Agoraphobia

What is Agoraphobia?

A panic disorder is the presence of recurrent, unexpected panic attacks followed by constant worry that the panic attacks will return and the implications or consequences of the attacks. There may also be a change in behavior associated with the attacks. Agoraphobia is a fear of being out in public. The fear is generally caused by panic attacks. This fear leads to staying home and persistently avoiding these situations, or enduring the situation with intense dread and with the help of a companion. Examples of feared situations are being in a grocery store, shopping mall, or other crowded situations. Agoraphobia is usually diagnosed in association with panic disorder, in which there are recurrent panic attacks that may be predictable or occur unexpectedly. A panic attack is a sudden onset of multiple symptoms of intense fear, consistent with a sense of an impending disaster.

Panic disorder, with or without agoraphobia, is present in between one to three percent of people at some time in their lives. Age at onset is usually between the late teens and mid-30s. The distress is not due to a social or specific phobia or another anxiety disorder.

With this diagnosis, the panic attacks are judged not directly due to drug abuse, a medical condition (such as an overactive thyroid gland), or side effects of medication. The panic is not explained by other anxiety disorders such as a specific or social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, or separation anxiety disorder.

How is Agoraphobia diagnosed?

• History is of recurrent panic attacks, which is an experience of at least four of the following: a pounding heart, sweating, trembling, shortness of breath or suffocating, choking, chest pain, nausea, dizziness, feelings of unreality, fear of going crazy, fear of dying, numbness, or chills. Onset of the attack is sudden, with symptoms peaking in ten minutes or less. There is chronic worry about having another attack, or that the attacks indicate a serious medical or mental disease. Agoraphobia is the additional fear about being in public places and having a panic attack there; the belief is that help would be unavailable, and escape from this situation might be difficult or embarrassing. The fear leads to consistently avoiding those situations. The individual might be able to expose themselves to the situation with difficulty if accompanied by a trusted person.
• Physical exam, if performed during a panic attack, could demonstrate a rapid heart rate and elevated blood pressure. Observation of the individual's orientation, dress, mannerisms, behavior and content of speech provide essential signs to diagnose the illness.
• Tests do not establish this diagnosis.

How is Agoraphobia treated?

It is treated with both cognitive behavioral therapy and drug therapy. Cognitive therapy is done to suggest that panic is a misinterpretation of body sensations and that the danger is not as extreme as is perceived. Relaxation training and progressive muscle relaxation can be done, along with respiratory control training. Exposure therapy, where the person is gradually exposed little by little to the dreaded situation, is a useful treatment. Supportive psychotherapy is done as needed. Drug therapy is usually a serotonin-specific reuptake inhibitor (SSRI) with some use of benzodiazepine. Tricyclic antidepressants are occasionally prescribed.

Medication for Agoraphobia

Information	Brand	Generic	Label	Rating
	Zoloft	Sertraline
	Elavil	Amitriptyline
	Paxil	Paroxetine

Klonopin (Clonazepam), Xanax (Alprazolam), Prozac (Fluoxetine), Tofranil (Imipramine), Trileptal (Oxcarbazepine)

What might complicate it?

Staying at home can often result in a loss of most relationships and employment. Some individuals may become convinced that they have an undiagnosed life threatening disease or that they are going crazy and may limit their activities even further.

Predicted outcome

Outcome is variable. The panic attacks come and go over the years. The agoraphobia may subside if the panic attacks subside but may remain chronically present.

Alternatives

Other possibilities are agoraphobia without a history of panic disorder, anxiety disorder due to a medical condition, substance-induced anxiety disorder, social phobia, specific phobia, obsessive-compulsive disorder, hyperventilation syndrome, separation anxiety disorder, and delusional disorder. Medical causes include an underactive or overactive thyroid gland.

Appropriate specialists

Psychiatrist or psychologist.

Last updated 20 December 2011