Why not join Chat or find more information on the Phobia Support Forum

Annie Price

Axia

Agoraphobia

Agoraphobia is a complicated mental health condition, involving the fear of panic, leaving a “safe zone” or one’s own home, and panic attacks when faced with having to do these things. Although agoraphobia is a lesser-known illness in the public eye, the often paralyzing symptoms can infringe on the lives of the millions of sufferers seeking treatment. There is hope out there for people suffering with this condition.

According to the Mayo Clinic, with agoraphobia, one fears being in places where it may be difficult or embarrassing to get out quickly or where one may have a panic attack and can’t get help. Because of these fears, the agoraphobic person avoids places where they think they may have a panic attack or panic-like symptoms. People with agoraphobia often have a hard time feeling safe in any public place, especially places where crowds gather.

Approximately 1.8 million Americans aged eighteen and over suffer with agoraphobia with the median onset age of approximately twenty years old. These statistics may be drastically lower than the actual number of people who suffer with agoraphobia, as it is a cause of embarrassment and shame as well as underreported.

Life with agoraphobia lacks most any quality. Some of the common symptoms, according to the New York Times, of agoraphobia include:

• The fear of being alone. This is called monophobia. People with monophobia may not feel safe or may feel unable to cope without a specific person in their lives.

• The fear of losing control in a public place. This is also the fear of embarrassment in a public place.

• Becoming housebound for prolonged periods of time. Many agoraphobics do not leave their own homes for days, weeks, months, and even years on end. This is the result of not feeling safe anywhere else. Many have panic attacks at the very idea of leaving their home.

• Feelings of detachment or estrangement from others. This is called depersonalization. This is a feeling of watching oneself act, without having any control over the situation.

• Feelings of helplessness. Given the vast array of other symptoms and fears that the agoraphobic person experiences, he or she will often feel helpless. The housebound person may even become quite helpless, leading to more feelings of helplessness.

• Dependence on other people. When the agoraphobic becomes housebound or near housebound, they begin to rely on other people for basic needs like grocery shopping and taking their mail to the mailbox.

• A feeling that the body is unreal. This is also known as detachment. It is a part of depersonalization. The person feels that his or her body is unreal, is changing, or is dissolving; or that he or she is outside of the body.

• Anxiety or panic attacks. A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions. Panic attacks can be terrifying.

• An unusual temper or agitation with trembling or twitching. Mood swings are not uncommon for the agoraphobic person, who experiences fear coming and going so frequently.

• Lightheadedness, sometimes near fainting. These are physical symptoms of anxiety.

• Dizziness. This is a physical symptom of anxiety.

• Excessive sweating. This is a physical symptom of anxiety.

• Skin flushing. This is a symptom of anxiety.

• Difficulty breathing. During an anxiety attack, the person often hyperventilates or feels an imaginary weight on their chest causing breathing difficulties.

• Heartbeat sensations or palpitations. These are symptoms of anxiety and usually treated with beta-blockers.

• Nausea and vomiting. These are symptoms of anxiety. Oftentimes, the housebound agoraphobic will attempt to leave the home to have an attack of nausea and vomiting that prevent them from doing so.

• Numbness and tingling. This usually happens in the arms and legs and can also be described as a “shaky” feeling. This is another symptom of anxiety.

• Abdominal distress that occurs when upset. This is another symptom of anxiety.

• Confused or disordered thoughts. When panic has taken over the agoraphobic person’s brain, the rest of their thoughts can become jumbled and disorderly.

• The intense fear of going crazy. This is usually a symptom of an anxiety attack. It correlates closely with the fear of losing control and the fear of dying.

• The intense fear of dying. Because of the physical symptoms, including nausea and vomiting, racing heart and/or palpitations, and difficulty breathing, the agoraphobic person may truly believe they are dying each time one of these attacks occur.

The need for professional help is immense in the situation of agoraphobia. Currently, the treatments for agoraphobia include medication and therapy, or a combination of both. One way to seek treatment is for the sufferer of agoraphobia to consult their family doctor. The doctor will most likely refer the patient to see a specialist in mental health matters.

Medications used to treat agoraphobia include SSRIs (Selective Serotonin Reuptake Inhibitor) and SNRIs (Serotonin Norepinephrine Reuptake Inhibitor), generally. These are both classes of anti-depressant drugs. They include drugs like Effexor, Pristiq, Cymbalta, Celexa, Lexapro, Prozac, Paxil, and Zoloft. This is not an exhaustive list. The way that Selective Serotonin Reuptake Inhibitors work on the brain is to stimulate the nerve cell by staying in the synaptic gap longer than it normally would. The way that Serotonin Norephinephrine Reuptake Inhibitors work is essentially the same as Selective Serotonin Reuptake Inhibitors, but they work on the neurotransmitter norephinephrine as well.

Another class of drugs given to people with agoraphobia is called benzodiazepines. These are often referred to as anti-anxiety medications. They include medications such as Xanax, Klonopin, Ativan, and Valium. Again, this is not an exhaustive list. Benzodiazepines are used for the immediate relief of panic symptoms. This class of drug is usually given on a short-term basis, as they are addictive and habit-forming, and is tapered off of when the patient has other coping techniques to use instead. These coping techniques are usually learned through various types of therapy.

One more class of drug worth mentioning that is used to treat symptoms of panic is the beta-blocker. Beta-blockers ease the bodily symptoms that panic produces like heart palpitations and sometimes even associated headaches. It is becoming more and more common now for doctors to prescribe beta-blockers to their patients with panic disorders like agoraphobia.

The most widely used therapy to treat agoraphobia is Cognitive Behavioral Therapy. This approach is based on the idea that one’s thoughts control their behaviors. It aims to change thought patterns, then to gradually expose the agoraphobic person to situations that cause them anxiety. For example, leaving the house, driving, being alone for short periods of time, or whatever the problematic stimuli may be are all situations that the agoraphobic is increasingly exposed to. In the early stages of Cognitive Behavior Therapy, the therapy attempts to change the thoughts that prevent and individual from overcoming his or her fear. During the later stages is when the patient is gradually exposed to the situations that cause anxiety.
There are a number of key points to Cognitive Behavior Therapy. Cognitive Behavioural Therapy for Dummies (Willson & Branch, 2006, p. 16) points to these as:

• Emphasizes the role of personal meanings that one gives to events in determining their emotional responses

• Was developed through extensive scientific evaluation

• Focuses more on how one’s root problems are being maintained rather than on searching for a single root cause of the problem

• Offers practical advice and tools for overcoming common emotional problems

• Holds the view that one can change and develop by thinking things through and by trying out new ideas and strategies

• Can address material from one’s past if doing so can help the person to understand and change the way they are thinking and acting now

• Shows that some of the strategies people are using to cope with their emotional problems are actually maintaining those problems

• Strives to normalize one’s emotions, physical sensations, and thoughts rather than to persuade that they’re clues to “hidden” problems

• Recognizes that one may develop emotional problems about one’s emotional problems, for example feeling ashamed about being depressed

• Highlights learning techniques and maximizes self-help so that ultimately one can become their own therapist

Agoraphobia is a serious condition requiring the help of professionals. There is hope and help for those suffering with this condition, and millions of people suffering too. With the impact agoraphobia has on the lives of its sufferers, there are many great reasons to seek professional help. Treatment is available and ready to be taken advantage of by those who need it.

Reference Page Citation
Willson, R., & Branch, R. (2006) Cognitive Behavioural Therapy for Dummies. Great Britian: Wiley Publishing

Mayo Clinic Staff [no author]. (April 15, 2007). Agoraphobia. Retrieved February 11, 2009, from http://www.mayoclinic.com/health/agoraphobia/DS00894

National Institute of Mental Health [no author]. (June 26, 2008). The Numbers Count: Mental Disorders in America. Retrieved February 11, 2009, from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml

New York Times [no author]. (November 15, 2006). Agoraphobia. Retrieved February 11, 2009, from http://health.nytimes.com/health/guides/disease/agoraphobia/overview.html

The American Institute for Cognitive Therapy [no author]. (2003). What is Cognitive Therapy? Retrieved February 11, 2009, from http://www.cognitivetherapynyc.com/default.asp?sid=768