Agoraphobia

Definition

The word agoraphobia is derived from Greek words literally meaning "fear of the marketplace." The term is used to describe an irrational and often disabling fear of being out in public.

Description

Agoraphobia is just one type of phobia, or irrational fear. People with phobias feel dread or panic when they face certain objects, situations, or activities. People with agoraphobia frequently also experience panic attacks, but panic attacks, or panic disorder, are not a requirement for a diagnosis of agoraphobia. The defining feature of agoraphobia is anxiety about being in places from which escape might be embarrasing or difficult, or in which help might be unavailable. The person suffering from agoraphobia usually avoids the anxiety-provoking situation and may become totally housebound.

Causes and symptoms

Agoraphobia is the most common type of phobia, and it is estimated to affect between 5-12% of Americans within their lifetime. Agoraphobia is twice as common in women as in men and usually strikes between the ages of 15-35.

The symptoms of the panic attacks which may accompany agoraphobia vary from person to person, and may include trembling, sweating, heart palpitations (a feeling of the heart pounding against the chest), jitters, fatigue, tingling in the hands and feet, nausea, a rapid pulse or breathing rate, and a sense of impending doom.

KEY TERMS

Benzodiazepines— A group of tranquilizers often used to treat anxiety.

Desensitization— A treatment for phobias which involves exposing the phobic person to the feared situation. It is often used in conjunction with relaxation techniques.

Phobia— An intense and irrational fear of a specific object, activity, or situation.

Agoraphobia and other phobias are thought to be the result of a number of physical and environmental factors. For instance, they have been associated with biochemical imbalances, especially related to certain neurotransmitters (chemical nerve messengers) in the brain. People who have a panic attack in a given situation (e.g., a shopping mall) may begin to associate the panic with that situation and learn to avoid it. According to some theories, irrational anxiety results from unresolved emotional conflicts. All of these factors may play a role to varying extents in different cases of agoraphobia.

Diagnosis

People who suffer from panic attacks should discuss the problem with a physician. The doctor can diagnose the underlying panic or anxiety disorder and make sure the symptoms aren't related to some other underlying medical condition.

The doctor makes the diagnosis of agoraphobia based primarily on the patient's description of his or her symptoms. The person with agoraphobia experiences anxiety in situations where escape is difficult or help is unavailable-or in certain situations, such as being alone. While many people are somewhat apprehensive in these situations, the hallmark of agoraphobia is that a person's active avoidance of the feared situation impairs his or her ability to work, socialize, or otherwise function.

Treatment

Treatment for agoraphobia usually consists of both medication and psychotherapy. Usually, patients can benefit from certain antidepressants, such as amitriptyline (Elavil), or selective serotonin reuptake inhibitors, such as paroxetine (Paxil), fluoxetine (Prozac), or sertraline (Zoloft). In addition, patients may manage panic attacks in progress with certain tranquilizers called benzodiazepines, such as alprazolam (Xanax) or clonazepam (Klonipin).

The mainstay of treatment for agoraphobia and other phobias is cognitive behavioral therapy. A specific technique that is often employed is called desensitization. The patient is gradually exposed to the situation that usually triggers fear and avoidance, and, with the help of breathing or relaxation techniques, learns to cope with the situation. This helps break the mental connection between the situation and the fear, anxiety, or panic. Patients may also benefit from psychodynamically oriented psychotherapy, discussing underlying emotional conflicts with a therapist or support group.

Prognosis

With proper medication and psychotherapy, 90% of patients will find significant improvement in their symptoms.

Resources

PERIODICALS

Forsyth, Sondra. "I Panic When I'm Alone." Mademoiselle April 1998: 119-24.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. 〈http://www.psych.org〉.

Anxiety Disorders Association of America. 11900 Park Lawn Drive, Ste. 100, Rockville, MD 20852. (800) 545-7367. 〈http://www.adaa.org〉.

National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. 〈http://www.nimh.nih.gov〉.

Agoraphobia

What Is Agoraphobia?

What Causes Agoraphobia?

What Are the Symptoms of Agoraphobia?

How Is Agoraphobia Treated?

Resources

Agoraphobia (a-go-ra-FO-bee-a) is an anxiety disorder that involves intense fear of having a panic (PA-nik) attack and avoidance of situations that a person fears may trigger a panic attack, such as leaving the home or being in a crowd. The effort to avoid such situations may greatly limit a person’s life.

KEYWORDS

for searching the Internet and other reference sources

Anxiety

Anxiety disorders

Fears

Panic attack

Phobia

In Greek, the word agoraphobia means “fear of the marketplace.” In English, the term is used to describe a disabling disorder that often leads people to fear being in crowds, standing in lines, going to shopping malls, or riding in cars, buses, or subways. In its most extreme form, the disorder can make people afraid of traveling beyond their neighborhoods or even stepping outside their homes. Put simply, agoraphobia is a fear of fear.

What Is Agoraphobia?

Agoraphobia refers to an intense, unreasonable, and long-lasting fear (a phobia) of panic attacks and avoidance of situations in which a panic attack might arise. A panic attack is a sudden surge of overwhelming terror that occurs unexpectedly and without good reason. The person is actually in no real danger. Although it is harmless, a panic attack can cause upsetting psychological symptoms, such as a feeling of unrealness and a fear of losing control, as well as unpleasant physical symptoms, such as a racing heart, sweating, trembling, shortness of breath, chest pain, upset stomach, and dizziness. People with agoraphobia have experienced panic attacks and are fearful about experiencing more attacks.

Charles Darwin, Agoraphobic

Charles Darwin (1809-1882), father of the theory of evolution, is one of the best-known figures in the history of science. Many people do not know, however, that Darwin suffered for much of his adult life from a strange illness that greatly limited his activities. Two modern scientists, writing in the Journal of the American Medical Association, suggested that this illness might have been agoraphobia. This would partly explain Darwin’s lonely lifestyle and his trouble meeting with other people and speaking before groups.

People with agoraphobia may limit themselves to being in places they think of as safe. Any movement beyond this safety zone leads to mounting worry and nervousness. They may worry about whether they could quickly escape from a certain place if they should begin to have a panic attack there. People with agoraphobia often avoid being on busy streets or in crowded classes or stores for fear that they might feel trapped if they start to have a panic attack. Gradually, the places that feel “safe” become fewer and fewer. Some people reach the point where they are too frightened even to leave their homes. Others still go out, but it causes great distress, and they may insist that family members or friends go with them. Such self-imposed limits can make it difficult for people to get on with their lives at school and work.

What Causes Agoraphobia?

Most people with agoraphobia experience the disorder after first having one or more panic attacks. Panic attacks usually strike unexpectedly, which makes it difficult for people to predict which situations will trigger them. This lack of predictability prompts people to worry about when the next attack will occur. It also teaches them to fear situations where attacks have happened in the past, even if this fear is unreasonable. As a result, people may begin avoiding such situations. Over time, avoidance actually can reinforce the person’s phobia, making the condition worse.

What Are the Symptoms of Agoraphobia?

Agoraphobia typically starts between the ages of 18 and 35. Two-thirds of those affected are women. Most people with agoraphobia also have panic disorder, which means that they have repeated, unexpected panic attacks. A few do not have full-blown attacks, but they have similar symptoms of panic. Someone with agoraphobia may catastrophize (imagine the worst) about what could happen to them if they left home. For example, they may be afraid to leave home because they fear becoming dizzy, fainting, and then being left helpless on the ground. Without treatment, agoraphobia can cause misery for years.

How Is Agoraphobia Treated?

About one-third of people with panic disorder eventually go on to have agoraphobia, too. Treatment of panic disorder can help prevent agoraphobia. Once agoraphobia has set in, people still may be helped by the same kinds of medications and therapy used to treat panic disorder. People with agoraphobia may be helped by exposure therapy (a type of behavior therapy), in which they gradually are put in situations that frighten them until the fear begins to fade. Some therapists go to people’s homes for the first few sessions, because someone with agoraphobia may not feel able to get to the therapist’s office. Therapists who do exposure therapy also teach coping skills to help with anxiety. Exposure therapy may involve taking patients on short trips to shopping malls or other places that the patients have been avoiding. As people begin to spend more and more time in feared situations, using coping skills instead of avoidance, they may learn that they can handle their feelings after all.

See also

Anxiety and Anxiety Disorders

Panic

Phobias

Therapy

Resources

Organizations

Anxiety Disorders Association of America, 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. This nonprofit group promotes public awareness of agoraphobia and related disorders. Telephone 301-231-9350 http://www.adaa.org

Anxiety Disorders Education Program, National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. This government program provides reliable information about agoraphobia and related disorders. Telephone 888-8ANXIETY http://www.nimh.nih.gov/anxiety

KidsHealth.org is a website sponsored by the Nemours Foundation, created and maintained by the medical experts at A. I. duPont Hospital for Children, Wilmington, DE. It posts articles and information for kids, teens, and parents on a range of emotional concerns. http://www.KidsHealth.org

ag·o·ra·pho·bi·a / ˌagərəˈfōbēə/ • n. extreme or irrational fear of crowded spaces or enclosed public places. DERIVATIVES: ag·o·ra·pho·bic / -ˈfōbik/ adj. & n. ag·o·ra·phobe / ˈagərəˌfōb/ n.

agoraphobia morbid dread of public places. XIX. — modL., irreg. f. Gr. agorā́ (place of) assembly, market-place; see PHOBIA.

agoraphobia (ag-er-ă-foh-biă) n. a morbid fear of public places and/or of open spaces. See also phobia.

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