Agoraphobia

Definition

Definition of Agoraphobia
Agoraphobia is an anxiety disorder characterized by anxiety in situations where it is perceived to be difficult or embarrassing to escape. These situations can include, but are not limited to, wide-open spaces, crowds, and uncontrollable social situations such as may be met in shopping malls, airports, and on bridges. Agorophobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven.

Symptoms

Symptoms of Agoraphobia
The symptoms of agoraphobia include anxiety that one will have a panic attack when in a situation from which escape is not possible or is difficult or embarrassing. The panic attack associated with agoraphobia, like all panic attacks, may involve intense fear, disorientation, rapid heart beat, dizziness, or diarrhea. Agoraphobic individuals often begin to avoid the situations that provoke these reactions. Interestingly, the situations that are often avoided by people with agoraphobia and the environments which cause people with balance disorders to feel disoriented are quite similar. This leads some cases of agoraphobia to be considered as vestibular function agoraphobia.

Causes

Causes of Agoraphobia
There are a number of theories about what can cause agoraphobia. One hypothesis is that agoraphobia develops in response to repeated exposure to anxiety-provoking events. Mental-health theory that focuses on how individuals react to internal emotional conflicts (psychoanalytic theory) describes agoraphobia as the result of a feeling of emptiness that comes from an unresolved Oedipal conflict, which is a struggle between the feelings the person has toward the opposite-sex parent and a sense of competition with the same-sex parent. Although agoraphobia, like other mental disorders, is caused by a number of factors, it also tends to run in families and for some people, may have a clear genetic factor contributing to its development.

Diagnosis

Diagnosis of Agoraphobia
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur. In rare cases where agoraphobics do not meet the criteria used to diagnose panic disorder, the formal diagnosis of agoraphobia without history of panic disorder is used (primary agoraphobia).

Prognosis

Prognosis of Agoraphobia
Most patients can get better with medications or behavioral therapy. However, without early and effective help, the disorder may become more difficult to treat.

Risk

Risk of Agoraphobia
Agoraphobia tends to begin by adolescence or early adulthood. Girls and women, Native Americans, middle-aged individuals, low-income populations, and individuals who are either widowed, separated, or divorced are at increased risk of developing agoraphobia. Individuals who are Asian, Hispanic, or of African/African-American descent tend to have a lower risk of developing this disorder.

Treatment

Treatment of Agoraphobia
There are a variety of treatments available for agoraphobia, including specific kinds of psychotherapy as well as several effective medications. A specific form of psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-defeating thoughts and behaviors (called cognitive behavioral therapy) has been found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs along with panic disorder, cognitive behavioral therapy, with or without treatment with medications, is considered to be the most effective way to both relieve symptoms and prevent their return. In fact, sometimes patients respond equally as well when treated with group cognitive behavioral therapy or a brief course of cognitive behavioral therapy as they do when treated with traditional cognitive therapy. Psychotherapy for agoraphobia has even been found to be effective for many people when they receive it over the Internet, which is optimistic news for people who live in areas that are hundreds of miles from the nearest mental-health professional.

Another form of therapy that has been found effective in managing agoraphobia includes self-exposure. In that intervention, the person either imagines or puts him or herself into situations that cause increasing levels of agoraphobic anxiety, using relaxation techniques in each situation in order to master their anxiety. As people gain access to the Internet, there is increasing evidence that exposure therapy can also be done effectively through that medium.