Agoraphobia is often defined as the fear of leaving home, but this definition is somewhat inaccurate. Instead, agoraphobia is properly defined as the fear of being in a situation where escape would be difficult or impossible, or help would be unavailable, if a panic attack occurs. In many ways, then, agoraphobia is a fear of fear. However, untreated agoraphobia can lead to ever-increasing restriction of freedom, eventually causing the sufferer to become housebound.
Symptoms of Agoraphobia
The symptoms of agoraphobia vary between sufferers. The symptoms that you experience depend on many factors, including the severity of your condition. Nonetheless, agoraphobia generally presents a common pattern of symptoms:
Panic: Ironically, the fear of having a panic attack can increase your chances of having one. Many agoraphobia sufferers experience panic attacks when contemplating placing themselves in feared situations.
Avoidance: The fear of panicking in public leads many agoraphobia sufferers to severely restrict their movements. You may find yourself making excuses for skipping social activities or going out of your way to avoid driving over a bridge.
Clustering: Agoraphobia avoidance generally occurs in clusters. Common clusters include driving, crowded events, and leaving home.
Diagnosing Agoraphobia
Agoraphobia can mimic many other disorders, including specific phobias, other anxiety disorders, and even more serious mental health conditions. Only a trained mental health professional can make a definitive diagnosis of agoraphobia. However, a list of diagnostic criteria can be found in the Diagnostic and Statistical Manual (4th ed., DSM-IV).
Agoraphobia is often present as part of panic disorder, but may occur separately as well. Your clinician will determine whether or not you have concurrent panic disorder.
Treating Agoraphobia
Like all phobias, agoraphobia can be treated in a variety of ways. The most common are medication, therapy, and alternative remedies.
The medical model states that agoraphobia is based in changes in brain chemistry. Certain medications can be used to balance the brain’s chemicals and treat the phobia. Commonly used types of medication include SSRIs, MAOIs, and benzodiazepines.
Each of these medications has a unique effect on brain chemistry. Each also carries a risk of side effects, which may vary according to your overall health and other prescription medications. Your psychiatrist or family doctor will work carefully with you to find the optimal prescription and dosage to meet your needs.
Various types of talk therapy, from psychoanalysis to behavior therapy, have been demonstrated to be effective in treating agoraphobia. For many reasons, though, cognitive-behavioral therapy is one of the most popular.
The approach that your therapist uses will be based on many factors including the severity of your agoraphobia, your personal preferences, and the therapist’s style. Because agoraphobia is complex, many therapists prefer to draw techniques from a variety of disciplines. This eclectic approach allows flexibility in your treatment plan.
Many agoraphobia sufferers find partial or total relief from a range of alternative therapies. Some of the most popular include hypnotherapy, guided visualization, homeopathy, and aromatherapy. It is important to note that few of these remedies have been rigorously studied under clinical conditions. Therefore, if you plan to use alternative methods to treat your agoraphobia, it is highly recommended that you consult both an expert in that remedy and a licensed mental health professional.
Agoraphobia in Older Adults
While most anxiety disorders first appear by early adulthood, new-onset agoraphobia is not unusual among older adults. This new phobia can be difficult for both the sufferer and his family to recognize and manage.
Unlike in younger adults, new agoraphobia in the elderly is rarely associated with panic disorder. Instead, it appears to be based in reasonable fears that spiral out of control. For example, an older adult whose eyesight is failing may make the prudent decision not to drive at night. Soon, however, she may become afraid of driving at all.
Likewise, a well-meaning relative may become overprotective, encouraging the older person to remain close to home. Eventually, this could lead to a fear of traveling.
Because agoraphobia in the elderly can be insidious, it is crucial that professional guidance be sought. A geriatric psychologist can help determine whether agoraphobia or any other disorder is present, and make individualized recommendations for treatment.
Living With Agoraphobia
Agoraphobia can be devastating to all aspects of your life, including work, school, and personal relationships. Untreated, it may become chronic and even progress to new clusters. Over time, you might find yourself restricting your movements further and further until you eventually become housebound.
Fortunately, treatment is readily available and generally successful. Seeking out a qualified mental health professional is an important first step. Meanwhile, joining a support group can teach you tips and tricks for managing your daily life and fighting this insidious, often debilitating condition.
Source:American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.
