July 29 , 2008
Agoraphobia – Coping with Overwhelming Fear in Public Places
Dr. David Prescott – Acadia Hospital
Introduction: Summer time offers lots of activities that involve crowds. For many of us the chance to attend the state fair, soak up some sun on a busy beach, or attend an outdoor concert is another great reason to live in Maine. But for others, the thought of being in such situations brings on overwhelming fear, panic, and embarrassment.
What is Agoraphobia? The term agoraphobia derives from the Greek words literally meaning “fear of the market place.” Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.
Around 5-12% of people will develop agoraphobia in their lifetime, and women are about twice as likely as men to develop agoraphobia. Symptoms of agoraphobia usually develop in the late teens or early 20’s. Agoraphobia may also include panic attacks, where a person rapidly becomes dizzy, short of breath, sweaty, and often feels like they are about to have a heart attack or lose control.
Symptoms of agoraphobia include:
- Fear of being alone.
- Fear of being in a crowded place, such as shopping mall or sports event.
- Fear of losing control in public places.
- Fear of being in places it is hard to get out of, such as an elevator.
- Inability to leave your house for long periods.
Agoraphobia impacts both the person and their family and friends:
Because people with agoraphobia often go to great lengths to avoid being in public settings, or will only go out in public if they stay with a trusted other, the impact of this problem extends to family members or close friends. Coping with agoraphobia is stressful for both the person with the disorder, and the people who support them. However, research suggests that when family members offer support without becoming highly irritated, and when family members help people with agoraphobia stay in treatment, improvement is usually dramatically better.
Treatment for Agoraphobia
Making the First Call: Asking for help with agoraphobia may be difficult, since people with agoraphobia are often fearful about going places outside of their own home. Psychologists, physicians, and counselors who treat agoraphobia are aware of this and can often help with the first appointment. Start with just a phone call! In many cases, you can begin to get help by working out a strategy for the first visit.
Counseling and Psychotherapy: One type of psychotherapy, called cognitive-behavioral therapy, has strong support as a treatment approach for agoraphobia. Treatment usually involves learning systematic relaxation techniques, changing some of the “self-talk” which reinforces a fear, and gradually learning to spend more and more times in public places. For people with agoraphobia and panic disorder, learning to unwind the panic cycle is also a part of treatment.
Medication: The medications most frequently used to treat agoraphobia are medications originally developed to treat depression, called SSRI’s (serotonin selective reuptake inhibitors). Examples of these types of medications include Prozac, Paxil, or Zoloft. For some people, anti-anxiety medications called benzodiazepines can be used for short-term relief.
Want Additional Information?
American Psychological Association Help Center: http://www.apahelpcenter.org
Mayo Clinic Tools for Healthier Lives: http://www.mayoclinic.com/health/agoraphobia
National Institute for Mental Health: http://www.nimh.nih.gov/health/publications/anxiety-disorders