The Facts

Agoraphobia, meaning "fear of the marketplace" in Greek, is a type of anxiety disorder. It's a condition where a person feels intensely anxious about being trapped in certain situations from which they can't easily escape. The result is a feeling of panic. Movie theatres, long lineups in banks or stores, and buses or subways are examples of places feared by people with agoraphobia. They often end up avoiding these situations or only going with someone with whom they feel "safe." In extreme cases, they may end up housebound, terrified to go anywhere in public. Agoraphobia affects 3.8% of women and 1.8% of men in any given six-month period.

Causes

In many cases, agoraphobia develops after a person has experienced a panic attack (panic disorder). This involves feelings of intense, overwhelming terror along with physical symptoms such as sweating, dizziness, a pounding heart, and shortness of breath. Although panic attacks are unpredictable, the person learns to avoid the situation that seemed to trigger the episode for fear of having another one. Others may just feel uncomfortable in agoraphobic situations without ever having had, or going on to have, panic attacks. A few will go on to develop full-blown panic disorder. Agoraphobia is more common than panic disorder, which only affects about 1% of the population.

Symptoms and Complications

Agoraphobia can come on suddenly or develop gradually, typically developing between the ages of 18 and 35. It's an emotional and physical reaction to being put into a specific situation that triggers fear. Symptoms include:

• strong feelings of panic, dread, terror, and horror
• recognizing that the anxiety is overblown, yet not being able to "talk yourself out of it"
• rapid heartbeat, shortness of breath, trembling, and an overwhelming urge to flee the situation - all physical reactions associated with extreme fear
• going to great lengths to avoid the situation that causes fear

Left untreated, agoraphobia tends to better and worse in severity and can even disappear on its own. However, if the condition prevents you from working, socializing, or otherwise living a normal life, you should talk to a doctor to get the help you need.

Making the Diagnosis

As with most mental disorders, there are no blood tests or other "hard and fast" ways to diagnose agoraphobia. A doctor will ask many questions to find out whether you have the symptoms and signs of agoraphobia and to make sure that it isn't another mental condition. In particular, agoraphobia should be distinguished from social phobia (social anxiety disorder), where avoidance is limited to social situations due to fear of embarrassment, and treatment interventions can be either biological (with selected antidepressants) or psychological (cognitive behavioural therapy). In addition, it's important to be sure that the anxiety isn't being caused by a medication, drug abuse or addiction, or a medical condition. A doctor may refer someone to a psychiatrist or other therapist who specializes in recognizing and treating anxiety disorders, including agoraphobia.

Treatment and Prevention

Fortunately, agoraphobia can be effectively treated with a type of behaviour therapy called exposure therapy; over 90% of people who stick with this therapy are helped. Exposure therapy works by encouraging patients to confront the situation they fear rather than avoiding it. By deliberately staying in the circumstance that triggers a negative reaction, they gradually become used to it - this is called habituation - and their anxiety fades away as they realize nothing bad will happen to them.

Another form of behaviour therapy involves a technique called diaphragmatic breathing. There's good evidence that breathing deeply in a controlled way is effective in overcoming the body's fear responses. Cognitive-behavioural therapy is a different approach that teaches people new skills to cope with triggering situations. They learn to "think their way out" of their fear to lessen or stop the symptoms.

To help the therapy work, doctors may also recommend certain anti-anxiety medications to help combat the symptoms.

Of course, no matter what therapy is chosen, it has to be performed by a skilled therapist whom someone with agoraphobia can trust completely.