Agoraphobia

What is agoraphobia?

Agoraphobia is an anxiety disorder. If you have agoraphobia, you avoid going places or doing things because you are afraid you will have no way to escape or will panic and have no help. For example, you might have intense fear of driving, crossing bridges, or being in shopping malls. You fear the reactions you will have in these situations. The fears can disable you. At their most extreme, they can prevent you from ever leaving your home.

A person who has agoraphobia may also have panic disorder. People who have panic disorder have a number of severe panic attacks marked by a sense of impending doom. They may become agoraphobic because they want to avoid situations or places that might trigger a panic attack.

How does it occur?

The cause of this disorder is unknown. Experts believe that both genetics and factors in the environment may play a role. People usually develop agoraphobia sometime between their teens and mid-thirties.

About 5% of people in the U.S. have had agoraphobia sometime during their lives. Women have it 2 to 4 times more often than men. When it occurs with panic disorder, the condition tends to run in families.

What are the symptoms?

You may have agoraphobia if you often avoid going places or doing things because you are afraid that:

• you will have no way to escape
• you will have symptoms of panic such as:
  • a suddenly fast heartbeat
  • a lot of sweating
  • trembling or shaking
  • shortness of breath
  • a feeling that you are choking
  • chest pain
  • nausea or diarrhea
  • dizziness
  • a feeling of being detached
  • fear of going crazy or losing control
  • fear of dying
  • numbness
  • chills or hot flashes.

How is it diagnosed?

Your health care provider or therapist will ask about your symptoms. He or she will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

It is often very difficult at first for people with agoraphobia to go to see their health care provider or therapist for appointments. Some people with agoraphobia will use alcohol or drugs to try to control the anxiety.

Do not resist a psychiatric diagnosis because you think there is a stigma attached. You should not feel embarrassed. Searching for a physical cause will likely only delay the relief that therapy can provide.

How is it treated?

Psychotherapy

Seeing a therapist is helpful. Several types of therapy can help treat agoraphobia:

• behavior modification (learning to change your response to situations that cause anxiety)
• relaxation therapy
• desensitization (practicing facing increasingly frightening situations)
• visual imagery (practicing facing a situation that causes anxiety by picturing it in your mind)
• support groups.

The treatment your provider or therapist uses may depend on how much the disorder interferes with your day-to-day life.

Medicine

Several medicines can help treat agoraphobia. Your provider will carefully select the best one for you. Some medicines are:

• antianxiety medicines such as lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and buspirone (BuSpar)
• selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa)
• tricyclic antidepressants such as imipramine (Tofranil), desipramine (Norpramin), and clomipramine (Anafranil).

No nonprescription medicines are available to treat agoraphobia.

Natural and Alternative Treatments

• Herbs and Supplements. Claims have been made that certain herbal and dietary products (kava root, lemon balm, lavender, passion flower, valerian) help control anxiety problems. No herb or dietary supplement has been proven to help agoraphobia.
• Biofeedback. With biofeedback you learn to control body functions such as heart rate, blood pressure, muscle tension, or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration. It is an effective addition to medical or psychotherapy.
• Massage Therapy. Massage therapy may help lower stress and muscle tension.
• Relaxation Therapies. Learning special relaxation methods can help you control the general anxiety that goes along with agoraphobia. Relaxation may also help you to shorten or make panic attacks less severe. Yoga and meditation may be helpful.
• Hypnotherapy. Hypnosis can be useful in learning to control anxiety symptoms and environmental events that trigger panic attacks.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, helps control general anxiety.

How long will the effects last?

Without treatment, agoraphobia can last many years. Sometimes it lasts a lifetime. Researchers are continuing to try to learn more about this disorder.

What can I do for myself?

• Discuss any of your concerns with your health care provider or therapist.
• Tell your provider about any medicine you are taking.
• Realize you are not alone and that your anxiety can be overcome.
• Join a local support group. Establish a "phone buddy" relationship with someone from your group.
• Do not use alcohol or other drugs not prescribed by your provider to overcome your anxiety.
• Avoid the kind of shallow or rapid breathing that can be caused by anxiety. Exhale slowly and completely and breathe regularly.

You may find it helpful to contact the National Mental Health Association. NMHA's toll-free Information Center number is 1-800-969-NMHA (969-6642). NMHA's Web site address is http://www.NMHA.org.