Agoraphobia is a kind of anxiety disorder where the sufferer is afraid of leaving a place that they consider safe. Any attempts of leaving that place will result in a panic attack. Agoraphobia is often mistakenly thought to be a fear of open spaces, but this is a myth.
Some sufferers have shared experiences where they were petrified of leaving their house to collect the milk or newspaper from their doorstep. Some agoraphobics may be limited to one or two rooms of their house. Moreover, agoraphobics are more sensitive to their personal sensations and sometimes simple actions like a fast heart beat while running to catch a bus can trigger an attack because the individual interprets it the start of a panic attack.
The prevalence of agoraphobia is thought to be about 5% of the population in Australia. This condition is also twice as common in women as compared to men.
What is agoraphobia?
The word agoraphobia is derived from the Greek word ‘agora’, which means marketplace and ‘phobia’ which means fear. This phobia was initially considered to be associated with marketplaces but quite recently it has been associated with the panic attacks and anxiety that these individuals experience when they leave their home or any other place that they consider safe.
These individuals will be reluctant to travel in public transport or go to crowded places. This reaction holds its roots in a previous panic attack in the same place or situation. The fear is basically related to the embarrassment felt during a previous panic episode that may have been triggered by non-specific factors like stress.
Agoraphobia may involve completely different situations for different people but usually it involves the fear of being in a situation where escape is not possible or help is unavailable. This usually involves bridges, crowds or travelling alone. It could even be in a room where the exit is not immediately obvious or easily accessible. However this fear can develop anywhere whether it is open public places (shopping malls, airports, bus stops, railway stations), closed places (churches, theatre, cinema halls, aircrafts, trains, tunnnels) or even isolated quiet places like a store at the closing hour.
Symptoms of Agoraphobia
The onset of agoraphobia can be sudden or it may take years to develop. Since it is a learned panic behaviour, it may take some time to develop from a mild condition to a severe one. The agoraphobia symptoms may be triggered by sudden life changes or emotional stress. The symptoms are similar to that of any other panic attack. They may show characteristic behaviours or symptoms such as:
- Feeling depressed
- Alcohol abuse and abusing prescription drugs like tranquilisers
- Fearing the loss of control in certain situations or public places
- Harbouring other phobias like social phobias, phobias of elevators, OCD, PTSD, separation anxiety etc.
- Possessing a low self-esteem and low self-confidence
- Feeling angry and frustrated with oneself
- Anxiety and panic attacks
- Being in a state of confusion
- Being housebound for a long period of time
- Dependence on others and harbouring feelings of helplessness
- Fear of being alone
- Fear of being in a place where escape is impossible
- Fear of feeling detached or estranged from other people
When an agoraphobic is having a panic attack he may experience some physical symptoms. They occur for a short period of time and peak in 10 minutes and these symptoms may fluctuate with time. The symptoms are as follows:
- Dizziness, light-headedness or feeling faint
- Feeling detached with everything even with their own body
- Blurred vision, tinnitus, dry mouth or tingling in face and arms
- Feeling breathlessness without a cause
- Indigestion and nausea
- Severe backache, headache or muscle ache without a cause
- Weakness in legs
- Shaky hands or trembling body
- Hot flashes or chills
- Fear or a heart attack, dying, going crazy or fainting
Treatment for Agoraphobia
Most agoraphobics are recognised by their characteristic behaviour of staying home bound or going to a hospital very frequently with the fear that they are going to have a heart attack or are going to die. A thorough physical and psychological examination is required to rule out other medical conditions before a diagnosis for Agoraphobia can be established.
Living with an illness like agoraphobia can be quite isolating for the sufferer. They should be reassured that help is available for their mental health problem. The first step towards management is reaching out and asking for help.
The standard treatment approach involves a combination of cognitive behaviour therapy with anti-depressant medication.
Cognitive behaviour therapy
This will involve 10-20 visits with a mental health professional over a period of few weeks. CBT will help the individual change the thoughts that influence the situation. It involves gaining an understanding of the triggers and the feelings about the stressful situation and then establishing control over them. Then the individual is taught how to recognise the panic-causing thoughts and replace them with positive ones. The individual is also taught various stress management and relaxing techniques to cope with the panic disorders. A technique of systemic desensitization and exposure therapy is also provided which makes the individual is put in a relaxed state and then made to imagine the things that cause anxiety starting from the least fearful to the most fearful.
Selective serotonin reuptake inhibitors are the first line drugs preferred in individuals suffering from agoraphobia. This is followed by Serotonin or epinephrine reuptake inhibitor drugs as an alternative. Other anti-depressants, anti-seizure drugs or anti-anxiety drugs like benzodiazepine can also be prescribed to individuals with severe or refractory agoraphobia.
An important part of being able to overcome the symptoms of agoraphobia is being able to gain a sense of mastery and control over the triggers and attacks. Relaxation training can be incredibly helpful in assisting the sufferer do this. This may include breathing exercises, guided imagery exercises, hypnosis sessions and self-hypnosis audios, meditation and mindfulness approaches.
Change of lifestyle
Changing your lifestyle can be very effective in reducing anxiety and the symptoms of agoraphobia. This may involve reducing stress by working less and taking more holidays, eating a better diet, exercising more frequently, limiting your use of certain medications and reducing your caffeine and alcohol intake.
Support groups can be very helpful on a number of levels. The power of working in a group on personal issues such as relationships, anxiety, depression and other stressors can have enormous benefits for the group member. You can also receive support and encouragement from other members who are also struggling with similar issues. This support can be healing and allow the sufferer to realise they are not alone in their difficulty, which helps them raise their self-esteem and quality of life.
Many of the interpersonal and relational psychotherapies are very effective for dealing with the underlying issues and traumas that may be related to the agoraphobia attacks and symptoms. Interpersonal therapy has some of the highest success rates of all the therapies and involves using the relationship with your therapist as part of the therapeutic process to learn about your own relationship style and other relational issues that are contributing to the anxiety and agoraphobia.
If you want help with dealing with anxiety, Australia Counselling links you with professional counsellors and psychologists in Melbourne, Perth, Sydney, Brisbane, Adelaide and regional areas of Australia. Just visit our anxiety and/or panic attacks page to see counsellors and psychologists listed in your local area.