Until recently agoraphobia was defined as a fear of open spaces. It now also includes several other related fears such as a fear of entering shops, fear of crowds and public places, or of travelling alone on trains, buses or aeroplanes. It also includes the anxiety associated with being unable to reach a place of safety (eg home) quickly.
Panic attacks are a common feature of agoraphobia. A panic attack is an unpredictable attack of intense fear and anxiety. Because panic attacks can be unpredictable, people often worry about them happening when they have to go into a public place. This can cause the person to start avoiding any situation where a panic attack might happen.
In extreme cases, people with agoraphobia may be unable to leave their home unless accompanied by another trusted person.
Agoraphobia usually begins in the late 20s and is more common in women than men, (although that may be because fewer men seek help).
Approximately 5% of adults develop agoraphobia. Agoraphobia sometimes starts suddenly and sometimes it develops slowly. Often there is no obvious cause. Without treatment, agoraphobia can continue for years and may become more severe with time.
Many agoraphobics have other phobias too. This is described as a complex phobia.
Symptoms
People with agoraphobia may experience some or all of the following symptoms when in public places:
Shaking
Rapid heart beat
Intense sweating
Chest pain
Difficulty breathing
Feelings of choking
Feeling sick (nausea)
Dizziness
Feelings of losing control
Fear of fainting
Fear of dying
It is rare for a person to have all of these symptoms at once. However, if someone experiences several of these symptoms together this suggests it is a panic attack.
In extreme cases, the symptoms can make the person flee from where they are to a place where they feel safe. This can make them avoid the situation that brought on the symptoms in the future.
Although some people with agoraphobia will feel marked anxiety or distress on leaving home or being in public places the symptoms do not develop into a panic attack.
Some agoraphobics may experience little anxiety because they can avoid the situations that cause their phobia. Agoraphobia is also linked to some other conditions like depression and obsessive-compulsive disorder.
Causes
The root cause of agoraphobia is not known.
Research studies have found that agoraphobia tends to run in families, but it is not clear if this is because of a genetic link or for some other reason
Diagnosis
A diagnosis is usually made by a healthcare professional based on a description of the symptoms. However, the following need to be considered:
The symptoms must be due to anxiety and should not be secondary to other symptoms, such as delusions or obsessions;
The anxiety should occur mainly in at least two of the following situations: crowds, public places, travelling away from home, and travelling alone; and;
Avoiding the situation where anxiety occurs must be, or have been, a prominent feature.
Treatment
Agoraphobia can be treated using drugs or by using talking treatments like cognitive-behavioural therapy (CBT), psychotherapy and group therapy.
Drug treatments
Two types of drug treatments have been shown to be effective in treating panic attacks;
Antidepressants (especially the type known as Selective Serotonin Reuptake Inhibitors - SSRI). SSRIs are the most commonly prescribed drugs for panic attacks. They usually result in an improvement in about 6-8 weeks. SSRIs should not be prescribed to the under 18s, although fluoxetine can be prescribed if specialist advice is obtained.
Benzodiazepines are only used for the short-term relief of more extreme cases as they can be addictive. Courses of the drugs are usually less than four weeks and the drug should be withdrawn gradually to avoid a rebound effect.
Non-drug treatments
There is evidence to support the use of Cognitive behaviour therapy (CBT) in treating agoraphobia and panic attacks. Cognitive behaviour therapy combines two types of psychotherapy: cognitive therapy and behaviour therapy. It is based on the theory that most emotional and behavioural responses are learned and the goal is to unlearn unwanted responses and learn new ways of reacting to situations.
Talking and sharing experiences in individual and group psychotherapy can help understanding and recovery from agoraphobia.
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