Agoraphobia
Agoraphobia is a fear of
being in situations where escape might be difficult or that help wouldn't be
available if things go wrong. Many people assume agoraphobia is simply a fear of
open spaces, but it's actually a more complex condition. Someone with
agoraphobia may be scared of:
- travelling
on public transport
- visiting
a shopping centre
- leaving
home.
If someone with agoraphobia finds themselves in a
stressful situation, they'll usually experience the symptoms of a panic attack, such as:
- rapid
heartbeat
- rapid
breathing (hyperventilating)
- feeling
hot and sweaty
- feeling
sick.
They will avoid situations that cause anxiety and may only leave the house
with a friend or partner. They'll order groceries online rather than going to
the supermarket. This change in behaviour is known as avoidance.
What causes agoraphobia?
Agoraphobia usually develops as a complication of panic disorder, an anxiety disorder
involving panic attacks and moments of intense fear. It can arise by
associating panic attacks with the places or situations where they occurred and
then avoiding them.
A minority of people with agoraphobia have no
history of panic attacks. In these cases, their fear may be related to issues
like a fear of crime, terrorism, illness, or being in an accident. Traumatic events, such as bereavement, may contribute towards
agoraphobia, as well as certain genes inherited from your parents.
Diagnosing agoraphobia
You must speak to your doctor/ GP if you think you may be
affected by agoraphobia. It should be possible to arrange a telephone
consultation if you don't feel ready to visit your GP in person.
Your doctor will ask you to describe your symptoms, how
often they occur, and in what situations. It is very important you tell them how
you've been feeling and how your symptoms are affecting you. Your doctor may ask you the following questions:
- Do
you find leaving the house stressful?
- Are
there certain places or situations you have to avoid?
- Do
you have any avoidance strategies to help you cope with your symptoms,
such as relying on others to shop for you?
It can sometimes be difficult to talk about your
feelings, emotions, and personal life, but try not to feel anxious or
embarrassed. Your doctor needs to know as much as possible about your symptoms
to make the correct diagnosis and recommend the most appropriate
treatment.
Treating agoraphobia
With psychological treatment (talking therapies),
most people with agoraphobia will make significant improvements, particularly
if the three steps described below are followed. A stepwise approach is usually recommended for
treating agoraphobia and any underlying panic disorder:
- step one – educate yourself
about your condition, possible lifestyle changes you can make, and
self-help techniques to help relieve symptoms
- step two – enrol yourself on a
guided self-help programme
- step three – more intensive treatments,
such as cognitive behavioural therapy (CBT) or
medication.
Lifestyle changes may include taking regular exercise, eating more healthily, and avoiding
alcohol, drugs and drinks that contain caffeine, such as tea, coffee
and cola. Self-help techniques that can help during a panic
attack include staying where you are, focusing on something that's
non-threatening and visible, and slow, deep breathing.
If your agoraphobia fails to respond to these
treatment methods, your doctor may suggest trying a guided self-help
programme. This involves working through self-help manuals that cover the types
of issues you might be facing, along with practical advice about how to deal
with them.
Medication may be recommended if self-help
techniques and lifestyle changes aren't effective in controlling your symptoms.
You will usually be prescribed a course of selective serotonin reuptake inhibitors (SSRIs),
which are also used to treat anxiety and depression. In severe cases of agoraphobia, medication can be
used in combination with other types of treatment, such as CBT and relaxation
therapy.
Outlook
Around a third of people with agoraphobia
eventually achieve a complete cure and remain free from symptoms. Around half experience an improvement in symptoms,
but they may have periods when their symptoms become more troublesome –
for example, if they feel stressed. Despite treatment, about one in five people with
agoraphobia continue to experience troublesome symptoms.
How common is agoraphobia?
In the UK, up to 2 people in 100 have panic
disorder. It's thought around a third will go on to develop agoraphobia. Agoraphobia is twice as common in women as men. It
usually starts between the ages of 18 and 35.
Source: NHS Choices