Agoraphobia

Definition

Agoraphobia is a fear of being in places where help might not be available. It usually involves fear of crowds, bridges, or of being outside alone.

Causes, incidence, and risk factors

Agoraphobia often accompanies another anxiety disorder, such as panic disorder or a specific phobia. If it occurs with panic disorder, it usually starts in a person's 20s, and women are affected more often than men.

Symptoms

• Anxiety or panic attack (acute severe anxiety)
• Becoming housebound for prolonged periods of time
• Dependence on others
• Fear of being alone
• Fear of being in places where escape might be difficult
• Fear of losing control in a public place
• Feelings of detachment or estrangement from others
• Feelings of helplessness
• Feeling that the body is unreal
• Feeling that the environment is unreal
• Unusual temper or agitation with trembling or twitching

Additional symptoms that may occur:

• Abdominal distress that occurs when upset
• Breathing difficulty
• Chest pain
• Confused or disordered thoughts
  • Intense fear of dying
  • Intense fear of going crazy
• Dizziness
• Excessive sweating
• Heartbeat sensations
• Lightheadedness, near fainting
• Nausea and vomiting
• Numbness and tingling
• Skin flushing

Signs and tests

The individual may have a history of phobias. Family, friends, or the affected person may tell the health care provider about agoraphobic behavior.

Signs include:

• High blood pressure
• Rapid pulse (heart rate)
• Sweating

Treatment

The goal of treatment is to help you function effectively. The success of treatment usually depends on the severity of the phobia.

Systematic desensitization is a technique used to treat phobias. You are asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation also been used with success to help people overcome their fears.

Anti-anxiety and antidepressant medications are often used to help relieve the symptoms of phobias.

Expectations (prognosis)

Phobias tend to be chronic, but respond well to treatment.

Complications

Some phobias may affect job performance. People with this disorder may become housebound for years, which is likely to hurt their social and interpersonal relationships.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of agoraphobia.

Prevention

As with other panic disorders, prevention may not be possible. Early intervention may reduce the severity of the condition.

References

Moore DP, Jefferson JW. Agoraphobia (panic disorder with agoraphobia and agoraphobia without history of panic disorder). In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 84.

Katon W, Geyman JP. Anxiety disorders. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 57.