Agoraphobia

Symptoms

A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place.

Typical agoraphobia symptoms include:

• Fear of being alone
• Fear of being in crowded places, such as in a shopping mall or sports stadium
• Fear of losing control in a public place
• Fear of being in places where it may be hard to leave, such as an elevator or train
• Inability to leave your house for long periods (housebound)
• Sense of helplessness
• Overdependence on others
• A sense that your body is unreal

In addition, you may also have signs and symptoms similar to a panic attack, including:

• Lightheadedness
• Trouble breathing
• Dizziness
• Excessive sweating
• Rapid heart rate
• Flushing
• Nausea
• Upset stomach or diarrhoea
• Chest pain
• Feeling a loss of control
• Trouble swallowing

Causes

• Many experts consider agoraphobia to be a complication of panic disorder. Panic disorder is a type of anxiety disorder characterized by frequent episodes of intense fear (panic attacks) that for no apparent reason trigger severe physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
• You may develop agoraphobia when you begin to associate your panic attacks with one or more situations in which those attacks have occurred. You may avoid similar situations in an attempt to prevent future panic attacks. People with agoraphobia are especially likely to avoid circumstances in which it would be difficult or embarrassing to escape if a panic attack occurred, such as in a crowded stadium or an airplane.
• In some cases, fear of having a panic attack may be so great that you may not be able to leave the safety of your home. In other cases, you may be able to overcome your fear and tolerate most situations as long as you're accompanied by a trusted companion.
• Rarely, agoraphobia may develop without an accompanying panic disorder. In these cases, the cause of agoraphobia isn't known.

Risk factors

Agoraphobia usually starts during late adolescence or early adulthood, but younger children and older adults also can develop agoraphobia. Between 1 and 5 percent of population develop agoraphobia during their lifetime. Women are diagnosed with agoraphobia more often than are men.

Although researchers don't know exactly what causes agoraphobia, they do know several risk factors involved, or the things that make you more likely to get agoraphobia. These risk factors may include:

• Having panic disorder
• Experiencing stressful life events, including sexual or physical abuse during childhood
• Having a tendency to be nervous or anxious
• Have an alcohol or substance abuse disorder
• Being female

How is agraphobia diagnosed

• Agoraphobia is diagnosed based on signs and symptoms, as well as a thorough psychological interview with your doctor. You may also have a physical exam. A physical exam is important because some of the signs and symptoms of a panic attack are similar to those of other conditions.
• To be diagnosed with agoraphobia, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

For agoraphobia to be diagnosed, you must meet these criteria:

• Anxiety about being in places or situations that it may be difficult or embarrassing to get out of, or in which you may not be able to get help if you develop panic-like symptoms
• Avoiding places or situations where you fear you may have a panic attack, or having great distress and anxiety in those situations

In addition, your mental health provider will try to determine if you might have panic disorder, social phobia or another specific type of phobia, rather than agoraphobia, since these all can resemble one another.

Treatments

As with many other mental disorders, agoraphobia treatment typically includes a combination of medication and psychotherapy. Treatment of agoraphobia is often successful, and you can overcome agoraphobia and learn to keep it under control.

Medications

Antidepressant and anti-anxiety medications are commonly used to treat agoraphobia and panic symptoms. You may have to try several different medications before you find one that works best for you.

Your doctor is likely to prescribe one or both of the following:

• A selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are commonly used to treat agoraphobia include fluoxetine (Prozac, Prozac Weekly), paroxetine or sertraline.
• Another type of antidepressants, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.
• An anti-anxiety medication. Also called benzodiazepines, these drugs — including alprazolam (Xanax), clonazepam and others — can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. Your doctor will weigh this risk against the potential benefit of this class of drugs.

Psychotherapy

• Several types of psychotherapy or counseling can help agoraphobia. One common therapy used is cognitive behavioral therapy.
• Cognitive behavioral therapy has two parts. The cognitive portion involves learning more about agoraphobia and panic attacks and how to control them. You learn what factors may trigger a panic attack or panic-like symptoms, and what makes them worse. You also learn how to cope with these distressing symptoms, such as using breathing and relaxation techniques.
• The behavioral portion of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely confront the places and situations that cause fear and anxiety. A therapist may accompany you on excursions to help you remain safe and comfortable, such as trips to the mall or driving your car. Through gradually practicing going to feared places, people with agoraphobia learn that the fears don't come true and that their anxiety goes away with time.
• If you have trouble leaving your home, you may wonder how you can possibly venture out to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer initial appointments in your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through e-mail. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed.

Coping

Living in fear of anxiety can make life difficult for anyone with agoraphobia, no matter how severe it is. Professional treatment of agoraphobia can help you overcome this disorder or manage it effectively so that you don't become a prisoner to your fears.

You can also take some steps on your own to cope and care for yourself when you have agoraphobia:

• Try not to avoid feared situations. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places does make them less frightening and anxiety-provoking. Family, friends and your therapist can help you work on this.
• Learn calming skills. People with agoraphobia worry excessively about losing control or having a panic attack. Working with your health care professional, you can learn skills to help calm and soothe yourself. You can practice these skills on your own, especially at the first hint of anxiety.
• Practice relaxation techniques. Meditation, yoga and imagery are among the simple relaxation techniques that may help — and you can do them in the comfort of your own home. Practice these techniques when you aren't anxious or worried and then put them into action during stressful situations.
• Reach out. Consider joining a self-help or support group, where you can connect with others who understand what you're going through.
• Avoid alcohol and illicit drugs. These can worsen your panic or anxiety symptoms.
• Take medications as directed. It may take a couple of weeks to start seeing benefits when you first start a medication, but stick it out. Also, don't stop a medication without first consulting your health care professional, as some medications can cause withdrawal-like symptoms.
• Take care of yourself. Get enough rest, eat a balanced diet and try to exercise every day.

References:

http://en.wikipedia.org/wiki/Agoraphobia

http://www.nhs.uk/conditions/Agoraphobia/Pages/Introduction.aspx

http://www.mayoclinic.com/health/agoraphobia/DS00894

http://www.medicalnewstoday.com/articles/162169.php

http://psychcentral.com/disorders/agoraphobia-symptoms/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/

http://pages.infinit.net/drnayman/agorapho.htm