Agoraphobia

Agoraphobia (a-go-ra-FO-bee-a) is an anxiety disorder that involves intense fear of having a panic (PA-nik) attack and avoidance of situations that a person fears may trigger a panic attack, such as leaving the home or being in a crowd. The effort to avoid such situations may greatly limit a person's life.

In Greek, the word agoraphobia means "fear of the marketplace." In English, the term is used to describe a disabling disorder that often leads people to fear being in crowds, standing in lines, going to shopping malls, or riding in cars, buses, or subways. In its most extreme form, the disorder can make people afraid of traveling beyond their neighborhoods or even stepping outside their homes. Put simply, agoraphobia is a fear of fear.

What Is Agoraphobia?

Agoraphobia refers to an intense, unreasonable, and long-lasting fear (a phobia) of panic attacks and avoidance of situations in which a panic attack might arise. A panic attack is a sudden surge of overwhelming terror that occurs unexpectedly and without good reason. The person is actually in no real danger. Although it is harmless, a panic attack can cause upsetting psychological symptoms, such as a feeling of unrealness and a fear of losing control, as well as unpleasant physical symptoms, such as a racing heart, sweating, trembling, shortness of breath, chest pain, upset stomach, and dizziness. People with agoraphobia have experienced panic attacks and are fearful about experiencing more attacks.

People with agoraphobia may limit themselves to being in places they think of as safe. Any movement beyond this safety zone leads to mounting worry and nervousness. They may worry about whether they could quickly escape from a certain place if they should begin to have a panic attack there. People with agoraphobia often avoid being on busy streets or in crowded classes or stores for fear that they might feel trapped if they start to have a panic attack. Gradually, the places that feel "safe" become fewer and fewer. Some people reach the point where they are too frightened even to leave their homes. Others still go out, but it causes great distress, and they may insist that family members or friends go with them. Such self-imposed limits can make it difficult for people to get on with their lives at school and work.

What Causes Agoraphobia?

Most people with agoraphobia experience the disorder after first having one or more panic attacks. Panic attacks usually strike unexpectedly, which makes it difficult for people to predict which situations will trigger them. This lack of predictability prompts people to worry about when the next attack will occur. It also teaches them to fear situations where attacks have happened in the past, even if this fear is unreasonable. As a result, people may begin avoiding such situations. Over time, avoidance actually can reinforce the person's phobia, making the condition worse.

What Are the Symptoms of Agoraphobia?

Agoraphobia typically starts between the ages of 18 and 35. Two-thirds of those affected are women. Most people with agoraphobia also have panic disorder, which means that they have repeated, unexpected panic attacks. A few do not have full-blown attacks, but they have similar symptoms of panic. Someone with agoraphobia may catastrophize (imagine the worst) about what could happen to them if they left home. For example, they may be afraid to leave home because they fear becoming dizzy, fainting, and then being left helpless on the ground. Without treatment, agoraphobia can cause misery for years.

How Is Agoraphobia Treated?

About one-third of people with panic disorder eventually go on to have agoraphobia, too. Treatment of panic disorder can help prevent agoraphobia. Once agoraphobia has set in, people still may be helped by the same kinds of medications and therapy used to treat panic disorder. People with agoraphobia may be helped by exposure therapy (a type of behavior therapy), in which they gradually are put in situations that frighten them until the fear begins to fade. Some therapists go to people's homes for the first few sessions, because someone with agoraphobia may not feel able to get to the therapist's office. Therapists who do exposure therapy also teach coping skills to help with anxiety. Exposure therapy may involve taking patients on short trips to shopping malls or other places that the patients have been avoiding. As people begin to spend more and more time in feared situations, using coping skills instead of avoidance, they may learn that they can handle their feelings after all.