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Agoraphobia

Overview

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.

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 have other disabling or embarrassing symptoms.

In addition:

  • 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

Diagnosis

Agoraphobia is diagnosed based on:

  • Symptoms.

  • In-depth interview with your health care provider or a mental health provider.

  • Physical exam to rule out other conditions that could be causing your symptoms.

Treatment

Agoraphobia treatment usually includes both psychotherapy — also called talk therapy — and medicine. It may take some time, but treatment can help you get better.

Talk therapy

Talk therapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of talk therapy for anxiety disorders, including agoraphobia.

Cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you've avoided because of anxiety. Cognitive behavioral therapy is usually a short-term treatment. Through this process, your symptoms improve as you build on your initial success.

You can learn:

  • What factors may trigger a panic attack or panic-like symptoms and what makes them worse.

  • How to cope with and tolerate symptoms of anxiety.

  • Ways to directly challenge your worries, such as whether bad things are actually likely to happen in social situations.

  • That anxiety gradually decreases and that feared outcomes tend not to happen if you remain in situations long enough to learn from them.

  • How to approach feared and avoided situations in a gradual, predictable, controllable and repetitive manner. Also known as exposure therapy, this is the most important part of treatment for agoraphobia.

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia are aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. The therapist may offer to see you first in your home or meet you in what you consider a safe place. Some therapists also may offer some sessions by video, over the phone or through email.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety. An intensive outpatient program usually involves going to a clinic or hospital for either a half or full day over a period of at least two weeks to work on skills to better manage your anxiety. In some cases, a residential program may be needed. This includes a stay in the hospital for a period of time while receiving treatment for severe anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

Medicines

Certain types of antidepressants are often used to treat agoraphobia. Sometimes anti-anxiety medicines are used on a limited basis. Antidepressants are more effective than anti-anxiety medicines in the treatment of agoraphobia.

  • Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants also may effectively treat agoraphobia. Antidepressants also are used for other mental health conditions, such as depression.

  • Anti-anxiety medicine. Anti-anxiety medicines called benzodiazepines are sedatives that, in limited situations, your health care provider may prescribe to relieve anxiety symptoms. Benzodiazepines are generally used only on a short-term basis for relieving anxiety that happens suddenly, also called acute anxiety. Because they can be habit-forming, these medicines are not a good choice if you've had long-term problems with anxiety or problems with alcohol or drug misuse.

It may take weeks for medicine to help manage symptoms. And you may have to try several different medicines before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your health care provider likely will gradually increase your dose during treatment, and slowly decrease your dose when you're ready to stop taking medicine.

Reference

Agoraphobia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987. Published January 7, 2023. Accessed January 11, 2023.

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