Definition

Agoraphobia is classed as an Anxiety Disorder in the DSM-IV. It is an overwhelming fear of being in places or situations where escape might be difficult or embarrassing or where assistance may not be forthcoming in the event of the onset of acute anxiety or panic symptoms.

Agoraphobics are typically extremely anxious about losing control, "going crazy," or suffering physical symptoms that are often taken to be indicative of their impending demise. Although there may be no rational basis to their fears, they may nevertheless have a profound effect on behavior such that an individual may restrict travel, especially on public transportation; avoid confined places, including tunnels, bridges, restaurants, and movie theaters; or avoid straying from home or places where help may be unavailable. In many cases, the agoraphobic individual will need a trusted friend or family member to accompany them away from home.

With this condition, it is important to note that an individual's anxiety and fear is likely not the product of a particular event or situation per se, but results from an association that is made between the experience of something like a Panic Attack and the particular setting that the person was in at that time. An individual will thus associate a particular setting(s) with feelings of extreme discomfort and will consequently avoid such circumstances in the future for fear of suffering the same discomfort. If the disorder is left unchecked, avoidant behavior may be generalized to any number of events or situations.

Agoraphobia is evident in countries around the world. Current research is showing that the disorder is diagnosed more often in women than in men. This does not necessarily suggest, however, that there may be some subtle biological factor(s) that predisposes women, in particular, to the disorder. Consideration must also be given to how men and women are socialized to deal with difficulties in their lives; for example, it may be that social expectations for men are such that they become less inclined to seek help for such difficulties. In any case, such issues should be kept in mind when considering incidence rates between the sexes.

Symptoms

Psychological

• feelings of depression
• abuse of tranquilizing drugs and/or alcohol for relief of symptoms
• fear of loss of control
• other associated phobias
• loss of self-esteem and self-confidence
• frustration and anger directed towards oneself
• anxiety and panic attacks
• confusion
• fear of fainting
• sudden feelings of extreme panic
• fear of heart attack

• feelings of lightheadedness
• feelings of being detached or distant from surroundings or even one's own body
• buzzing in the ears, blurred vision, dry mouth, tingling in the face and arms
• difficulty breathing
• heart palpitations
• indigestion
• nausea
• dizziness
• severe back ache in the absence of a direct cause
• headaches and other muscle aches and pains
• weakness of the legs
• shaking or trembling

Cause(s)

The exact cause of Agoraphobia is presently unknown. Research has considered biological, psychodynamic, family systems, and cognitive-behavioral explanations. Current clinical research tends to focus on biological and/or cognitive-behavioral explanations.

The former have considered whether neurochemical defects in the brain give rise to such behaviors and whether the disorder is genetically inherited. Studies have found that Agoraphobia tends to run in families, particularly among female relatives of agoraphobics. It is so far unknown however, whether familial transmission is due to genetic and/or environmental influence. Other research has suggested that agoraphobics may have unusually high levels of autonomic nervous system arousal and thus may be more acutely sensitive to stressful stimuli than most individuals. Here again, it is not known whether such arousal levels may be a cause or an effect of the disorder. Cognitive-behavioral explanations suggest that a misinterpretation of bodily sensations (such as those that are associated with anxiety) triggers more intense levels of anxiety, which in turn create more disturbing sensations until extreme discomfort or panic ensues and phobic avoidance develops. Once an agoraphobic pattern is established, it is maintained by the negative reinforcement of avoiding anxiety evoking situations and, perhaps, by the positive reinforcement of such behavior by close friends and family.

Course

The age of onset typically occurs in the late twenties. Without treatment the disorder can persist for years as well as increase in severity.

Treatment

A combination of medication and cognitive-behavioral therapy has proved particularly efficacious in treating both agoraphobia and panic disorder. Antianxiety medications such as clonazepam (Klonopin), diazepam (Valium), and alprazolam (Xanax) are often prescribed to reduce feelings of panic and anxiety. Antidepressants including fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and imipramine (Tofranil) can also be prescribed to allay any associated depressive symptoms that may arise as a consequence of living with the disorder. In many cases, the right combination of medication and dosage has been able to eliminate symptoms entirely.

Cognitive-behavioral therapy can involve educating individuals about the nature of anxiety and stress responses and challenging fearful cognitions that are tied to particular events or situations. Behavioral treatment methods can include exposure techniques such as systematic desensitization, a method involving gradual exposure to a source of anxiety, and flooding, direct exposure to the source of anxiety if the individual is capable of tolerating it.

Dealing with Relapse

During a period of stability and wellness, individuals should devise a relapse management plan with their mental health professional and family members or friends that will outline what steps may need to be taken should a relapse occur. The plan will need to identify symptoms that may constitute warning signs and, if they are evident, an agreement should be made by the individual and members of his or her immediate support network to contact the family physician, counselor, or other mental health professional. In addition, methods to reduce stress and stimulation should be established with a counselor so that they can be put into effect pending any relapse.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

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