Agoraphobia: Roots, Symptoms and Treatment of Psychological Fear

The word agoraphobia is derived from Greek words literally meaning "fear of the marketplace." Agoraphobia is an anxiety or panic disorder related to fear, and treatment can be difficult, because it involves facing those fears head on.

Many people suffer from general anxiety or panic attacks. The agoraphobic has a fear of places where it may be difficult or embarrassing to get help or where she might have a panic attack and not be able to get help, such as elevators or buses. People with agoraphobia also tend to feel unsafe and overwhelmed in public places, especially where there are crowds, as at sporting events, shopping malls, and airports. Because of this irrational fear of public places, many venture out of their homes less and less often, with some eventually becoming homebound.

Agoraphobia is the most common type of phobia. The numbers vary. Some report that as many as 5-12% of Americans will experience agoraphobia, while others say less than one percent (1%) of the population is thought to have it. Agoraphobia is twice as common in women as in men and usually strikes between the ages of 15-35, most often in the mid- to late twenties.

Cause and Affect
A diagnosis of agoraphobia is made primarily on the patient's description of his or her symptoms. Often a person will become aware of the stress and anxieties associated with going out in public or feel as if they are "losing their mind," and seek help on their own. It is also not unusual for a friend or family member to notice that another person is reluctant to leave home alone and encourage them to talk with a doctor or counselor.

Agoraphobia and other phobias are thought to be the result of a number of physical and environmental factors. There is much speculation, but no real understanding as to what causes agoraphobia. Life experiences, genetics, and biology are all thought to play a role. The anxiety component, like other anxiety disorders, may be linked to chemical imbalances in the brain, specifically the neurotransmitters.

Medication
The anxiety and panic components of agoraphobia are typically treated with antidepressant and anti-anxiety medications. The class of medications known as SSRIs--selective serotonin reuptake inhibitors-which are thought to affect nerve transmission are most often prescribed. These include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft). SSRIs have been approved by the Food and Drug Administration to treat panic disorder. Other types of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) also are sometimes used to treat agoraphobia, but reportedly have more side effects and more serious side effects than SSRIs.

Benzodiazepines, including alprazolam (Xanax), clonazepam (Klonopin) are also helpful in controlling symptoms of anxiety and panic attacks, and are often used in treatment of agoraphobia.

Anti-anxiety medications may start working right away to reduce symptoms, while antidepressants may take a couple of weeks to make a real difference. A doctor may suggest taking both types of drugs to maximize effectiveness. It may also be necessary to try different medications before finding one that works.

Therapy
Cognitive behavior therapy is widely recognized as the most beneficial way to treat agoraphobia. It has two main components, cognitive and behavioral.

The cognitive component focuses on helping the patient learn more about agoraphobia and panic attacks and how to control them. This involves understanding what triggers the attacks or worsens them, recognizing the onset of anxiety, as well as coping skills for when the symptoms do occur, such as breathing and relaxation exercises.

The behavioral component involves changing unwanted or unhealthy behaviors through a process known as desensitization, or exposure therapy. Simply put, this is a process whereby the therapist supports the patient in confronting her fears by accompanying her on outings and to places and situations that cause fear and anxiety. With practice and the reassurance of the presence of the therapist, the patient is gradually able to learn that the fears are unfounded and the anxiety typically goes away in time. The process is often aided by the earlier introduction of cognitive therapy and appropriate medication. Given that the very nature of the phobia is an inability to leave home, many therapists who treat it will make "house calls," meet patients in a "safe zone" agreed upon in advance or in the company of a trusted friend or relative for the initial visits.

The most important thing for an agoraphobic to know is that help and support are available-even before they step outside.