Agoraphobia is a type of anxiety disorder in which the sufferer doesn’t fear crowded situations, as is commonly believed, but rather, the individual fears having a panic attack in general in any place, be it home, at work, or in a shopping mall. Social anxiety disorder (SAD) is often confused for agoraphobia.
Agoraphobia often leads to avoidance of situations such as being alone outside of the home; traveling in a bus, car or airplane; or being in a crowded area where they may have a panic attack and won’t be able to receive help. Some people with agoraphobia are comfortable seeing visitors, but only in a defined space they feel in control of. These people may live for years without leaving their homes, happily seeing visitors and working, content as long as they can stay within their safety zones.
A person with this disorder may have severe panic attacks in situations where he or she feels trapped, out of control, insecure, or simply too far from his or her comfort zone. In times of severe anxiety, an agoraphobic person may be confined not only to his or her home, but to one or two rooms, and may even become bed-bound until the over-stimulated nervous system is calmed, and adrenaline levels have returned to normal.
Individuals with agoraphobia are often extremely sensitized to their own bodily sensations, subconsciously over-reacting to perfectly routine events. For example, the exertion required to climb a flight of stairs may lend to a full-blown panic attack, because it increased the heart and breathing rate, which the agoraphobic interprets as the start of a panic attack. People with severe agoraphobia learn to avoid situations where an attack may be brought on.
Agoraphobia occurs in women twice as commonly as in men. This may be attributable to social/cultural factors that encourage, or permit, the greater expression of avoidance coping strategies by women, though other reasons may play into this as well.
The National Institute of Mental Health (NIMH) reports that one out of three people with panic disorder will develop agoraphobia as well. It’s estimated that 3.2 million Americans aged 18-54 are living with agoraphobia. Most people develop agoraphobia after the onset of panic disorder, and as such, the diagnosis of panic disorder with agoraphobia was established. However, for people who do not meet full criteria for panic disorder, the formal diagnosis of “agoraphobia without history of panic disorder” is used.
Successful treatment of agoraphobia is possible for many people through a very gradual process of exposure therapy combined with cognitive therapy and sometimes antidepressant or anti-anxiety medications. Anti-anxiety medications include benzodiazepines such as alprozalam. The antidepressants most often used are SSRIs like paroxetine, fluoxetine and sertraline. The treatment options for panic disorder and agoraphobia are similar.
Behavior therapy for agoraphobia helps the individual modify and gain control over unwanted behavior, and allows them to cope with difficult situations, often through controlled exposure to them. Cognitive therapy gives the sufferer the tools to change unproductive or harmful thought patterns, and allows them to examine his or her feelings and learn to separate realistic from unrealistic thoughts. As with behavior therapy, the individual is actively involved in his or her own recovery and has a sense of control.
Cognitive-Behavior Therapy, or CBT, is a combination of the above two therapeutic approaches. One of the benefits of these types of therapies is that the patient learns recovery skills that are useful for a lifetime.
While those are the most commonly used treatment options, others include relaxation techniques, hypnotherapy, neuro-linguistic programming (NLP), and energy psychology. With proper treatment and techniques, agoraphobia can be treated and the person can go on to live a productive life.
There’s no miracle cure for agoraphobia, but there are numerous treatment options that will help the sufferer learn to deal with and overcome the fear and anxiety that has become so prohibitive to their daily functioning.