals whose functioning is disrupted by severe anxiety or panic in locations and/or situations outside their usual, and often narrow, everyday routines .  

Agoraphobia is often identified by one's decreased capacity to leave one’s home due to anxiety.  It may affect an individual's capacity to travel, not just by airplane (that's a simple phobia) but by car or bus or train, too.  Even walking outside one's "safe zone" can become a trigger for anxiety.  Agoraphobia often affect's people's capacity to venture into unfamiliar locations, crowded spaces, or places that are especially loud or over stimulating, like concerts or amusement parks.  With agoraphobia, sufferers typically report  irrationally feeling "trapped" or "confined" making events like movies, business meetings, or weddings and other social occasions difficult if not impossible to tolerate.

Agoraphobia may be more or less complete.  Sometimes the anxiety it produces causes people to avoid leaving their homes altogether.  These are the most significant cases of people becoming "shut in" by their anxiety.  More commonly, however, agoraphobic symptoms cause a narrowing of activities outside one’s home, not necessarily a complete halt.  

Agoraphobia and Panic and Depression

Agoraphobia is often associated with panic disorder as individuals with agoraphobia typically cite, as their reason for staying close to home,  the previous experience of a panic attack or the fear that they will suffer a  future panic attack.  Agoraphobia may also be closely tied to depression as the severe limiting affect it can have on one’s lifestyle often results in a significant shrinking of one’s self-confidence as well as one's enjoyment and satisfaction of life.  Agoraphobia may also be linked with social anxiety as issues with self-esteem such as severe self-consciousness and fears of how one comes across in social situations can lead to panic episodes that prelude the withdrawal that defines agoraphobia.

People with agoraphobia often fear helplessness in situations in which strong anxiety, panic, or embarrassment can develop, and typically don't feel comfortable or safe in public places — especially places that are crowded.  This fear may eventually cause a person with agoraphobia to want to stay at home, indoors, at all times. If they do leave the house, they may feel that they need to have one particular person accompanying them. 

People with agoraphobia may feel:

• Afraid of spending time alone, of places where escape is difficult, or of losing control in public
• Detached or isolated from other people
• Helpless
• That their body or their environment isn't real

Agoraphobia may also lead people to depend on others (to handle their financial obligations, for example), to have a volatile temper, or to stay indoors for long periods of time.

Agoraphobia can also cause panic attacks or panic-like symptoms, which may include: (1,2,3)

• Nausea or other gastrointestinal issues, such as diarrhea
• Rapid heartbeat
• Chest pain or discomfort
• Dizziness or light-headedness
• Breathing problems
• Sweating and trembling
• Facial flushing
• A feeling of choking
• Numbness or "pins and needles" sensations 

As with other anxiety disorders, it's not clear what causes people to develop agoraphobia.

Several factors may make some people more likely to develop the condition, such as:

• Genetics Agoraphobia and other anxiety disorders sometimes run in families. Some of this relationship could be learned behavior but some may be related to genetics. (2)
• Brain structure Differences in the areas of the brain that regulate fear and anxiety may contribute to the condition, notes the NHS. (4)
• Traumatic events Physical or sexual trauma during childhood can play a role as well. (4)

How Is Agoraphobia Diagnosed?

Your doctor will make a diagnosis on the basis of your signs and symptoms, and may also conduct a physical exam or order blood tests to rule out other possible causes of your symptoms.

According to the American Psychiatric Association, to be diagnosed with agoraphobia, you need to experience intense fear that you won’t be able to leave in the event of a panic attack or a possibly embarrassing event like fainting, in at least two of the following five situations: 

·  Using public transportation

·  Being in open spaces, including parking lots, bridges, and malls

·  Being in theaters and other enclosed spaces

·  Waiting in line or being in a crowd

·  Being outside of your home alone

Prognosis of Agoraphobia

With proper treatment, often a combination of psychotherapy and medication,  people can eventually manage their anxiety, in order to feel better and function.

Duration of Agoraphobia

Without early interventions, agoraphobia can become more severe and more difficult to treat.  But effective treatment can help you function with agoraphobia. Cognitive behavioral therapy (CBT), a form of psychotherapy, typically consists of 10 to 20 sessions with a therapist over the course of several weeks. 

Agoraphobia and other anxiety disorders are generally treated with psychotherapy, such as CBT. 

CBT — which is used for a variety of psychological disorders — helps people identify, understand, and change the thoughts and behaviors that contribute to their condition. It's thought that this therapy may be more cost-effective in the long run, and better tolerated, than medication. 

                                                                                            --M. William  Futtersak, Ph.D.