Agoraphobia is an intense fear of public places where you perceive that escape might be difficult. This tends to have a significant effect on quality of life by leading to avoidance of most public places and in severe cases may cause some individuals to be house bound.
Agoraphobia can occur alone or concurrently with panic disorder or any other mental health illness.
Agoraphobia may affect up to 1% of individuals over the course of their lives and is more common amongst young adults and teenagers.
The primary symptom of agoraphobia is anxiety about certain situations where escape may be difficult or unavoidable. This then subsequently leads to avoidance of such situations to reduce anxiety or panic symptoms.
Examples of common situations that cause anxiety for people with agoraphobia include:
- Waiting in line
- Movie theatres
- Public transportation
Anxiety can affect the body in a number of ways and each person may experience anxiety very differently. Common symptoms include:
- A sense of fear or dread
- A feeling of being detached from or outside one’s body
- Poor concentration and ‘fogginess’ of thought
- Sleep disturbance and fatigue
- Muscle tension
- Palpitations and/or chest pain
- Shaking (tremor)
- Dry mouth
- Nausea and diarrhoea
Many factors contribute to the development of agoraphobia including both genetic and environmental factors. The following have been shown to increase the risk of developing agoraphobia:
- Family history of agoraphobia and other psychiatric disorders
- Female Sex
- Childhood adversity
- Chronic illness
- Environmental stressors including trauma (physical or emotional), unemployment, and low socioeconomic status
Agoraphobia is diagnosed from speaking to a patient to understand their symptoms in full, however other conditions may mimic agoraphobia and it is important to rule these out with further tests if suspected.
Questionnaires are a commonly used tool to aid making a diagnosis. They are also useful in monitoring response to treatment.
The treatment options are dependent on any specific symptoms a person experiences and how severely they are affected.
Simple approaches; including exercise, relaxation techniques, improved sleep hygiene, identifying and removing stressors, and spending time with natural support groups (family and friends), can improve symptoms and reduce the impact on quality of life.
Most patients will also benefit from an element of psychological therapy, including cognitive behavioural therapy.
Medical management primarily involves the use of anti-depressants (e.g. sertraline, fluoxetine). Beta-blockers (e.g. propranolol) can sometimes be useful for controlling symptoms experienced with panic disorder if this is present alongside agoraphobia.
Medicinal cannabis can be considered when first line therapies have not achieved adequate benefit.
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