Agoraphobia

Agoraphobia facts. Agoraphobia treatment.
People with agoraphobia fear places or situations in which they feel trapped, embarrassed, or helpless. Usually these feelings lead to panic attacks, which makes such places and situations traumatic for them. Agoraphobia treatment reduces the agoraphobia symptoms, and gives you tools to get through difficult moments. Nowadays online agoraphobia treatment is becoming more popular, because people with agoraphobia don’t have to travel to the clinic for the agoraphobia treatment sessions. On top of that, online treatment is more affordable, easier, and more comfortable.
On this page you can read everything you need to know to about Agoraphobia: from symptoms and causes to treatment and interesting agoraphobia facts.
 


 

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For more information about Agoraphobia:


 

At Barends Psychology Practice, we offer (online) therapy for agoraphobia. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).

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What is agoraphobia?

Agoraphobia is an anxiety disorder characterized by anxiety in any situation where escape may be difficult or where help may not be available. People with agoraphobia (agoraphobics) often fear crowded places, bridges or wide open spaces, because it may make them feel trapped, embarrassed or helpless. Often, agoraphobics avoid the places they fear and become more and more isolated. Agoraphobics usually need someone else to join them to go out to the supermarket or social activities, because it makes them feel more confident that they won’t have a panic attack. However, it’s impossible to ask someone to join you every time you need to go out of the house.
Agoraphobia symptoms may lock you inside your own house, and may make you lose your friends over time. People with agoraphobia often find it difficult to attend agoraphobia treatment, because for most agoraphobia treatments they need to travel to the clinic. Fortunately, agoraphobia treatment is also available online. This means that people with agoraphobia don’t have to travel to get to the clinic.
Experts used to believe that agoraphobia was a sub-type of panic disorder. However, not every person with agoraphobia experienced panic disorder fears, thus experts now think agoraphobia is not a sub-type of panic disorder.
 
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How does agoraphobia work?

Imagine you are running errands in the supermarket when suddenly your heart starts pounding, your throat tightens, you start sweating, the world starts spinning around you, and you question yourself: ‘What is going on? Am I crazy? Am I dying?’. The panic escalates more and more, until you think you cannot stand it any more. Then, slowly, you start to realize that everything is getting back to normal again. At this moment, feelings of embarrassment and confusion take over. Puzzled you go home. After a while, it’s still unclear to you why this had happened to you. The supermarket will probably become a no-go area for at least a while, because of the embarrassment and the panic attack: ‘will people laugh when they see me? What if I have another attack in that supermarket?’ And even later you might think: ‘what if this happens somewhere else?’.
The example above is a typical experience for people with agoraphobia. How someone develops agoraphobia is explained below:

Fear

The problem with an experience mentioned above is that it makes you afraid. Afraid that it may happen again. And a natural reaction to fear is to avoid situations, people, and locations that remind you of that experience. Unfortunately, avoidance of such reminders leads to an increase of fear for these reminders. In other words, the longer you stay away from that particular supermarket, the more likely it is that you start to associate the supermarket with having another panic attack if you go there. Therefore, it’s important to stop avoiding certain locations and situations.
Because of the previous bad experience, you are more alert to physical sensations (pounding heart, heavy breathing, being nervous etc.) when you go to supermarkets, and later other stores. These physical sensations ˝warn˝ you that a possible new panic attack is about to happen, because this is what you recognize from your previous panic attack. A natural response is to go away from that situation. Eventually, you will start avoiding other supermarkets as well as other stores, because you’ll start to notice physical sensations more often when you go out. And it won’t take long before you start associating going out of your house with the increased risk of getting a panic attack.
In the end you find yourself locked up inside your own house or apartment. Unable to go out on your own, because you never know when or if you will get another panic attack.
 
 

Agoraphobia symptoms and causes.

Agoraphobia symptoms.

A lot of these symptoms are the same as for other conditions, such as heart disease and breathing problems. For a proper diagnosis either visit your general practitioner or a psychologist/psychiatrist.

  • Having a fast, pounding heart.
  • Having breathing problems.
  • Starting to sweat.
  • Starting to shake, tremble.
  • Feeling hot or cold.
  • Nausea / diarrhea.
  • Having chest pain.
  • Having problems swallowing.
  • Feeling dizzy or faint.
  • Fear of dying.

 
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Agoraphobia causes.

It’s still unclear why some people develop Agoraphobia and others don’t. Specialists know that there is an heritable factor: people who have relatives with anxiety disorders tend to have a higher chance of developing agoraphobia [9]. Often, agoraphobia develops after having a couple of panic attacks. However, agoraphobia can develop sooner when:

  • You have the tendency to be nervous or anxious. Anxiety can be triggered by drinking caffeine. Read more about: Caffeine and Panic Attacks.
  • You have a blood relative with anxiety disorder. This means that you can develop agoraphobia sooner if your parents, siblings, or other family members have an anxiety disorder.
  • You experienced stressful life events, such as abuse or death etc. People who experienced traumatic experiences may develop agoraphobia, because they may be afraid of getting an accident themselves, or to come across the person who harmed them (think of abuse, robbery, and so on).

 
 

Agoraphobia treatment.

Online therapy is the perfect solution for people suffering from agoraphobia, because the agoraphobic does not need to go to the clinic for the agoraphobia treatment. Sessions can be held via Skype. Online therapy is based on evidence based psychotherapy treatments. With the online psychologist you can start with agoraphobia treatment and reduce the symptoms. The therapist will also give you some tools to get through difficult moments in the future. On top of that the therapist tells you everything you need to know about agoraphobia, how to recognize possible stressful situations and how to recognize a starting panic attack. For a first, free of charge, online therapy session, contact us.

Psychotherapy

Psychotherapy involves working with a therapist in order to reduce symptoms of anxiety, and to make you function better. This involves get psycho-education and learning how to cope with symptoms of agoraphobia, recognizing thoughts that can lead to a panic attack, how to manage stress. On top of that, Agoraphobia treatment also involves practicing how to cope with Agoraphobia symptoms in the session.

Medication

Medication in combination with psychotherapy is the most effective Agoraphobia treatment, because medication takes away the fear, which makes it easier for people to practice going to the store. However, medication alone is not enough to get rid of agoraphobia, because it will lower anxiety, but it won’t teach people that they will not get a panic attack when they go out of their houses.
 
 

Interesting agoraphobia facts.

    • The onset of Agoraphobia is between 15-39 years [2],[6]. In South Africa, approximately 20% of people with Agoraphobia are between 15-39 years old.
    • In 2012, agoraphobia was more common in the age group 13-17 (2%), compared to the age groups 18-64 (1.7%) and 64+ (0.4%) [12].
    • More women than men suffer from Agoraphobia [2],[3],[7],[12]; 0.6% versus 1.5% [2] or 2.0% versus 3.2% [12].
    • In the United States, 0.65% of people have Agoraphobia (without panic attacks (PA) or panic disorder (PD)), and between 1.27 and 2.5% of people had Agoraphobia (with or without PA or PD) at least once in their lives [1],[4],[5],[12].
    • In Europe, in 2005, between 0.9 and 1.3% of people had Agoraphobia without a history of panic [2],[7].
    • In the Netherlands, 0,9% of people had Agoraphobia (without panic disorder); 0.4% of men versus 1.4% of women [11]. This is in line with the findings of articles [2] and [7].
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    • Agoraphobia in South Africa and Morocco seem to be more prevalent than in Europe or the United States [6],[10]. In South Africa, 9.8% of people have Agoraphobia without panic [6], and in Morocco 8.4% [10].
    • Of the adults older than 55 in Canada, 0.61% had Agoraphobia, 0.38% of those of 65 years and older [3].
    • Agoraphobia is more common among those who were previously married (1.08%) compared with the 0.86% in the group of people who were never married, and 0.41% in the group of currently married group [3].
    • People with chronic health conditions or with comorbid psychiatric disorders were more common to develop Agoraphobia [3],[8],[10]. Of those with Borderline personality disorder, 51.0% also had panic disorder with Agoraphobia in the past 12 months [8], and of those people with Agoraphobia 60.7% of the people in Morocco also had a specific phobia [10].
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    • Of those who were diagnosed with Major Depressive Disorder, 5.5% had Agoraphobia [13].
    • 3.8% of people with Separation Anxiety Disorder in childhood met the criteria for Agoraphobia (without panic disorder) as well [14].

 
 

Literature:

    • [1] Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Goldstein, R. B., Smith, S., … & Saha, T. D. (2006). The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry.
    • [2] Goodwin, R. D., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R., & Wittchen, H. U. (2005). The epidemiology of panic disorder and agoraphobia in Europe. European Neuropsychopharmacology, 15, 435-443.
    • [3] McCabe, L., Cairney, J., Veldhuizen, S., Herrmann, N., & Streiner, D. L. (2006). Prevalence and correlates of agoraphobia in older adults. The American journal of geriatric psychiatry, 14, 515-522.
    • [4] Kessler, R. C., Ruscio, A. M., Shear, K., & Wittchen, H. U. (2009). Epidemiology of anxiety disorders. In Behavioral neurobiology of anxiety and its treatment (pp. 21-35). Springer, Berlin, Heidelberg.
    • [5] Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006). The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of general psychiatry, 63, 415-424.
    • [6] Stein, D. J., Seedat, S., Herman, A., Moomal, H., Heeringa, S. G., Kessler, R. C., & Williams, D. R. (2008). Lifetime prevalence of psychiatric disorders in South Africa. The British Journal of Psychiatry, 192, 112-117.
    • [7] Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., … & Haro, J. M. (2004). Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta psychiatrica scandinavica, 109, 21-27.
    • [8] Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., … & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 69, 533.
    • [9] Mosing, M. A., Gordon, S. D., Medland, S. E., Statham, D. J., Nelson, E. C., Heath, A. C., … & Wray, N. R. (2009). Genetic and environmental influences on the co‐morbidity between depression, panic disorder, agoraphobia, and social phobia: a twin study. Depression and anxiety, 26, 1004-1011.
    • [10] Kadri, N., Agoub, M., El Gnaoui, S., Berrada, S., & Moussaoui, D. (2007). Prevalence of anxiety disorders: a population-based epidemiological study in metropolitan area of Casablanca, Morocco. Annals of General Psychiatry, 6, 6.
    • [11] de Graaf, R., Ten Have, M., van Gool, C., & van Dorsselaer, S. (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social psychiatry and psychiatric epidemiology, 47, 203-213.
    • [12] Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184.
    • [13] Fava, M., Rankin, M. A., Wright, E. C., Alpert, J. E., Nierenberg, A. A., Pava, J., & Rosenbaum, J. F. (2000). Anxiety disorders in major depression. Comprehensive psychiatry, 41, 97-102.
    • [14] Brückl, T. M., Wittchen, H. U., Höfler, M., Pfister, H., Schneider, S., & Lieb, R. (2007). Childhood separation anxiety and the risk of subsequent psychopathology: Results from a community study. Psychotherapy and Psychosomatics, 76, 47-56.