Agoraphobia - Fear of Leaving Home

What Is Agoraphobia?

Agoraphobia is a progressive condition where a person initially fears a place where he or she previously had a panic attack. They then start to avoid other places which might be crowded or where help might be unavailable when they have another attack. This includes potentially harmless places like shopping malls and marketplaces as well. In its severe form, the person is unable to even leave their house or room due to fear of going outside their comfort zone, where there is the least chance of embarrassing themselves. So, agoraphobia includes fear of:

• Leaving home.

• Enclosed spaces (like tunnels).

• Open spaces (like parking lots).

• Crowded places (like markets).

• Using public transport vehicles (bus, train, etc.).

In short, it is a fear of any place or situation that they visualize as threatening or inescapable in case of embarrassment or distress.

What Are the Symptoms of Agoraphobia?

Individuals with agoraphobia show the following characteristic behaviors:

• Avoiding places and situations that could trigger their panic attack.

• Not having left the house in an unusually long period of time.

• Fear of leaving the house alone.

• Dependence on others for procuring basic necessities and getting their work done.

• Fear of traveling on a bus or train.

• Feeling agitated or anxious.

• Hesitating to leave the house even in case of a medical emergency.

Some individuals also show signs and symptoms of panic disorder along with agoraphobia. Panic disorder results in sudden episodes of extreme fear, which reach a peak quickly and cause severe physical symptoms. The person might feel that they have completely lost it or have a heart attack. When they do get out, they experience panic attack symptoms such as:

• Feeling distressed.

• Pounding of the heart.

• Shortness of breath.

• Hot flushes.

• Chest pain.

• Numbness.

• Diarrhea.

• Chills.

• Choking.

• Excessive perspiration.

• Feeling faint.

What Are the Causes of Agoraphobia?

Agoraphobia, like most mental health disorders, is not caused by a single factor, but a combination of various factors, such as:

• Past physical or sexual abuse.

• Personality traits.

• Depression or similar mental health conditions such as obsessive-compulsive disorder and generalized anxiety disorder.

• General temperament.

• Substance abuse.

• A family history of the same.

• People with other phobias, such as claustrophobia.

This phobia is more common in females, and the symptoms usually begin around 20 years of age.

When to Consult a Doctor for Agoraphobia?

In the following situations, consult a physician immediately:

• Feeling fear or anxiety whenever exposed to the situation.

• The fear experienced by one does not justify the actual danger of the situation.

• Because of the fear and anxiety, one gets distressed with work or other areas.

• One gets extremely distressed thinking about the situation or needs someone to go with him.

• If this has lasted for longer than six months.

How Does a Doctor Diagnose Agoraphobia?

The doctor will diagnose agoraphobia based on the signs and symptoms. The patients will be asked when and how often they experience these symptoms. The doctor will take the complete medical and family history. The doctor will perform blood tests to rule out other conditions that can result in similar conditions.

The doctor can diagnose agoraphobia only if the patient meets the following criteria that are listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The patient must feel unreasonable fear or anxiety in two or more of the situations that are listed below:

• Taking public transportation like a bus or airplane.

• Standing in open spaces like a parking lot.

• Being in a crowded place.

• Getting out of the house alone.

• Taking the elevator or riding in a car.

There are some additional criteria for the diagnosis of agoraphobia with panic disorder. The patient must have had recurrent panic attacks, which should have followed:

• The fear of having consecutive panic attacks.

• Fear thinking about the complications of panic attacks.

• A behavior change because of panic attacks.

What Are the Treatment Options for Agoraphobia?

Educating people about the condition is the first step in getting better because they know they are not alone in this struggle. Treatment modalities include:

1) Lifestyle Changes -

• Regular exercise increases the production of brain chemicals. This will make the patient happier and more relaxed.

• Eat a healthy diet.

• Practice meditation and deep breathing exercises.

• Avoid taking dietary supplements or herbs during treatment.

2) Psychotherapy or Talk Therapy -

• Cognitive Behavior Therapy: It is a talk therapy that helps to manage problems by changing the way of thinking and behaving.

• Exposure Therapy: In this therapy, therapists help people to overcome their fears by breaking the pattern of avoidance and fear.

• Systematic Desensitization: It is also known as graduated exposure therapy. This therapy combines gradual exposure and relaxation to help people fight their fears.

3) Medications -

• Selective serotonin reuptake inhibitors (SSRIs) such as Paroxetine and Fluoxetine.

• Tricyclic antidepressants such as Amitriptyline and Nortriptyline.

• Anti-anxiety medications such as Alprazolam and Clonazepam.

• Selective serotonin and norepinephrine reuptake inhibitors such as Venlafaxine and Duloxetine.

The treatment of agoraphobia decided for the individual depends on the severity of the symptoms experienced. While some find they can travel a certain distance comfortably, some remain house-bound or room-bound, while others feel safe to venture out when they are accompanied by a friend or someone they are close to. So, it is vital to consult a healthcare professional for this condition, who will ask some questions to assess the severity accurately and treat it accordingly. With proper treatment, there is a good chance of improvement in the overall lifestyle of the affected individual.

What Are the Possible Complications of Agoraphobia?

Agoraphobia greatly limits a person’s day-to-day activities, and in severe cases, leaving home is a challenge. If left untreated, it might result in the following:

1. People becoming housebound for years.

2. They avoid meeting their friends and family or going to work or school.

3. They become dependent on others.

4. Depression.

5. Alcohol or substance abuse.

6. Anxiety disorders.

7. Personality disorders.

Conclusion:

Agoraphobia is a rare type of fear that is characterized by panic and anxiety attacks in places that one finds scary and inescapable. The causes of agoraphobia are unknown, and it is believed that it runs in families. The correct combination of therapy and medication can help manage agoraphobia.