Agoraphobia is an irrational fear of being trapped in places or situations where escape could be difficult or impossible. People with agoraphobia often will not leave the house. It often occurs in association with panic disorder.

Causes

The exact cause is unknown. Most people develop agoraphobia after having panic attacks. Afraid of having another attack, an agoraphobic avoids places and situations that have triggered an attack. Factors that may contribute to the development of this phobia include:

• Genetics

• Changes in brain chemistry or activity

• Having a nervous system that reacts excessively, even to normal stimuli

• Increased awareness of physical changes (such as increased heart rate)

• Distorted thinking, which may start a cycle of fear

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for agoraphobia include:

• A tendency to be nervous or anxious

• Stressful situations

• Family members with panic disorder or phobias

• Age: 18-35

• Sex: Female

• Other psychiatric disorders

• Personality disorder

Symptoms

Symptoms include:

• Fear of being in a crowd, shopping, standing in line, or similar activities

• Fear of riding in a car, bus, or train

• Creation of a safe zone

• Feelings of anxiety when outside the safe zone

• Fear of being alone

• Avoidance of situations that might cause a panic attack

• Restriction of activities outside the home

• Feeling of being safer with a trusted friend

• Lack of interest in normal activities

• Becoming homebound

Agoraphobia is commonly associated with the following:

• Panic disorder

• Depression

• Eating disorders (anorexia nervosa and bulimia nervosa)

• Alcohol or drug abuse

Feared situations may trigger a panic attack. Attacks start quickly and peak in about 10 minutes. A panic attack usually includes four or more of the following:

• Intense fear

• Shaking

• Rapid heartbeat

• Pounding or racing feeling in the chest

• Sweating

• Blushing

• Shortness of breath

• Chest pain

• Dizziness or lightheadedness

• Hot flashes or chills

• Numbness or tingling

• Nausea

• Feeling of loss of control or "going crazy"

• Fear of having a heart attack or dying

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may also look for a medical condition, drug, or other substance that may be causing your symptoms.

You may be asked questions about your:

• Use of alcohol and drugs

• Mental health

• Family's mental health

There are no tests for agoraphobia or panic disorder. However, you may have heart or blood tests done to look for an underlying cause.

Treatment

Treatment aims to help you overcome irrational fears and live more independently. Goals include:

• Reducing the number and severity of panic attacks

• Learning to manage panic attacks that do occur

Treatments may include:

Prevention

Agoraphobia often develops as a response to panic attacks. Instead of avoiding places where you have had a panic attack, it is better to seek medical care. Early treatment for panic attacks can help prevent agoraphobia.

RESOURCES:

American Psychiatric Association
http://www.psych.org

Anxiety Disorders Association of America
http://www.adaa.org

Mental Health America
http://www.nmha.org

References:

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Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005 Aug 20-26;366(9486):665-75.

National Institute of Mental Health website. Available at: http://www.nmha.org.

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