Agoraphobia

Agoraphobia is an irrational fear of being trapped in places or situations where escape could be difficult or impossible. People with agoraphobia often will not leave the house. It often occurs in association with panic disorder . In this case, the affected people may fear that help will not be available in certain places in case a panic attack occurs.

The exact cause is unknown. Most people develop agoraphobia after having panic attacks. Afraid of having another attack, an agoraphobic avoids places and situations that have triggered an attack. Factors that may contribute to the development of this phobia include:

• Changes in brain chemistry or activity
• Distorted thinking, which may start a cycle of fear
• Genetics
• Having a nervous system that reacts excessively, even to normal stimuli
• Increased awareness of physical changes (such as increased heart rate)

These factors increase your chance of developing agoraphobia. Tell your doctor if you have any of these risk factors:

• A tendency to be nervous or anxious
• Age: 18-35
• Family members with panic disorder or phobias
• Other psychiatric disorders
• Personality disorder
• Sex: female
• Stressful situations

Symptoms include:

• Feelings of anxiety when outside the safe zone
• Avoidance of situations that might cause a panic attack
• Becoming homebound
• Creation of a safe zone
• Fear of being alone
• Fear of being in a crowd, shopping, standing in line, or similar activities
• Fear of riding in a car, bus, or train
• Feeling of being safer with a trusted friend
• Lack of interest in normal activities
• Restriction of activities outside the home

Agoraphobia is commonly associated with the following:

• Eating disorders ( anorexia nervosa , bulimia nervosa )
• Alcohol or drug abuse
• Depression
• Panic disorder

Feared situations may trigger a panic attack. Attacks start quickly and peak in about 10 minutes. A panic attack usually includes four or more of the following:

• Fear of having a heart attack or dying
• Blushing
• Chest pain
• Dizziness or lightheadedness
• Feeling of loss of control or "going crazy"
• Hot flashes or chills
• Intense fear
• Nausea
• Numbness or tingling
• Pounding or racing feeling in the chest
• Rapid heartbeat
• Shaking
• Shortness of breath
• Sweating

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may also look for a medical condition, drug, or other substance that may be causing your symptoms.

You may be asked questions about your:

• Family's mental health
• Mental health
• Use of alcohol and drugs

There are no tests for agoraphobia or panic disorder. However, you may have heart or blood tests done to look for an underlying cause.

Treatment aims to help you overcome irrational fears and live more independently. Goals include:

• Learning to manage panic attacks that do occur
• Reducing the number and severity of panic attacks

Treatments may include:

Agoraphobia often develops as a response to panic attacks. Instead of avoiding places where you have had a panic attack, it is better to seek medical care. Early treatment for panic attacks can help prevent agoraphobia.