Agoraphobia as defined by the APA Dictionary of Psychology is literally the fear of the market place. Agoraphobia is manifested as anxiety about being in places or situations, fearing one may have panic symptoms or a panic attack, throwing up or having diarrhea in public. Those with agoraphobia live with the terror that they may become trapped, desperately avoiding situations where they feel that they would not be able to escape quickly or that may not be able to get help if they need it.κ Those with agoraphobia have a hard time feeling safe in public places, and most especially where crowds gather. Common areas that most people suffering from agoraphobia dread are elevators, sporting events, bridges, lines, driving, public transportation, malls and airplanes. In the more serious cases of agoraphobia, one’s fears become so intense that they are just trapped in their own homes because that is the only place they truly feel safe.λ

Unlike most phobias and fears, Agoraphobia usually begins between late adolescence and the mid-30s. This phobia is often passed along in families. It can also occur if a person grows up with an overprotective parent or a parent that is a perfectionist. According to the Mayo Clinic, between 1 and 5 percent of people in the United States develop agoraphobia in their lifetime. Nearly 80% of those suffering from this phobia are women.μ Something familiar to all of us is anxiety at its minor symptom level. This often seems to weigh against a person who is suffering more acutely from seeking help. The embarrassment and shame at a perceived ‘over reaction’, possibly aggravated by the blending of emotions such as anger, guilt, sadness, or shame with a dominating fear, make up one’s personal anxiety. It keeps that person from realizing that these responses don’t mean that they are weak in any way.ν Other risk factors include low-income populations, individuals who are widowed, separated or divorced, those who have experienced stressful life events such as sexual or physical abuse during childhood and those who have an alcohol or substance abuse disorder. According to the research done with agoraphobia; there are no particular personality differences between agoraphobics and members of the general public. A component of the problem seems to be the fear of fear (the fear of a panic attack). Yet not all agoraphobics experience panic attacks. Other anxiety disorders that tend to co-occur with agoraphobia include general anxiety disorder and social anxiety disorder. There are many other factors that lead to the core problem of the disorder, avoidance.ν

Typical agoraphobia symptoms include: the fear of being alone, the fear of being in crowded places, the fear of losing control in a public/crowded place, the sense of helplessness, a sense that your body is unreal, the inability to leave the home for long periods of time, the fear of being in places where it may be hard to leave and an overdependence of others.λ In addition, for the agoraphobics that also suffer from panic disorder they may also suffer from these symptoms: vertigo or lightheadedness, shortness of breath or feeling of being smothered or a sense of choking, perspiring, irregular, rapid or pounding heartbeat, chest pain/discomfort, hot or cold flashes, stomach nausea, upset stomach or diarrhea, trouble swallowing, trembling and/or shaking, fear that you are about to die, fear of losing control or going insane, dizziness and/or faintness, numbness and tingling, feeling that you or events are ‘unreal’ or ‘not there’.κλν

Agoraphobia is often diagnosed and treated when patients are seeking treatment for other medical or emotional problems. There is no single test for agoraphobia. A primary- care doctor or psychiatrist will take a patient history and perform a physical examination and order the laboratory tests as they are needed. Often determining the cause requires the involvement of a mental health professional. In order to diagnose agoraphobia, the mental health professional will ask pertinent questions to ensure that the anxiety a person is suffering is truly the result of a fear of being in situations that make it impossible, difficult or embarrassing to escape, rather than in the context of another emotional problem (for example, the fear of being near people that remind one of an abuser as in PTSD or the fear of hearing voices that one knows that they have no basis in reality as in schizophrenia). A person should contact their doctor when their anxiety symptoms are so sever that they may believe medications is needed, if the symptoms interfere with their lives, if they are experiencing depression and suicidal or homicidal feelings, or if they are regularly experiencing the panic attack symptoms of chest pain, shortness of breath, headaches, dizziness, etc. ο

There have been many advances in the treatment of agoraphobia since the early 1980s. Many carefully designed studies indicate that with guided practice most sufferers should make a recovery. Treatments that have been evaluated across the world include a combination of medications and psychotherapy.π

Medications that are commonly used to treat agoraphobia are antidepressants and anti-anxiety medications, which include members of the serotonin selective reuptake inhibitor (SSRI) and the minor tranquilizer groups. Phobias can also be treated using beta-blocker medications. These medications block the effects of adrenaline on the body.ο Of course with any treatment of a psychological disorder one may have to try several different medications or combinations of these medicines to find one that works best for them.ϕ Many sufferers don not wish to take medications due to their side-effects and some may have dependency issues. Taking medication also doesn’t allow the person suffering from agoraphobia to gain control over the situation and may interfere with attempts to learn techniques of self-control. There is also the fear of a relapse after they cease to take the medication.π

The most common psychotherapy used in the treatment of agoraphobia is cognitive behavioral therapy. Cognitive behavioral therapy integrates theories of cognition and learning with treatment techniques derived from cognitive therapy and behavior therapy. Treatment is aimed at identifying and modifying the sufferer’s maladaptive thought process and problematic behavior through cognitive restructuring and behavioral techniques to achieve change.ϕ The cognitive part of the therapy includes learning more about agoraphobia and if applicable the panic attacks and how the sufferer can control them. Agoraphobics learn what factors trigger the attacks and what may make them worse. They also learn how to cope with the distressing symptoms. Some coping techniques learned during this process are breathing are relaxation exercises. The behavioral part of the therapy includes changing unwanted and unhealthy behavior through desensitization- exposure therapy. It helps the agoraphobic person to safely confront the places and situations that cause the anxiousness and fear. Through this gradual practice of going to feared places, the people suffering from agoraphobia learn that the fears do not come true and with time the anxiety calms and eventually goes away.λ

As I researched the topic of agoraphobia for this paper I found that there are many similarities to the treatment of this phobia as to the treatment of PTSD, the topic of my first paper. I also learned that PTSD can be a factor of agoraphobia. Personally experiencing both of these anxiety disorders and panic attacks, I can tell someone who is currently suffering that things do get better, but you have to be ready to make the changes and go through the processes to become well again. Most importantly, though, I believe that they need to know that they aren’t crazy, they are scared. When you are experiencing the symptoms you feel that you are losing your mind, you know it is not “normal” and fear that you are losing it. Agoraphobics sometimes don’t realize that it is a fear of something that is buried in them that is causing it. That is why finding a good psychiatrist is so important. Another important piece of advice is that you also need a mental health care professional that is genuinely interested in you and helping you, not one who is too quick to whip out that prescription pad as you walk in and then to set up your next appointment.

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