Agoraphobia
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Agoraphobia

En Español (Spanish Version)

Definition

Agoraphobia is an irrational fear of being trapped in places or situations where escape could be difficult or impossible. People with agoraphobia often will not leave the house. It often occurs in association with panic disorder . In this case, the affected people may fear that help will not be available in certain places in case a panic attack occurs.

Causes

The exact cause is unknown. Most people develop agoraphobia after having panic attacks. Afraid of having another attack, an agoraphobic avoids places and situations that have triggered an attack. Factors that may contribute to the development of this phobia include:

  • Genetics
  • Changes in brain chemistry or activity
  • Having a nervous system that reacts excessively, even to normal stimuli
  • Increased awareness of physical changes (such as increased heart rate)
  • Distorted thinking, which may start a cycle of fear

Nervous System

female nervous system 3D

Changes or genetic problems in the nervous system (brain and nerves) may contribute to agoraphobia.

© 2008 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for agoraphobia include:

  • A tendency to be nervous or anxious
  • Stressful situations
  • Family members with panic disorder or phobias
  • Age: 18-35
  • Sex: female
  • Other psychiatric disorders
  • Personality disorder

Symptoms

Symptoms include:

  • Fear of being in a crowd, shopping, standing in line, or similar activities
  • Fear of riding in a car, bus, or train
  • Creation of a safe zone
  • Feelings of anxiety when outside the safe zone
  • Fear of being alone
  • Avoidance of situations that might cause a panic attack
  • Restriction of activities outside the home
  • Feeling of being safer with a trusted friend
  • Lack of interest in normal activities
  • Becoming homebound

Agoraphobia is commonly associated with the following:

Feared situations may trigger a panic attack. Attacks start quickly and peak in about 10 minutes. A panic attack usually includes four or more of the following:

  • Intense fear
  • Shaking
  • Rapid heartbeat
  • Pounding or racing feeling in the chest
  • Sweating
  • Blushing
  • Shortness of breath
  • Chest pain
  • Dizziness or lightheadedness
  • Hot flashes or chills
  • Numbness or tingling
  • Nausea
  • Feeling of loss of control or "going crazy"
  • Fear of having a heart attack or dying

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may also look for a medical condition, drug, or other substance that may be causing your symptoms.

You may be asked questions about your:

  • Use of alcohol and drugs
  • Mental health
  • Family's mental health

There are no tests for agoraphobia or panic disorder. However, you may have heart or blood tests done to look for an underlying cause.

Treatment

Treatment aims to help you overcome irrational fears and live more independently. Goals include:

  • Reducing the number and severity of panic attacks
  • Learning to manage panic attacks that do occur

Treatments may include:

Cognitive-Behavioral Therapy

This therapy combines:

  • Cognitive therapy to change troublesome thought patterns
  • Behavioral therapy to help learn how you can alter your actions

This therapy helps you learn to:

  • Identify and change anxious thoughts
  • Use relaxation techniques to decrease feelings of anxiety
  • Control breathing by taking slower, deeper breaths
  • Cope with physical changes associated with anxiety
  • Confront feared situations

Medications

Commonly used drugs include:

  • Antidepressants
  • Benzodiazepines or other anti-anxiety medicines

Note: Benzodiazepines may cause dependence. This means that withdrawal symptoms occur once the medication is stopped.

Lifestyle Changes

Avoid caffeine and nicotine because they can increase anxiety.

Prevention

Agoraphobia often develops as a response to panic attacks. Instead of avoiding places where you have had a panic attack, it is better to seek medical care. Early treatment for panic attacks can help prevent agoraphobia.

RESOURCES:

American Psychiatric Association
http://www.psych.org

Anxiety Disorders Association of America
http://www.adaa.org

Mental Health America
http://www.nmha.org

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.ontario.cmha.ca/index.asp

Mental Health Canada
http://www.mentalhealthcanada.com/

References:

Beers MH et al. The Merck Manual of Medical Information—Home Edition . 2nd ed. Simon and Schuster, Inc; 2003.

Conn's Current Therapy 2001 . 53rd ed. WB Saunders Company; 2001.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment . 8th ed. St. Louis, MO: Mosby; 2006.

Goldman L. Cecil Textbook of Medicine . 22nd ed. Philadelphia, PA: Saunders; 2004.

Griffith's 5-Minute Clinical Consult . 2001 ed. Lippincott Williams & Wilkins; 2001.

Harrison's Principles of Internal Medicine . 14th ed. McGraw-Hill; 2000.

Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet . 2005;20-26;366:665-675.

National Institute of Mental Health website. Available at: http://www.nmha.org .

Primary Care Medicine . 4th ed. Lippincott Williams & Wilkins; 2000.

Psychiatry . WB Saunders Company; 1997.



Last reviewed November 2007 by Theodor B. Rais MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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