Agorabphobia is an anxiety disorder in which the patient fears being in public places, particularly crowded ones. Agoraphobia is closely linked to panic disorder. As a matter of fact, the problem is often referred to as panic disorder with agoraphobia.
Agoraphobic patients are afraid of being in public situations, experiencing feelings of distress, and being unable to get help. Such feelings of distress might include acute embarrassment or a sensation of being trapped. In extreme cases, agoraphobia may keep patients housebound. Some patients with agoraphobia are frightened by being on bridges or being outdoors alone.
Causes of Agoraphobia
The exact causes of panic disorder and agoraphobia are unknown, but there may be a genetic link since the disorder is much more prevalent in some families than in others. Since panic attacks often reoccur in areas or situations where they have previously happened, it is believed that panic is, at least partially, a learned behavior.
Individuals of any age may develop agoraphobia, although the condition is more common after age 25 and is found more commonly in women than in men.
Symptoms of Agoraphobia
Agoraphobic panic attacks have physical, as well as psychological, symptoms. While usually of limited duration, perhaps 10 to 20 minutes, the combination of symptoms is excruciating for patients experiencing them.
Physical Symptoms of Agoraphobia
Physical manifestations of agoraphobia may be experienced in many parts of the body. Typically, symptoms include several of the following:
- Chest pain
- Shortness of breath
- Choking sensation
- Tachycardia (rapid heartbeat)
- Dizziness or feeling faint
- Chills or hot flashes
- Sweating or trembling
- Nausea of other intestinal distress
- Tingling or numbness
Psychological Symptoms of Agoraphobia
The intense anxiety or panic patients experience during an agoraphobic attack may include intense fear of:
- Losing control mentally or physically
- Becoming incompetent
- Being alone or abandoned
- Being unable to escape
In addition, patients with agoraphobia may experience intense agitation or feelings of detachment. The latter may include sensations that the environment is unreal or that they themselves are not really present.
Diagnosis of Agoraphobia
Agoraphobia may sometimes be difficult to diagnose because of its physical symptoms. In many cases, patients may be admitted to emergency rooms mistakenly believing they are having heart attacks. Often, EKGs, breathing, blood, or neurological tests may be administered to rule out physical causes of the episode. Once physical causes are ruled out, a psychiatrist may be called in to evaluate the patient from a psychological perspective.
Treatment of Agoraphobia
Agoraphobia, like other psychiatric disorders, is usually treated with a combination of psychotropic medication and psychotherapy.
Medications for Agoraphobia
Anti-anxiety medications, usually benzodiazepines, may be of great assistance in treating acute symptoms of agoraphobia and may even be able to prevent a full-fledged attack if administered at the onset of symptoms. Such medications are also prescribed to keep patients comfortable until longer acting medications are able to take effect, since the latter may take as much as a month to provide relief.
Longer acting anti-depressants known as serontonin reuptake inhibitors, or SSRIs, are usually administered to treat the condition on an ongoing basis. In some cases, another variety of anti-depressants, known as serotonin-norepinephrine reuptake inhibitors, or SNRIs, may be prescribed. In more severe cases, anti-seizural medications may also be administered.
Psychotherapy for Agoraphobia
The most difficult aspect of agoraphobia treatment may be that patients need to face their fears in order to conquer them. Usually, by combining medication with psychotherapy to reinforce their sense of safety, patients with agoraphobia can overcome their fears sufficiently to resume activities and lead normal, productive lives.
The types of therapy most frequently employed with agoraphobic patients are:
- Cognitive behavioral therapy, or CBT
- Stress management and relaxation techniques
- Systematic desensitization
- Exposure therapy
During systematic desensitization, the patient is gradually exposed (exposure therapy) to situations that have become anxiety-producing. Gradually the extent and duration of such exposure is increased as the patient learns techniques to replace fearful thoughts with reassuring ones. As with many types of disorders, early intervention is key to complete recovery, since when a patient experiences ongoing episodes of agoraphobic, the sense of panic is reinforced and harder to overcome.
Risks of Agoraphobia
Without treatment, there are risks that patients may either increasingly withdraw from situations that create discomfort for them and eventually become reclusive or that they may attempt to self-medicate with alcohol other substances. Either path may lead patients to serious substance abuse and/or to such feelings of isolation and despair that they become suicidal.