Agoraphobia- Definition, Causes, Treatment

Definition:
The word agoraphobia is from Greek words meaning "fear of the outdoor marketplace." Agoraphobia is the most common type of phobia/fear and it affects about 5-10% of Americans at some point within their lifetime. It is twice as common in women as in men and usually starts between the ages of 15-35.

Agoraphobia is all about the fear of being in certain types of places. Anxiety and panic attacks are the result. Fear of future anxiety or attacks can actually bring them on. Symptoms include trembling, sweating, pounding heart, jitters, fatigue, tingling in the hands and feet, nausea, a rapid pulse or breathing rate, and a sense of impending doom.

People with agoraphobia often have a hard time feeling safe in places where crowds gather such as the mall, concert and sporting event arenas, carnivals and fairs. Times Square in NYC on New Year's Eve is an extreme example of this kind of setting. Another uncomfortable situation is one where escape or exit is difficult or not practical such as being in an elevator; riding in a bus, train or airplane; or crossing a bridge. If one does have a panic attack and has to leave suddenly or receive on-site medical attention in a public place, it's viewed as "embarrassing" so people with agoraphobia tend avoid places where a quick exit is not available. A person with agoraphobia has high anxiety levels in places that are new and unfamiliar because they have no control.

Home becomes a "safe place" with some people becoming so fearful of leaving the indoors and going into their own yard.

Causes:
No one knows the exact cause of agoraphobia but there are several suspects:

Continual use of tranquilizers such as benzodiazepines can bring on agoraphobia. When benzodiazepine dependence is treated and after some time off of them, agorphobia symptoms gradually lessen.

Research has uncovered a connection between agoraphobia and difficulties with spatial orientation. A disproportionate percentage of agoraphobics become disoriented when visual cues are sparse (wide open spaces) or overwhelming (crowds). Sometimes they may be confused by sloping or irregular surfaces. In some virtual reality studies, agoraphobics on average show difficulty processing changing audiovisual data.

In the social sciences there is the approach that links the development of agoraphobia with modernity (industrialized society).

The Feminist Theory explains agoraphobia and other anxiety disorders as gendered issues. One such theory explains agoraphobia as a fear of being perceived by others as overly feminine and out of control. Just worrying about this brings on the anxiety.

Treatment-Medication:
Fighting agoraphobia includes a combination of medication and psychotherapy. Treatment is often successful. It can be overcome and kept under control.

Antidepressants and anti-anxiety medications are often prescribed. Fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft) are approved by the Food and Drug Administration to treat panic disorder and also may help agoraphobia.

Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are sometimes used to treat agoraphobia but they tend to have more side effects and more serious side effects than do SSRIs.

Benzodiazepines can help control symptoms of anxiety and panic attacks, and are often prescribed. These include alprazolam (Xanax), clonazepam (Klonopin) and others.

Anti-anxiety medications often work immediately to reduce symptoms, while antidepressants may take a couple of weeks before one starts feeling better. The doctor may suggest taking both to increase the effectiveness. You may have to try several different medications before you find one that works best for you. Don't give up if the first try doesn't work out. Even after one feels "cured," maintenance treatment may help prevent the unexpected return of symptoms, especially as you return to the outside world of crowds, less control and uncertainty.

Treatment-Psychotherapy:
Cognitive behavior therapy may help quite a bit for agoraphobia. This involves learning more about agoraphobia and panic attacks, what the triggers are, and how to control them. One also learns how to de-stress using breathing and relaxation techniques.

There is also "desensitization" which helps one safely confront the places and situations that cause fear and anxiety. Together, the doctor and patient go places, such as trips to the mall or driving around town. Baby steps - a little at a time is best. By repeatedly visiting feared places, people with agoraphobia become a little more comfortable with the situation once it's realized that the fears are not becoming reality.

Getting out to see a doctor or therapist can be a big challenge for people with agoraphobia. Therapists who treat agoraphobia know this and may offer to make house calls or meet at other "safe zones." They may also try sessions over the phone or through e-mail. Another thing that might help is to bring a trusted relative or friend to appointments who can offer companionship, comfort and help.

Here are some helpful links:

Agoraphobia Resouce Center

Anxiety & Agoraphobia Treatment Center

Anxiety Disorders Association of Ontario

Books on agoraphobia
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