Agoraphobia
Overview
The most common type of anxiety disorder, roughly 19 million Americans have one or more phobias.[1] Phobias can affect anyone, regardless of age, sex and social background.[2] Provoking anxiety and avoidance, phobias are an overwhelming, unreasonable, uncontrollable fear of something that pose’s little real danger; these intense physical and psychological reactions can affect one’s ability to function normally.[3,4]
Phobias can be divided into 2 main categories: Specific/Simple and Complex. Complex phobias tend to be more disabling than simple phobias. These usually develop during adulthood and are often associated with a deep-rooted fear or anxiety about a particular situation or circumstance.[5]
Agoraphobia is one of the two most common complex phobias (along with social phobia.) Agoraphobia involves the fear of having a panic attack in a place or situation from which escape may be hard or embarrassing.
The anxiety of agoraphobia can be so severe that it provokes panic attacks; thus those with this disorder often try to avoid the location or cause of their fear. Typically, people with agoraphobia tend to avoid crowded places like streets, crowded stores, churches, and theaters.
Examples of agoraphobia involve fear of situations such as:[6]
Being alone outside of one’s home
Being in a crowd
Traveling in a vehicle
Being in an elevator or on a bridge
Most people with agoraphobia get it after first suffering a series of panic attacks. The attacks happen randomly and without warning, and make it impossible for a person to predict what will trigger the reaction. This unpredictability of the panic causes the person to anticipate future panic attacks and, eventually, fear any situation in which an attack may happen. As a result, they avoid going into any place or situation where previous panic attacks have happened.
People with the disorder often become so disabled that they literally feel they cannot leave their homes. Others who have agoraphobia do go into potentially "phobic" situations, but only with great distress, or when accompanied by a trusted friend or family member.
People with agoraphobia may also have depression, fatigue, tension, alcohol or drug abuse problems, and obsessive disorders, making treatment crucial.[7]
Signs and Symptoms
Regardless of phobia type, common symptoms those with phobias exhibit include:[8]
An immediate feeling of intense fear, anxiety and panic when exposed to or even thinking about the source of your fear
Awareness that your fears are unreasonable or exaggerated but feeling powerless to control them
Worsening anxiety as the situation or object gets closer to you in time or physical proximity
Doing everything possible to avoid the object or situation or enduring it with intense anxiety or fear
Difficulty functioning normally because of your fear
Physical reactions and sensations, including: sweating, trembling, shaking, rapid heartbeat, tight chest or difficulty breathing
Feeling nauseated and/or upset stomach
Dizzy, lightheadedness or fainting
Children present: tantrums, clinging, crying, or refusing to leave a parent's side or approach their fear
Causes
Most cases of agoraphobia develop as a complication of panic disorder. If a person has a panic attack in a specific situation or environment, they can often begin to worry about having another panic attack. This can lead to someone beginning to feel the symptoms of a panic attack returning when they're in a similar situation or environment. To avoid such reemergence of feelings, a person may avoid that particular situation or environment.[9]
Psychological factors that increase one’s risk of developing agoraphobia include:[10]
a traumatic childhood experience, such as the death of a parent or being sexually abused
experiencing a stressful event, such as bereavement, divorce, or losing your job
a previous history of mental illnesses, such as depression, anorexia nervosa, or bulimia
alcohol misuse or drug misuse
being in an unhappy relationship, or in a relationship where your partner is very controlling.
Additionally, one can develop agoraphobia without first experiencing a panic attack. This type of agoraphobia can be triggered by a number of different irrational fears (phobias), such as the fear of:[11]
being a victim of violent crime or a terrorist attack if you leave your house
becoming infected by a serious illness if you visit crowded places
doing something by accident that will result in you embarrassing or humiliating yourself in front of others.
Diagnosis
While phobias are often not formally diagnosed, the majority of people with a phobia know their fear is extreme. Sometimes, a person will choose to simply live with a phobia, taking great care to avoid the object or situation they are afraid of. However, as a phobia cannot be overcome in this manner, the continual avoidance tends to result in a worsened situation.[12,13]
A physician or mental health professional (e.g., psychiatrist or psychologist) can make a formal diagnosis of a phobia based on specific criteria in the DSM-5. This typically occurs when the specific fear interferes with one’s daily activities of school, work, or home life or is excessively upsetting.[14]
Complications
Phobias can be devastating, leading to problems that affect many aspects of life. If untreated, phobias can cause:[15]
Social isolation - Avoiding places and things one fears can cause academic, professional and relationship problems. Children with phobias are at risk of academic problems and loneliness, and may have trouble with social skills if their behaviors significantly differ from their peers.
Mood disorders - Many people with specific phobias have depression as well as other anxiety disorders.
Substance abuse - The stress of living with a severe specific phobia may lead to abuse of drugs or alcohol.
Treatment
The majority of phobias can be successfully treated and cured.[16] Generally, cognitive behavioral therapy (CBT) is the primary treatment for phobias and is usually considered a short-term treatment. CBT focuses on teaching a person the specific skills to better tolerate anxiety, directly challenge their worries and gradually return to the activities they have avoided due to their anxiety. Through this process, symptoms improve as one builds on their initial success. While medication is not usually used to treat phobias, it may be prescribed to help people cope with the effects of anticipatory anxiety.[17]
Treating complex phobias often takes longer than treating specific phobias and typically involves psychotherapy, particularly CBT.[18] In cases of agoraphobia, medication is often used during treatment. Antidepressants are typically more effective than anti-anxiety medications in the treatment of this disorder.[19]
Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants may also effectively treat agoraphobia.
Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, doctors may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs are not a good choice if one has had long-term problems with anxiety or problems with alcohol or drug abuse.
Self-Help Techniques
In addition to cognitive behavioral therapy (and medication at the direction and supervision of one’s physician), a person suffering from phobias may wish to incorporate the following self-help techniques into their routine:[20]
Relaxation Techniques – A series of physical exercises that can help someone relax and have better control over their breathing, particularly during an anxiety or panic attack.
Visualization – This combines relaxation and breathing techniques mentioned above with the mental visualization of how one will successfully deal with a situation that could cause anxiety.
Self-Help Groups and/or Group Therapy – Meeting others with similar experiences and sharing ways of coping can provide enormous support for those suffering from phobias.
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
References
1 “Phobias,” Johns Hopkins Medicine. (accessed 2-22-2022). www.hopkinsmedicine.org/health/conditions-and-diseases/phobias
2 “Overview – Phobias,” NHS. (accessed 2-23-2022). www.nhs.uk/mental-health/conditions/phobias/overview/
3 “Specific Phobias,” Mayo Clinic. (accessed 2-22-2022). www.mayoclinic.org/diseases-conditions/specific-phobias/symptoms-causes/syc-20355156
4 Johns Hopkins Medicine.
5 “Overview – Phobias,” NHS.
6 Johns Hopkins Medicine.
7 Ibid.
8 “Specific Phobias,” Mayo Clinic.
9 “Causes – Agoraphobia,” NHS. (accessed 4-19-2022). www.nhs.uk/mental-health/conditions/agoraphobia/causes/
10 Ibid.
11 Ibid.
12 “Overview – Phobias,” NHS.
13 Johns Hopkins Medicine.
14 Ibid.
15 “Overview – Phobias,” NHS.
16 Ibid.
17 Ibid.
18 Ibid.
19 “Agoraphobia,” Mayo Clinic. (accessed 2-23-2022). www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993
20 “Self Help – Phobias,” NHS. (accessed 2-23-2022). www.nhs.uk/mental-health/conditions/phobias/self-help/