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Agoraphobia

Agoraphobia is clinically defined as a fear of public spaces, in which getting away from a situation may be difficult, so it is avoided.

  1. It is complex and can make some people house-bound
  2. Causes similar symptoms to a panic attack
  3. Can be treated with CBT and antidepressants

Agoraphobia is a condition that can severely affect peoples’ lives, as they may only leave the house with a friend or partner. Speaking to a doctor online via the treated.com video consultation service could help you to formulate a treatment plan and manage symptoms more effectively.

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Description

What is agoraphobia?

Agoraphobia literally means the fear of open spaces. However, this does not cover the definition that is used in medicine. In order for agoraphobia to be diagnosed, the person must feel anxiety about being unable to escape from a situation, and subsequently avoid putting themselves in the situation altogether, to prevent this panic from manifesting.

The condition usually involves some overlapping with other phobias, such as being afraid of confined spaces, travelling alone away from home and being stuck in large crowds. In these situations, people with agoraphobia develop sudden anxiety, which often cannot be controlled. 

Who gets agoraphobia?

Agoraphobia has a tendency to affect more females than males, and the most commonly affected age bracket is between 25-35 years old.  In terms of developing the condition within a 12-month period, prevalence is around 6%. 

Around one third of people who have panic disorder are affected by agoraphobia, and the agoraphobic anxiety will occur before a panic attack. It is thought that the overall prevalence of agoraphobia without panic disorder is 0.8% and 0.6% among adolescents and young adults.

What causes agoraphobia?

The condition is thought to have several main causes. Biological factors may play a role. This could be an imbalance in neurotransmitters, which trigger the ‘fight or flight’ response in the body when it is not necessary. It is also possible that people with agoraphobia have a decreased ability to detect spatial awareness, which leads to a feeling of disorientation.

There are also various psychological factors that could have an influence on developing agoraphobia. Experiencing a traumatic event has been strongly associated with panic disorder, which could be linked to the development of the condition. Additionally, having a history of mental illness, or misusing drugs and alcohol, could trigger agoraphobia.

What symptoms can agoraphobia cause?

When someone who experiences agoraphobia is in an uncomfortable situation, they might experience:

  • Heart palpitations
  • Sweating
  • Feeling sick
  • General pain in the stomach
  • Shaking
  • Pain in the chest

The severity to which these symptoms will affect the person varies greatly; some people can cope with them by following routines and going to places where they understand the surroundings well. Others however can lose significant functionality and lose consciousness if the symptoms are very intense.

One of the main issues with agoraphobia is that avoiding feared situations for a prolonged period can cause the anxiety to intensify. This is why treatment is important - so that these fears can be confronted and overcome.

If you think that you are suffering from agoraphobia, or have already been diagnosed and would like to speak to a doctor online, you can do so by using the treated.com video consultation service. Once you have booked an appointment, you will be able to speak to one of our doctors at a convenient time for you.

Page last reviewed:  12/06/2020
Diagnosis and treatment

How does someone know they have agoraphobia?

If you have regularly avoided situations that are in public spaces in fear of having a panic attack over the last 6 months, this could be an indication of agoraphobia.

If leaving your home, being in a confined space, being in a wide open space or a crowded space has made you anxious, you could have agoraphobia. There is no way to self-diagnose the condition however, so you should contact your local GP to discuss your symptoms and history in more detail.

How is agoraphobia diagnosed?

Agoraphobia can be diagnosed by identifying two or more of five symptoms, as created by the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5). The five symptoms are (fear of):

  • Public transport
  • Being away from home
  • Closed-off buildings 
  • Open spaces
  • Standing in crowded queues

Someone with agoraphobia may avoid these situations and feel anxious about them. This is because there is a perception that escaping from them might be difficult, or that no one will be able to help them should the situation result in panic. 

The fear or anxiety that is felt in cases of agoraphobia should also be disproportionate to the actual threat that is posed. It should be a recurrent experience over a period of more than 6 months for a diagnosis to be given.

Does agoraphobia require treatment?

Like panic attacks, there is no specific treatment to alleviate the symptoms that occur during an episode. However, there are treatments which will lower the intensity of the agoraphobia, and help the person to stop relying on safe places.

A doctor will help the person through each step of the therapy. It is important that the decisions in terms of treatment are shared and agreed upon. A doctor will also advise support from a family member so that they know what to do should an episode occur in public.

What treatments are there for agoraphobia?

It's likely that a doctor will initially want to explore what the root cause of the agoraphobia is, so that they can get a sense of how it is affecting that person. They will advise refraining from drinking alcohol and caffeine, which can exacerbate anxiety.

After an initial discussion, it is likely that someone who has been diagnosed with agoraphobia will be referred for CBT. This form of therapy can help the person to develop an improved coping mechanism for the anxiety, in order to diminish its severity and frequency.

Agoraphobia presents similar symptoms to panic disorder; as such, a doctor may recommend taking antidepressants in the form of selective serotonin reuptake inhibitors (SSRIs). Imipramine or clomipramine are the two first-line treatments that can be taken for 12 weeks, but should not exceed this period.

A doctor may also give the person information outlining the principles of CBT, and support groups that are available. They can be useful in helping people to establish support networks, and in providing confidence with tackling agoraphobia.

Page last reviewed:  12/06/2020
Questions and Answers

What should I do if I think I might have agoraphobia?

If you have experienced fear of and anxiety about a public place or space in which you are worried about having a panic attack, or an inability to escape from that place, you may have agoraphobia. 

You should contact your local GP if this is the case; they will be able to talk to you about your symptoms and refer you to a specialist to begin CBT if it is necessary. They can also prescribe SSRIs.

Are there side effects of agoraphobia treatment?

Certain SSRIs for agoraphobia treatment may have some physical side effects. They are mostly related to feeling lethargic and a decreased sex drive. 

Moreover, if someone has a particularly intense session of CBT, it can have a detrimental impact on that person mentally. However, this is very rare as the specialist conducting the session will make sure that the person having the therapy maintains a level of comfort throughout.

Can I consult a doctor about agoraphobia online?

Using our online video consultation service, you will be able to speak to a doctor online.

They are available to consult with at a time that best suits you, and will help you to talk about your experiences. You may also be referred to a specialist to undergo CBT and may be prescribed with antidepressants.

Page last reviewed:  12/06/2020

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