Agoraphobia (Fear of Places and Situations) : Symptoms, Causes, Diagnosis and Treatment

Agoraphobia is defined as a type of anxiety disorder that causes people to avoid places & situations that might make them feel helpless, trapped, panicked, embarrassed and scared.

A person suffering from agoraphobia often feel symptoms of a panic attack such as increased heartbeat, nausea. They might also feel these symptoms even before they enter the situation.

Sometimes, the situation can be so severe that the person avoids performing daily activities such as visiting banks, grocery stores or malls. They prefer staying at their home mostly.

The treatment of Agoraphobia depends on the severity of your condition. It might consist of therapy, medications, and lifestyle remedies.

People suffering from agoraphobia are:

• Afraid of leaving their home for long
• Afraid of being alone at a social platform
• Afraid of losing control in a public place
• Afraid of being in places where it would be difficult to escape, such as a car or elevator
• Anxious or agitated

Agoraphobia often comes with panic attacks. It could include anxiety and other mental health disorders. The symptoms include:

• Chest pain
• Increased heartbeat
• Shortness of breath
• Dizziness
• Trembling
• Choking
• Sweating
• Chills
• Hot flashes
• Nausea
• Diarrhea
• Numbness
• Tingling sensations

People with agoraphobia may experience panic attacks whenever they face a stressful or uncomfortable situation which further enhances their fear.

The exact cause of agoraphobia is not yet known. There are, however, several factors that increase your risk of developing agoraphobia. The factors including:

• Depression
• Claustrophobia and social phobia
• Anxiety disorder (Generalised anxiety disorder or obsessive-compulsive disorder)
• History of physical or sexual abuse
• Family history of agoraphobia

Agoraphobia is more common in women than in men. This phobia begins in young adulthood (above 20 years of age). Symptoms, however, can emerge at any age.

Agoraphobia can limit your life’s activities. If it is severe, you may not even be able to leave your home. Without its treatment, individuals can become housebound for years. A person may not be able to visit family or friends or may even face problems in normal daily activities. A person may feel dependent on others for help. The phobia can also lead to:

• Alcohol or drug abuse
• Depression
• Mental Disorder like anxiety disorder or personality disorder

It can begin in childhood but usually starts in the later teen or early adult age group- usually before the age of 35- but older adults can also develop. You can find agoraphobia in women more than men. The major risk factor include:

• Responding to panic attacks with excessive fear and avoidance
• Having panic disorder
• Having a blood relative with agoraphobia
• Having an nervous or anxious temperament
• Experiencing stressful life events like the death of a parent or being attacked or abused.

The diagnosis of Agoraphobia is based on symptoms and signs. Your medical practitioner will check your symptoms and ask you when it started and how often you experience them. The doctor might also ask questions related to your medical and family history as well.

The patient might suffer from intense fear or anxiety in the following situations if diagnosed with agoraphobia:

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Being in a crowd
• Being away from home alone

The patient might also have been suffered recurrent panic attacks, and at least one panic attack must have been followed by:

• A fear of having more panic attacks
• A fear of the consequences of panic attacks, such as having a heart attack or losing control
• A change in your behavior as a result of the panic attacks

It is usually treated with medication, therapy or from the combination of both. People with agoraphobia can benefit from peer group support, which can help them feel less isolated and can gain more courage to manage their anxiety and overcome fears. Always remember that agoraphobia is highly treatable. There are many types of treatment available for agoraphobia.

• Psychotherapy: Psychotherapy which is also known as talk therapy involves meeting with a therapist on a regular basis. In this therapy, you get to talk about your fears and issues that might contribute to your fears. It is generally a short-term treatment that helps you in coping with your fear and anxiety within less time.
• Cognitive Behavioral Therapy (CBT): Cognitive-behavioral therapy or CBT is the most common form of psychotherapy that helps in treating patients suffering from agoraphobia. CBT helps you in understanding the distorted feelings and views associated with agoraphobia. It also teaches you how to cope with stressful situations by replacing negative thoughts with healthy thoughts.
• Exposure Therapy: Exposure therapy helps the patient in overcoming his/her fears. In this type of therapy, you’re slowly exposed to the situations or places you fear. This helps in diminishing your fear over time.

There are certain medications that help you in relieving agoraphobia or panic attack symptoms. These include:

• Selective serotonin reuptake inhibitors, such as paroxetine (Paxil) or fluoxetine (Prozac)
• Selective serotonin and norepinephrine reuptake inhibitors, such as venlafaxine (Effexor) or duloxetine (Cymbalta)
• Tricyclic antidepressants, such as amitriptyline (Elavil) or nortriptyline (Pamelor)
• Anti-anxiety medications, such as alprazolam (Xanax) or clonazepam (Klonopin)

Lifestyle changes do not always treat agoraphobia, but they may help in reducing everyday anxiety. You are advised to:

• Exercise on a regular basis that helps in increasing the production of brain chemicals that make you feel relaxed.
• Eat a healthy diet that consists of whole grains, vegetables, and lean protein
• Practice daily meditation to reduce anxiety & fight the onset of panic attacks

It is to be mentioned that during treatment, you are advised to avoid taking dietary supplements and herbs. Steps to manage fear of places and situation.

• Educate yourself: One of the challenges to overcome the phobia is learning how to correct your irrational thoughts of some environments being unsafe with no easy way to escape. Learn how to respond to anticipatory anxiety of entering open & closed space to manage your fear.
• Find support: Check out what support is available to you in your community. In-person and online support groups can be encouraging and help to manage their anxiety about leaving their home and entering open or closed spaces. .
• Take professional help: If you find yourself avoiding open or crowded space because it may make you anxious, do not hesitate to talk to a health professional. Do not let your fear interfere with the life you want to lead and keeps you from the places you want to go.

Early treatment for anxiety and panic disorders might help in easing agoraphobia. Treatments help in preventing the phobia easier and faster. The patient is advised to not hesitate in seeking help if he/she is suspecting of suffering from agoraphobia. There is no cure for agoraphobia but treatment will surely relieve the symptoms of Agoraphobia.

Below are the ways to cope with and overcome the agoraphobia:

• Professional Help: It is a treatable condition and the health specialist will be able to review your symptoms, and can diagnose your condition and can make a treatment plan accordingly. The phobia typically develops within the first year sufferer begins having persistent and unexpected panic attacks. So, it is important to seek professional help.
• Relax yourself: Relaxation techniques are self help strategies which help alleviate your feelings of anxiety. It assists in easing tension throughout the body and relaxing any nervousness of the mind.
• Practice desensitization: It is one the popular coping technique that can be learned on your own or through therapy. It involves the use of your imagination to help overcome triggers associated with your panic attacks and anxiety feelings.
• Reduce stress: Stress can be a major source of anxiety and it is known to contribute physical and mental health problems. Stress can trigger some of your symptoms. Learn some stress management techniques to reduce your panic and anxiety symptoms.

As such there is no way to prevent agoraphobia, however, anxiety tends to increase the more you avoid situations that you fear. If you have mild fears about going to places that are safe, try to practice going to those places over and over again before you become overwhelmed.

If this is too hard to do on your own, take help from your family member or your close friend to come with you and take professional help.

It is to be mentioned that around 0.8% of American adults suffer from Agoraphobia and around 40% of cases are severe. A patient suffering from this problem can hamper their personal and professional relationship and performance at schools or colleges. It is advised to get yourself treated immediately as soon as possible.