Disease: Agoraphobia

    Agoraphobia facts

    • Agoraphobia is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating.
    • Like other phobias, agoraphobia often goes unreported, probably because many phobia sufferers find ways to avoid the situations to which they are phobic.
    • Agoraphobia often occurs in combination with panic disorder.
    • Agoraphobia occurs alone in less than 1% to almost 7% of the population, more often in girls and women compared to boys and men.
    • There are a number of theories about what can cause agoraphobia, including a response to repeated exposure to anxiety-provoking events or a reaction to internal emotional conflicts.
    • As with other mental disorders, a number of factors usually cause agoraphobia, it tends to run in families, and for some people, there may be a clear genetic factor involved in its development.
    • Symptoms of agoraphobia include anxiety and subsequent avoidance of being in a situation in which one will have a panic attack, when in a situation from which escape is not possible, or is difficult or embarrassing.
    • The panic attacks associated with agoraphobia, like all panic attacks, may involve intense fear, disorientation, rapid heartbeat, dizziness, or diarrhea.
    • The situations that people with agoraphobia avoid and the environments that cause people with balance disorders to feel disoriented are sometimes quite similar, leading some cases of agoraphobia to be classified as vestibular function agoraphobia.
    • Agoraphobia tends to begin by adolescence or early adulthood.
    • Suffering from virtually any other anxiety disorder increases the risk of developing agoraphobia.
    • Symptoms of agoraphobia should be treated when the signs and symptoms of the associated anxiety are not easily, quickly, and clearly relieved.
    • Physicians often diagnose and treat agoraphobia when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought.
    • To diagnose agoraphobia, the treating psychiatrist or other physician will usually take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. The presence of any medical condition or other emotional problem will be considered.
    • Cognitive behavioral therapy and exposure therapy are the most effective psychotherapies that treat agoraphobia.
    • Medications like SSRIs, beta-blockers, and benzodiazepines most commonly treat agoraphobia. The risk of overdose, addiction, or need for increasingly higher doses make benzodiazepines a less desirable treatment for agoraphobia.
    • Agoraphobia increases the likelihood that the person will also suffer from another anxiety disorder and that both conditions will be more severe and difficult to treat.
    • Agoraphobia tends to occur more often in individuals who have a number of different physical conditions.
    • If left untreated, agoraphobia may worsen to the point where the person's life is seriously affected by the disease itself and/or by attempts to avoid or conceal it.

    What is the definition of agoraphobia?

    A phobia is generally defined as the severe, unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. The definition of agoraphobia is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating.

    Phobias are largely underreported and underdiagnosed, probably because many phobia sufferers find ways to avoid the situations to which they are phobic. The fact that agoraphobia often occurs in combination with panic disorder makes it even more difficult to track how often it occurs. Other statistics about agoraphobia include that researchers estimate it occurs from less than 1% to almost 7% of the population. Its age of onset is most often during the mid to late 20s.

    What causes agoraphobia?

    There are a number of theories about what can cause agoraphobia. One hypothesis is that agoraphobia develops in response to repeated exposure to anxiety-provoking events. Mental-health theory that focuses on how individuals react to internal emotional conflicts (psychoanalytic theory) describes agoraphobia as the result of a feeling of emptiness that comes from an unresolved Oedipal conflict, which is a struggle between the feelings the person has toward the opposite-sex parent and a sense of competition with the same-sex parent. Although agoraphobia, like other mental disorders, is related to a number of psychological and environmental risk factors, it also tends to run in families, and for some people, may have a clear genetic factor contributing to its development. Girls and women are more likely to develop agoraphobia compared to boys and men. For ethnic minorities in the United States, a number of factors influence the likelihood of developing agoraphobia or any other anxiety disorder, like immigration from another country, language proficiency, feeling discriminated against, as well as the specific ethnicity of the individual.

    What are agoraphobia symptoms?

    The symptoms of agoraphobia include anxiety that one will have a panic attack when in a situation from which escape is not possible or is difficult or embarrassing. Examples of such situations include using public transportation, being in open or enclosed places, being in a crowd, or outside of the home alone. The panic attacks that can be associated with agoraphobia, like all panic attacks, may involve symptoms and signs like intense fear, disorientation, rapid heartbeat, dizziness, or diarrhea. Agoraphobic individuals often begin to avoid the situations that provoke these reactions. Interestingly, the situations that people with agoraphobia avoid and the environments that cause people with balance disorders to feel disoriented are quite similar. This leads some cases of agoraphobia to be considered as vestibular function (related to balance disorders) agoraphobia.

    What are the risk factors for agoraphobia?

    Agoraphobia tends to begin by adolescence or early adulthood. Girls and women, Native Americans, middle-aged individuals, low-income populations, and individuals who are either widowed, separated, or divorced are at increased risk of developing agoraphobia. Individuals who are Asian, Hispanic, or of African/African-American descent tend to have a lower risk of developing this disorder.

    Having a history of panic attacks is a risk factor for developing agoraphobia. Agoraphobic individuals are at increased risk for developing panic attacks, as well. Other anxiety disorders that tend to co-occur with agoraphobia include social anxiety disorder (social phobia) and generalized anxiety disorder. Even the use of alcohol can result in severe, albeit temporary anxiety.

    When should one seek medical care for agoraphobia?

    Call a doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly relieved. For example,

    • if the symptoms are so severe that medication may be needed,
    • if the symptoms are interfering with someone's personal, social, or professional life,
    • if someone has chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness,
    • if someone is depressed or feeling suicidal or homicidal.

    When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting significantly worse), it's advisable to make an appointment with a doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may indicate serious medical illness that needs immediate evaluation and treatment in a hospital's emergency department.

    How do physicians diagnose agoraphobia?

    Interestingly, physicians often diagnose and treat agoraphobia, like other phobias, when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought. As with other mental disorders, there is no single, specific test for agoraphobia. The primary-care doctor or psychiatrist will take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. If someone has another medical condition that he or she knows about or there has been exposure to a medication, drug of abuse or other substance, there may be an overlap of signs and symptoms between the old and the new conditions. Just determining that anxiety does not have a physical cause does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, and/or other mental-health professional.

    In order to establish the diagnosis of agoraphobia, the professional will likely ask questions to ensure that the anxiety of the sufferer is truly the result of a fear of being in situations that make it impossible, difficult, or embarrassing to escape rather than in the context of another emotional problem (for example, fear of being near people that remind one of an abuser in the case of posttraumatic stress disorder or the fear of hearing voices that have no basis in reality as occurs in schizophrenia). The evaluator will also seek to determine if the symptoms of agoraphobia have occurred most times that the sufferer has been exposed to the previously described anxiety-provoking situations over at least a six-month period.

    What is the treatment for agoraphobia?

    There are many treatments available for overcoming agoraphobia, including specific kinds of psychotherapy as well as several effective medications. A specific form of psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-defeating thoughts and behaviors (called cognitive behavioral therapy) has been found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs along with panic disorder, cognitive behavioral therapy, with or without treatment with medication, is considered to be the most effective way to both relieve symptoms and prevent their return. In fact, sometimes patients respond equally as well when treated with group cognitive behavioral therapy or a brief course of that kind of therapy, as they do when treated with traditional cognitive behavioral therapy. Psychotherapy for agoraphobia is also effective for many people when they receive it over the Internet, which is optimistic news for people who live in areas that are hundreds of miles from the nearest mental-health professional.

    Another form of therapy that has been found effective in managing agoraphobia includes self-exposure. In that intervention, the person either imagines or puts him or herself into situations that cause increasing levels of agoraphobic anxiety, using relaxation techniques in each situation in order to master their anxiety. As people gain access to the Internet, there is increasing evidence that exposure therapy can also be done effectively through that medium.

    Regarding medical therapy, agoraphobia is usually treated in connection with panic disorder. Commonly, members of the selective serotonin reuptake inhibitor (SSRI) and the minor tranquilizer (benzodiazepine) groups of medications are used in treatment. Examples of SSRI medications include escitalopram (Lexapro), citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of SSRI medications can vary greatly from person to person and depend on which of the drugs is being used. Common side effects of this group of medications include dry mouth, sexual dysfunction, nausea or other stomach upset, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. In rare cases, some people have been thought to become acutely more anxious or depressed once on the medication, even trying to or completing suicide or homicide. Children and teens are thought to be particularly vulnerable to this rare possibility. Phobias are also sometimes treated using beta-blocker medications, which block the effects of adrenaline (like rapid heartbeat, stomach upset, shortness of breath) on the body. An example of a beta-blocker medication is propranolol.

    Learn more about: Lexapro | Celexa | Luvox | Zoloft | Paxil | Prozac

    Panic disorder and phobias are sometimes treated with drugs in a medication class known as benzodiazepines. This class of medications causes relaxation but is used less often these days to treat anxiety due to the possibility of addiction, increasing need for higher doses, and overdose. The risk of overdose is especially heightened if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

    Learn more about: Valium | Xanax | Ativan | Klonopin

    As anything that is ingested carries the risk of possible side effects, it is important to work closely with a doctor to decide whether medication is appropriate, and if so, which medication would be best. Further, the treating doctor will likely closely monitor for the possibility of side effects that can vary from the minor to the severe and in rare cases may even be life-threatening.

    What are the complications of agoraphobia?

    Agoraphobia increases the likelihood that the person will also suffer from another anxiety disorder, like social or other phobias, panic disorder or posttraumatic stress disorder. Agoraphobia also predisposes sufferers to having more severe and difficult to treat anxiety disorders of any kind. People with agoraphobia are more at risk for developing alcohol use disorder. Also, agoraphobia tends to occur more often in individuals who have a number of different physical conditions, including irritable bowel syndrome (IBS) and asthma. If left untreated, agoraphobia may worsen to the point at which the person's life is seriously affected by the disease itself and/or by attempts to avoid or conceal it. In fact, some people have had problems with friends and family, failed in school, and/or lost jobs while struggling to cope with severe agoraphobia or another severe phobia.

    What is the prognosis for agoraphobia?

    While there may be periods of spontaneous improvement of symptoms for people with agoraphobia, the condition does not usually go away unless the person receives treatment designed specifically to help agoraphobia sufferers. Some research has indicated a more chronic and debilitating course of agoraphobia in African-American individuals compared to Caucasians. One significant challenge of agoraphobia is revealed by the statistics related to treatment. Specifically, less than half of individuals with this illness in the United States are receiving treatment at any one time. Further, alcoholics can be up to 10 times more likely to suffer from a phobia than those who do not have alcohol use disorder, and phobic individuals can be twice as likely to be addicted to alcohol as are people who have never been phobic.

    Is it possible to prevent agoraphobia?

    As agoraphobia often develops as a fearful reaction to having panic attacks, prevention of agoraphobia tends to focus on developing ways to cope with the anxiety about the possibility of another panic attack without avoiding leaving one's home. The treatments for agoraphobia previously described are usually used to prevent its development, as well.

    What is the definition of agoraphobia?

    A phobia is generally defined as the severe, unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. The definition of agoraphobia is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating.

    Phobias are largely underreported and underdiagnosed, probably because many phobia sufferers find ways to avoid the situations to which they are phobic. The fact that agoraphobia often occurs in combination with panic disorder makes it even more difficult to track how often it occurs. Other statistics about agoraphobia include that researchers estimate it occurs from less than 1% to almost 7% of the population. Its age of onset is most often during the mid to late 20s.

    What causes agoraphobia?

    There are a number of theories about what can cause agoraphobia. One hypothesis is that agoraphobia develops in response to repeated exposure to anxiety-provoking events. Mental-health theory that focuses on how individuals react to internal emotional conflicts (psychoanalytic theory) describes agoraphobia as the result of a feeling of emptiness that comes from an unresolved Oedipal conflict, which is a struggle between the feelings the person has toward the opposite-sex parent and a sense of competition with the same-sex parent. Although agoraphobia, like other mental disorders, is related to a number of psychological and environmental risk factors, it also tends to run in families, and for some people, may have a clear genetic factor contributing to its development. Girls and women are more likely to develop agoraphobia compared to boys and men. For ethnic minorities in the United States, a number of factors influence the likelihood of developing agoraphobia or any other anxiety disorder, like immigration from another country, language proficiency, feeling discriminated against, as well as the specific ethnicity of the individual.

    What are agoraphobia symptoms?

    The symptoms of agoraphobia include anxiety that one will have a panic attack when in a situation from which escape is not possible or is difficult or embarrassing. Examples of such situations include using public transportation, being in open or enclosed places, being in a crowd, or outside of the home alone. The panic attacks that can be associated with agoraphobia, like all panic attacks, may involve symptoms and signs like intense fear, disorientation, rapid heartbeat, dizziness, or diarrhea. Agoraphobic individuals often begin to avoid the situations that provoke these reactions. Interestingly, the situations that people with agoraphobia avoid and the environments that cause people with balance disorders to feel disoriented are quite similar. This leads some cases of agoraphobia to be considered as vestibular function (related to balance disorders) agoraphobia.

    What are the risk factors for agoraphobia?

    Agoraphobia tends to begin by adolescence or early adulthood. Girls and women, Native Americans, middle-aged individuals, low-income populations, and individuals who are either widowed, separated, or divorced are at increased risk of developing agoraphobia. Individuals who are Asian, Hispanic, or of African/African-American descent tend to have a lower risk of developing this disorder.

    Having a history of panic attacks is a risk factor for developing agoraphobia. Agoraphobic individuals are at increased risk for developing panic attacks, as well. Other anxiety disorders that tend to co-occur with agoraphobia include social anxiety disorder (social phobia) and generalized anxiety disorder. Even the use of alcohol can result in severe, albeit temporary anxiety.

    When should one seek medical care for agoraphobia?

    Call a doctor when the signs and symptoms of anxiety are not easily, quickly, and clearly relieved. For example,

    • if the symptoms are so severe that medication may be needed,
    • if the symptoms are interfering with someone's personal, social, or professional life,
    • if someone has chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness,
    • if someone is depressed or feeling suicidal or homicidal.

    When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting significantly worse), it's advisable to make an appointment with a doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may indicate serious medical illness that needs immediate evaluation and treatment in a hospital's emergency department.

    How do physicians diagnose agoraphobia?

    Interestingly, physicians often diagnose and treat agoraphobia, like other phobias, when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought. As with other mental disorders, there is no single, specific test for agoraphobia. The primary-care doctor or psychiatrist will take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. If someone has another medical condition that he or she knows about or there has been exposure to a medication, drug of abuse or other substance, there may be an overlap of signs and symptoms between the old and the new conditions. Just determining that anxiety does not have a physical cause does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, and/or other mental-health professional.

    In order to establish the diagnosis of agoraphobia, the professional will likely ask questions to ensure that the anxiety of the sufferer is truly the result of a fear of being in situations that make it impossible, difficult, or embarrassing to escape rather than in the context of another emotional problem (for example, fear of being near people that remind one of an abuser in the case of posttraumatic stress disorder or the fear of hearing voices that have no basis in reality as occurs in schizophrenia). The evaluator will also seek to determine if the symptoms of agoraphobia have occurred most times that the sufferer has been exposed to the previously described anxiety-provoking situations over at least a six-month period.

    What is the treatment for agoraphobia?

    There are many treatments available for overcoming agoraphobia, including specific kinds of psychotherapy as well as several effective medications. A specific form of psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-defeating thoughts and behaviors (called cognitive behavioral therapy) has been found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs along with panic disorder, cognitive behavioral therapy, with or without treatment with medication, is considered to be the most effective way to both relieve symptoms and prevent their return. In fact, sometimes patients respond equally as well when treated with group cognitive behavioral therapy or a brief course of that kind of therapy, as they do when treated with traditional cognitive behavioral therapy. Psychotherapy for agoraphobia is also effective for many people when they receive it over the Internet, which is optimistic news for people who live in areas that are hundreds of miles from the nearest mental-health professional.

    Another form of therapy that has been found effective in managing agoraphobia includes self-exposure. In that intervention, the person either imagines or puts him or herself into situations that cause increasing levels of agoraphobic anxiety, using relaxation techniques in each situation in order to master their anxiety. As people gain access to the Internet, there is increasing evidence that exposure therapy can also be done effectively through that medium.

    Regarding medical therapy, agoraphobia is usually treated in connection with panic disorder. Commonly, members of the selective serotonin reuptake inhibitor (SSRI) and the minor tranquilizer (benzodiazepine) groups of medications are used in treatment. Examples of SSRI medications include escitalopram (Lexapro), citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of SSRI medications can vary greatly from person to person and depend on which of the drugs is being used. Common side effects of this group of medications include dry mouth, sexual dysfunction, nausea or other stomach upset, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. In rare cases, some people have been thought to become acutely more anxious or depressed once on the medication, even trying to or completing suicide or homicide. Children and teens are thought to be particularly vulnerable to this rare possibility. Phobias are also sometimes treated using beta-blocker medications, which block the effects of adrenaline (like rapid heartbeat, stomach upset, shortness of breath) on the body. An example of a beta-blocker medication is propranolol.

    Learn more about: Lexapro | Celexa | Luvox | Zoloft | Paxil | Prozac

    Panic disorder and phobias are sometimes treated with drugs in a medication class known as benzodiazepines. This class of medications causes relaxation but is used less often these days to treat anxiety due to the possibility of addiction, increasing need for higher doses, and overdose. The risk of overdose is especially heightened if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

    Learn more about: Valium | Xanax | Ativan | Klonopin

    As anything that is ingested carries the risk of possible side effects, it is important to work closely with a doctor to decide whether medication is appropriate, and if so, which medication would be best. Further, the treating doctor will likely closely monitor for the possibility of side effects that can vary from the minor to the severe and in rare cases may even be life-threatening.

    What are the complications of agoraphobia?

    Agoraphobia increases the likelihood that the person will also suffer from another anxiety disorder, like social or other phobias, panic disorder or posttraumatic stress disorder. Agoraphobia also predisposes sufferers to having more severe and difficult to treat anxiety disorders of any kind. People with agoraphobia are more at risk for developing alcohol use disorder. Also, agoraphobia tends to occur more often in individuals who have a number of different physical conditions, including irritable bowel syndrome (IBS) and asthma. If left untreated, agoraphobia may worsen to the point at which the person's life is seriously affected by the disease itself and/or by attempts to avoid or conceal it. In fact, some people have had problems with friends and family, failed in school, and/or lost jobs while struggling to cope with severe agoraphobia or another severe phobia.

    What is the prognosis for agoraphobia?

    While there may be periods of spontaneous improvement of symptoms for people with agoraphobia, the condition does not usually go away unless the person receives treatment designed specifically to help agoraphobia sufferers. Some research has indicated a more chronic and debilitating course of agoraphobia in African-American individuals compared to Caucasians. One significant challenge of agoraphobia is revealed by the statistics related to treatment. Specifically, less than half of individuals with this illness in the United States are receiving treatment at any one time. Further, alcoholics can be up to 10 times more likely to suffer from a phobia than those who do not have alcohol use disorder, and phobic individuals can be twice as likely to be addicted to alcohol as are people who have never been phobic.

    Is it possible to prevent agoraphobia?

    As agoraphobia often develops as a fearful reaction to having panic attacks, prevention of agoraphobia tends to focus on developing ways to cope with the anxiety about the possibility of another panic attack without avoiding leaving one's home. The treatments for agoraphobia previously described are usually used to prevent its development, as well.

    Source: http://www.rxlist.com

    Interestingly, physicians often diagnose and treat agoraphobia, like other phobias, when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought. As with other mental disorders, there is no single, specific test for agoraphobia. The primary-care doctor or psychiatrist will take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. If someone has another medical condition that he or she knows about or there has been exposure to a medication, drug of abuse or other substance, there may be an overlap of signs and symptoms between the old and the new conditions. Just determining that anxiety does not have a physical cause does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, and/or other mental-health professional.

    In order to establish the diagnosis of agoraphobia, the professional will likely ask questions to ensure that the anxiety of the sufferer is truly the result of a fear of being in situations that make it impossible, difficult, or embarrassing to escape rather than in the context of another emotional problem (for example, fear of being near people that remind one of an abuser in the case of posttraumatic stress disorder or the fear of hearing voices that have no basis in reality as occurs in schizophrenia). The evaluator will also seek to determine if the symptoms of agoraphobia have occurred most times that the sufferer has been exposed to the previously described anxiety-provoking situations over at least a six-month period.

    Source: http://www.rxlist.com

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