Agoraphobia

Overview

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder. Agoraphobia involves fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless or embarrassed. You may fear an actual or upcoming situation. For example, you may fear using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety gets overwhelming. You may avoid situations because of fears such as getting lost, falling, or having diarrhea and not being able to get to a bathroom. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack. They then avoid the places where it may happen again.

Agoraphobia often results in having a hard time feeling safe in any public place, especially where crowds gather and in locations that are not familiar. You may feel that you need a companion, such as a family member or friend, to go with you to public places. The fear can be so overwhelming that you may feel you can't leave your home.

Agoraphobia treatment can be challenging because it means confronting your fears. But with proper treatment — usually a form of therapy called cognitive behavioral therapy and medicines — you can escape the trap of agoraphobia and live a more enjoyable life.

Symptoms

Typical agoraphobia symptoms include fear of:

• Leaving home alone.
• Crowds or waiting in line.
• Enclosed spaces, such as movie theaters, elevators or small stores.
• Open spaces, such as parking lots, bridges or malls.
• Using public transportation, such as a bus, plane or train.

These situations cause anxiety because you fear you won't be able to escape or find help if you start to feel panicked. Or you may fear having other disabling or embarrassing symptoms, such as dizziness, fainting, falling or diarrhea.

In addition:

• Your fear or anxiety is out of proportion to the actual danger of the situation.
• You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely upset.
• You have major distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance.
• Your fear and avoidance usually lasts six months or longer.

Panic disorder and agoraphobia

Some people have panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder that includes panic attacks. A panic attack is a sudden feeling of extreme fear that reaches a peak within a few minutes and triggers a variety of intense physical symptoms. You might think that you're totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar situations or the place where it happened in an attempt to prevent future panic attacks.

Symptoms of a panic attack can include:

• Rapid heart rate.
• Trouble breathing or a feeling of choking.
• Chest pain or pressure.
• Lightheadedness or dizziness.
• Feeling shaky, numb or tingling.
• Sweating too much.
• Sudden flushing or chills.
• Upset stomach or diarrhea.
• Feeling a loss of control.
• Fear of dying.

When to see a doctor

Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.

Don't let agoraphobia make your world smaller. Call your health care provider or a mental health professional if you have symptoms of agoraphobia or panic attacks.

Causes

Biology — including health conditions and genetics — personality, stress and learning experiences may all play a role in the development of agoraphobia.

Risk factors

Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35. But older adults also can develop it. Females are diagnosed with agoraphobia more often than males are.

Risk factors for agoraphobia include:

• Having panic disorder or other excessive fear reactions, called phobias.
• Responding to panic attacks with too much fear and avoidance.
• Experiencing stressful life events, such as abuse, the death of a parent or being attacked.
• Having an anxious or nervous personality.
• Having a blood relative with agoraphobia.

Complications

Agoraphobia can greatly limit your life's activities. If your agoraphobia is severe, you may not even be able to leave your home. Without treatment, some people become housebound for years. If this happens to you, you may not be able to visit with family and friends, go to school or work, run errands, or take part in other routine daily activities. You may become dependent on others for help.

Agoraphobia also can lead to:

• Depression.
• Alcohol or drug misuse.
• Suicidal thoughts and behavior.

Prevention

There's no sure way to prevent agoraphobia. But anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places over and over again. This can help you feel more comfortable in those places. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.