04 March 2009

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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12 comments:

  1. Hi :)
    Interesting subject !
    I think I may have it in a mild form.
    I've only become like it over the last couple years, as a result of resigning from my job a, being stuck in a house most of time suffering from chronic pain, living in a lonely town, and from lack of interaction with people.
    It is very overwhelming to suffer with!
    My husband will try to take me out for a drive on the weekends, but if there's no houses in sight (and usually there isn't around many once we leave our town), I start to freak out ! :(
    It's happened quite a few times. I even had a really scary panic attack a few days ago when my parents drove me to the shops in nearby bigger town to ours. It happened while I was in the car with them :(
    I am on mild antidepressants for my tinnitus, and when I first went on them I was less anxious. But I think I am getting used to them now, and maybe they aren't as effective.
    I am also phobic of being in lifts. I will use the stairs instead, not that is bad for me, exercise wise, but I have a spine problem and shouldn't use be going up them.
    I don't have access to support groups or therapy where we live and I don't drive too far these days, so I just try to cope with it as best as i can ,and try not to allow myself to get any worse with it.
    In fact we are going away for a couple days over this coming weekend, and I am starting to get anxious about being out and driving to where we are staying, but I know I have to do it, just to get myself out of the house !
    Thank you for all the information, it is very helpful ! I don't intend to get into heavier medication tho if I can help it.
    I remember knowing of a lady years ago who suffered with it really bad, and she had to get people to come out put her rubbish out and bring her mail in. I used to think wow, that would be terrible to be like that !:(

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  2. Jules - keep going on those trips. Do the same trip over and over and over until it doesn't bother you anymore. Then move on to a 2nd trip and do it lots of times. Shorter trips to familiar places is the best start. Look into your health insurance and see if you have mental health coverage and get some help! A friend of mine went through this - severe anxiety even going to the mailbox in the front yard. HUGS TO YOU!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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  3. Thanks Liz :)
    I did cope fairly well with going away this weekend :)
    I did have one moment of panic when we went for a drive once we got to the caravan park we were staying at .. but I coped.
    Where we live, even if I did have health insurance (I'm on the public system because of my back condition), there is no places to go for help here for it anyway :(
    Thanks for the hugs, and support ! :)

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  4. My husband has expressed some concern that that I might have agoraphobia. I don't like going out any more and I use to get very self conscious in public. There are other issues that I will not share here but I'm 90% sure that is not my problem. I love people and can interact well if I have time to prepare. Now that I have a developed a new attitude I have seen major improvements in my self when I go out. Still it seems easier to stay at home so I have to remind myself to get out a few times a week.

    I love being outside though. So next month I'm going to start walking everyday.

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  5. There are all kinds of "problems" that we can have and there is alot of overlapping symptoms. If it's interfereing with your life, then go see a doctor. Anxiety and panic when you are out and about seems to be the agoraphobia symptoms.

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  6. As an effective medicine, paxil would surely provide you immense relief if you are in the grip of panic disorder, depression or generalized anxiety disorder but it is altogether true that the usage of Paxil occasionally facilitates certain side-effects such as headache, low blood pressure, irregular heartbeat et al. These side-effects can yield serious results if not treated immediately hence take this medicine only on proper prescription.

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  7. Xanax is known to be an FDA (Food and Drugs Administration) approved medicine for treating panic disorder, generalized anxiety disorder, anxiety related to depression et al and further details on Xanax info make it apparent that xanax is meant for short term treatment of anxiety.

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  8. Anonymous8/28/2009

    I had agoraphobia when I was in my 20's, had group and individual treatment to get past it, though I am still anxious and still take a small dose of ativan three times a day along with serzone for pain. until recently I have been active socially and politically but as my body pain from severe osteoarthritis has increased this last few months, I am staying home more, go out maybe three times a week. I am 79 and healthy otherwise. I am fine around friends and family, avoid crowds if I can. I feel safer at home,though being out for maybe 2 hours is ok. I then need a day to stay home after I'm out. I use a cane for balance when out, am friendly with others. I want to accept myself as I am!

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  9. Anonymous1/03/2010

    I am 18 and suffer from agrophobia i take 60 grams of fluoxitine a day i have been feeling alot better but the last few weeks i have been missing tablets and am slipping back in to my old ways, but now i am back on top of it and soon will be fine again. I live in the uk and there is alot of help avaliable here which is great but not when you dont want to leave the house. thanks guys

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  10. Anonymous 1/3/10 - Thanks for writing. Alot of people stop taking their meds when they start feeling better. They forget that the meds are not a cure but just a "bandaid" so please always take your meds until the doctor tells you otherwise. Good luck to you!!!!!!!!!

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  11. It's likely to be more helpful for anyone who can relate to cognitive behaviour therapy's ideas, its problem-solving approach and the need for practical self-assignments. People tend to prefer this if they want a more practical treatment, where gaining insight isn't the main aim.

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  12. Great explanation here. A combination of medication and psychotherapy are the best to fight agoraphobia. Thanks for the article :)

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