Agoraphobia

What is agoraphobia?

When you think of agoraphobia, you may picture someone whose anxiety has kept them from leaving their home for years. While this does describe some cases, it doesn’t apply to others.

A phobia is a fear of something. Generally, agoraphobia is a fear of situations that are hard to escape. Someone with agoraphobia might fear a train because they’re afraid of having a panic attack on a train, not the train itself.

What causes agoraphobia?

Most phobias occur in people with a panic disorder. Agoraphobia is no different. If you have agoraphobia, you may have had a panic attack in a situation you couldn’t escape. It might have been on a plane or in a grocery store. Wherever it was, the place came to represent the bad experience.

Although agoraphobia can start with a specific source of fear, it can become more general over time. So, for instance, a fear of planes may lead to avoiding all public transportation.

Left untreated, agoraphobia can get worse. For example, a fear of public transportation may lead to a fear of leaving home altogether.

What are the symptoms of agoraphobia?

When someone with agoraphobia is in a situation they can’t easily escape, they may have a panic attack. Symptoms of a panic attack include:

• Fast heart rate

• Dry mouth

• Breathlessness

• Sweating

• Dizziness

• Nausea

These symptoms can also happen before getting into a stressful situation. For example, you may have intense anxiety in the hours leading up to a trip to the store.

How is agoraphobia diagnosed?

Your healthcare provider will ask you about your symptoms and do a physical exam. To make a diagnosis, they will look to see if you have a long-term fear of any of these:

• Public transportation (planes, trains, ships, buses)

• Large, open spaces such as parking lots or bridges

• Closed-in spaces

• Crowds or standing in line

• Being outside alone

How is agoraphobia treated?

The good news is that agoraphobia usually can be treated. It may be difficult to work through, but you don’t have to live within an increasingly smaller world.

The main ways of treating agoraphobia are:

• Prescribed medicine. Antidepressants can help manage anxiety.

• Cognitive behavioral therapy. This form of therapy involves trying to change thinking patterns. A person may learn to replace negative thoughts with more realistic ones.

• Exposure therapy. This involves being exposed to what you fear. While it may sound scary, it is always done under the care and supervision of a therapist. It also happens gradually. If you are afraid of grocery stores, you may begin by looking at images of grocery stores.

Living with agoraphobia

There are ways to manage your symptoms. During or before any exposure to the situation you fear, try to:

• Breathe slowly. Panic attacks often cause rapid breathing. To ease your anxiety, concentrate on slow breaths. Expand your abdomen, not your chest, when you inhale.

• Use relaxation techniques. This can include meditation and regular exercise.

• Limit caffeine. This doesn’t have to mean swearing off coffee and tea altogether. Try staying away from caffeine on days you know you will have to face the situation you fear. Giving up coffee on the day of a flight, for example, can help.

• Focus on something specific. You could count to a certain number in your mind. You could draw, read, or listen to music. These activities give you something to focus on besides your anxiety.

• Set goals. Accomplishment can be a very useful motivator. Even achieving small goals can help.

• Accept your panic attacks. This may seem to go against logic. However, trying to fight a panic attack can often make it worse. Try not to feed your panic by focusing on your fear of having one. Instead, remember that a panic attack is temporary. It will pass and you will be OK.

Overcoming your phobia can be a hard process, but it’s doable with the right support. It’s OK to take it slowly. Go easy on yourself by setting small goals. Establish your support network. Talk with your healthcare provider. There are people who can help you through this.