Agoraphobia

Agoraphobia is a fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong. Many people assume agoraphobia is simply a fear of open spaces, but it's actually a more complex condition. Someone with agoraphobia may be scared of:

• travelling on public transport
• visiting a shopping centre
• leaving home

If someone with agoraphobia finds themselves in a stressful situation, they'll usually experience the symptoms of a panic attack, such as:

• rapid heartbeat
• rapid breathing (hyperventilating)
• feeling hot and sweaty
• feeling sick

They'll avoid situations that cause anxiety and may only leave the house with a friend or partner. They'll order groceries online rather than going to the supermarket. This change in behaviour is known as avoidance.

What causes agoraphobia?

Agoraphobia usually develops as a complication of panic disorder, an anxiety disorder involving panic attacks and moments of intense fear. It can arise by associating panic attacks with the places or situations where they occurred and then avoiding them. A minority of people with agoraphobia have no history of panic attacks. In these cases, their fear may be related to issues like a fear of crime, terrorism, illness, or being in an accident. Traumatic events, such as bereavement, may contribute towards agoraphobia, as well as certain genes inherited from your parents.

Diagnosing agoraphobia

Speak to your GP if you think you may be affected by agoraphobia. It should be possible to arrange a telephone consultation if you don't feel ready to visit your GP in person. Your GP will ask you to describe your symptoms, how often they occur, and in what situations. It's very important you tell them how you've been feeling and how your symptoms are affecting you. Your GP may ask you the following questions:

• Do you find leaving the house stressful?
• Are there certain places or situations you have to avoid?
• Do you have any avoidance strategies to help you cope with your symptoms, such as relying on others to shop for you?

It can sometimes be difficult to talk about your feelings, emotions, and personal life, but try not to feel anxious or embarrassed. Your GP needs to know as much as possible about your symptoms to make the correct diagnosis and recommend the most appropriate treatment.

Treating agoraphobia

With psychological treatment (talking therapies), most people with agoraphobia will make significant improvements, particularly if the three steps described below are followed. A stepwise approach is usually recommended for treating agoraphobia and any underlying panic disorder:

1. Educate yourself about your condition, possible lifestyle changes you can make, and self-help techniques to help relieve symptoms.
2. Enrol yourself on a guided self-help programme.
3. More intensive treatments, such as cognitive behavioural therapy (CBT) or medication.

Lifestyle changes may include taking regular exercise, eating more healthily, and avoiding alcohol, drugs and drinks that contain caffeine, such as tea, coffee and cola. Self-help techniques that can help during a panic attack include staying where you are, focusing on something that's non-threatening and visible, and slow, deep breathing. If your agoraphobia fails to respond to these treatment methods, your GP may suggest trying a guided self-help programme. This involves working through self-help manuals that cover the types of issues you might be facing, along with practical advice about how to deal with them. Medication may be recommended if self-help techniques and lifestyle changes aren't effective in controlling your symptoms. You'll usually be prescribed a course of selective serotonin reuptake inhibitors (SSRIs), which are also used to treat anxiety and depression. In severe cases of agoraphobia, medication can be used in combination with other types of treatment, such as CBT and relaxation therapy. Read more about treating agoraphobia.

Outlook

Around a third of people with agoraphobia eventually achieve a complete cure and remain free from symptoms. Around half experience an improvement in symptoms, but they may have periods when their symptoms become more troublesome – for example, if they feel stressed. Despite treatment, about one in five people with agoraphobia continue to experience troublesome symptoms.

How common is agoraphobia?

Agoraphobia is twice as common in women as men. It usually starts between the ages of 18 and 35. Resources : NHS UK This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.