Definition

The word agoraphobia is derived from Greek words literally meaning "fear of the marketplace." The term is used to describe an irrational and often disabling fear of being out in public.

Description

Agoraphobia is just one type of phobia, or irrational fear. People with phobias feel dread or panic when they face certain objects, situations, or activities. People with agoraphobia frequently also experience panic attacks, but panic attacks, or panic disorder, are not a requirement for a diagnosis of agoraphobia. The defining feature of agoraphobia is anxiety about being in places from which escape might be embarrassing or difficult, or in which help might be unavailable. The person suffering from agoraphobia usually avoids the anxiety-provoking situation and may become totally housebound.

Causes and symptoms

Agoraphobia is the most common type of phobia, and it is estimated to affect between 5-12% of Americans within their lifetime. Agoraphobia is twice as common in women as in men and usually strikes between the ages of 15-35.

The symptoms of the panic attacks which may accompany agoraphobia vary from person to person, and may include trembling, sweating, heart palpitations (a feeling of the heart pounding against the chest), jitters, fatigue, tingling in the hands and feet, nausea, a rapid pulse or breathing rate, and a sense of impending doom.

Agoraphobia and other phobias are thought to be the result of a number of physical and environmental factors. For instance, they have been associated with biochemical imbalances, especially related to certain neurotransmitters (chemical nerve messengers) in the brain. People who have a panic attack in a given situation (e.g., a shopping mall) may begin to associate the panic with that situation and learn to avoid it. According to some theories, irrational anxiety results from unresolved emotional conflicts. All of these factors may play a role to varying extents in different cases of agoraphobia.

Diagnosis

People who suffer from panic attacks should discuss the problem with a physician. The doctor can diagnose the underlying panic or anxiety disorder and make sure the symptoms aren't related to some other underlying medical condition.

The doctor makes the diagnosis of agoraphobia based primarily on the patient's description of his or her symptoms. The person with agoraphobia experiences anxiety in situations where escape is difficult or help is unavailable--or in certain situations, such as being alone. While many people are somewhat apprehensive in these situations, the hallmark of agoraphobia is that a person's active avoidance of the feared situation impairs his or her ability to work, socialize, or otherwise function.

Treatment

Treatment for agoraphobia usually consists of both medication and psychotherapy. Usually, patients can benefit from certain antidepressants, such as amitriptyline (Elavil), or selective serotonin reuptake inhibitors, such as paroxetine (Paxil), fluoxetine (Prozac), or sertraline (Zoloft). In addition, patients may manage panic attacks in progress with certain tranquilizers called benzodiazepines, such as alprazolam (Xanax) or clonazepam (Klonipin).

The mainstay of treatment for agoraphobia and other phobias is cognitive behavioral therapy. A specific technique that is often employed is called desensitization. The patient is gradually exposed to the situation that usually triggers fear and avoidance, and, with the help of breathing or relaxation techniques, learns to cope with the situation. This helps break the mental connection between the situation and the fear, anxiety, or panic. Patients may also benefit from psychodynamically oriented psychotherapy, discussing underlying emotional conflicts with a therapist or support group.

Prognosis

With proper medication and psychotherapy, 90% of patients will find significant improvement in their symptoms.

Resources:

Books

• Hallowell, Edward M. Worry: Controlling It and Using It Wisely. New York: Pantheon Books, 1997.

Periodicals

• Forsyth, Sondra. "I Panic When I'm Alone." Mademoiselle, Apr. 1998, 119-24.
• Hale, Anthony S. "ABC of Mental Health: Anxiety." British Medical Journal 314 (28 June 1997): 1886-9.
• "Panic Disorder -- Panic Attacks and Agoraphobia." American Family Physician 52, no. 7 (15 Nov. 1995): 2067-8.

Organizations

• American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org
• Anxiety Disorders Association of America. 11900 Park Lawn Drive, Ste. 100, Rockville, MD 20852. (800) 545-7367. http://www.adaa.org
• National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. http://www.nimh.nih.gov

Reviewed: 01/2006