Agoraphobia (AG) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.
The anxiety is caused by the fear that there is no way to escape or get help if intense anxiety develops. A person with agoraphobia will go to great lengths to avoid the place or situation; the presence or anticipated presence of the environment will lead to great distress. These irrational fears and reactions result in interferences with work and social life. The feelings of anxiety can become so overwhelming that the person may be unable to leave their home.
In order to be diagnosed with AG, a person must feel extreme fear and anxiety in two of the following situations:
- Being outside the home alone
- Being in a crowd or standing in line
- Being in enclosed spaces, such as a store or theater
- Being in open spaces, such as bridges, parking lots or marketplaces
- Using public transportation, such as buses, trains, planes, or ships
This fear/anxiety must be present for at least six months and occurs every time the person is confronted with the situation or place. Often a person with AG will require the presence of a friend, family member, or partner to confront the situation.
The person with AG may or may not experience a panic attack when in these environments. A person with agoraphobia may experience the following feelings:
- Detachment from others
- Loss of control
- As if their body isn’t real
- As if the environment isn’t real
No one really knows the cause of agoraphobia. Areas of the brain that control the fear response may play some role, as could genes and environmental factors, given that there is some evidence of anxiety disorders running in families. Agoraphobia also sometimes occurs after a person has had one or more panic attacks and begins to fear situations that could lead to panic attacks in the future. Other panic disorders or phobias could also play a developmental role. AG usually starts before 35 years of age and more often in women than men. Risk factors include:
- Having a tendency to be nervous or anxious
- Experiencing stressful life events such as the death of a parent, abuse, or being attacked
- Having a blood relative with agoraphobia
Treatment usually includes psychotherapy and medication. Cognitive behavioral therapy is one of the most effective forms of therapy for agoraphobia. It focuses on teaching skills to help the person gradually return to activities that were previously avoided. A person can learn:
- Fears are unlikely to come true
- Anxiety can gradually decrease if you remain in public
- What factors trigger panic symptoms and what makes them worse
- How to cope with symptoms
If a person is uncomfortable initially with coming to a therapist’s office, the first appointments can be conducted over the phone, computer, or the therapist can come to the client’s home.
Medications such as antidepressants and/or anti-anxiety drugs may also be used during treatment.