Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as 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 intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.
People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.
Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.
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 have other disabling or embarrassing symptoms.
- Fear or anxiety almost always results from exposure to the situation
- 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 distressed
- You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance
- Your phobia and avoidance usually lasts six months or longer
Panic disorder and agoraphobia
Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). 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 circumstances or the place where it occurred in an attempt to prevent future panic attacks.
Signs and 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
- Excessive sweating
- 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 doctor if you have signs or symptoms listed above.
Biology â including health conditions and genetics â temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.
Agoraphobia is diagnosed based on:
- Signs and symptoms
- In-depth interview with your doctor or a mental health professional
- Physical exam to rule out other conditions that could be causing your symptoms
- Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
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. You may not be able to visit with family and friends, go to school or work, run errands, or take part in other normal daily activities. You may become dependent on others for help.
Agoraphobia can also lead to or be associated with:
- Alcohol or drug abuse
- Other mental health disorders, including other anxiety disorders or personality disorders
There's no sure way to prevent agoraphobia. However, 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 before your fear becomes overwhelming. 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.
Coping and support
Living with agoraphobia can make life difficult. Professional treatment can help you overcome this disorder or manage it effectively so that you don't become a prisoner to your fears.
You can also take these steps to cope and care for yourself when you have agoraphobia:
- Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Communicate regularly with your therapist. Consistency can make a big difference, especially when it comes to practicing skills and taking your medication.
- Try not to avoid feared situations. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places can make them less frightening and anxiety provoking. Family, friends and your therapist can help you work on this.
- Learn calming skills. Working with your therapist, you can learn how to calm and soothe yourself. Meditation, yoga, massage and visualization are simple relaxation techniques that also may help. Practice these techniques when you aren't anxious or worried, and then put them into action during stressful situations.
- Avoid alcohol and recreational drugs. Also limit or avoid caffeine. These substances can worsen your panic or anxiety symptoms.
- Take care of yourself. Get enough sleep, be physically active every day, and eat a healthy diet, including lots of vegetables and fruits.
- Join a support group. Support groups for people with anxiety disorders can help you connect to others facing similar challenges and share experiences.
Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years â usually before age 35 â but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.
Risk factors for agoraphobia include:
- Having panic disorder or other phobias
- Responding to panic attacks with excessive fear and avoidance
- Experiencing stressful life events, such as abuse, the death of a parent or being attacked
- Having an anxious or nervous temperament
- Having a blood relative with agoraphobia
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