Agoraphobia

Agoraphobia is an anxiety disorder characterised by intense fear and avoidance of situations perceived to be unsafe or where escape might be difficult. Commonly feared situations include public transport, shopping centres, crowds, and being outside alone. This condition can lead to severe restrictions in daily activities, with some individuals becoming housebound.

Causes and Risk Factors

Agoraphobia results from a combination of genetic and environmental factors. It often runs in families and can be triggered by stressful events such as the death of a parent or a traumatic experience. Difficulties with spatial orientation and chronic use of tranquillizers have also been linked to the development of agoraphobia. Additionally, conditions like panic disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) can predispose individuals to agoraphobia.

Signs and Symptoms

Agoraphobia manifests as anxiety in unfamiliar environments or situations where individuals feel they have little control. This anxiety often leads to avoidance of these situations. Symptoms include:

• Panic attacks, characterised by rapid heartbeat, sweating, trembling, nausea, dizziness, and fear of dying or losing control.
• Avoidance of places where previous panic attacks occurred.
• Fear of social embarrassment due to panic attacks.
• Temporary separation anxiety when left alone or when certain household members are absent.

Diagnosis

Agoraphobia is often diagnosed in conjunction with panic disorder. However, it can develop independently, known as "primary agoraphobia." The diagnosis involves differentiating it from other mental disorders like depression and generalised anxiety disorder. According to DSM-5, agoraphobia can be diagnosed separately from panic disorder.

Treatment

Therapy

Cognitive Behavioural Therapy (CBT) is the primary treatment for agoraphobia, focusing on systematic desensitisation and gradual exposure to feared situations. Techniques include:

• In Vivo Exposure: Gradual exposure to feared situations or objects, either in individual or group settings.
• Cognitive Restructuring: Coaching to replace irrational beliefs with factual, beneficial ones.
• Relaxation Techniques: Methods to prevent or stop symptoms of anxiety and panic.

Emerging modalities like Videoconferencing Psychotherapy (VCP) and Virtual Reality Computer Stimulated Therapy are also being looked at.

Medications

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for their anxiolytic effects. Benzodiazepines, monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants are also used. Medications are often combined with CBT for optimal results.

Alternative Medicine

Eye Movement Desensitisation and Reprocessing (EMDR) has shown poor results in treating agoraphobia and is recommended only when other treatments fail. Support groups and stress management techniques can provide additional relief.

Epidemiology

Agoraphobia is more common in women and typically develops in adolescence or early adulthood. It affects about 1.7% of adults, with a higher prevalence among individuals of above-average intelligence. Panic disorder, often co-morbid with agoraphobia, affects roughly 5.1% of Americans.

Notable Cases

Several public figures have openly discussed their experiences with agoraphobia, including:

• Woody Allen, actor and director
• Kim Basinger, actress
• Howard Hughes, aviator and industrialist
• Barbra Streisand, singer and songwriter

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Self-assessment MCQs (single best answer)

What is agoraphobia primarily characterised by?

Which of the following is a common trigger for agoraphobia?

Which therapy is considered the primary treatment for agoraphobia?

Which medication class is commonly prescribed for agoraphobia?

What percentage of adults is affected by agoraphobia?

Which of the following is not a symptom of agoraphobia?

Agoraphobia can develop independently without panic disorder. This is known as:

Which of the following public figures has openly discussed their experience with agoraphobia?

Which emerging modality is being looked at for treating agoraphobia?

What is a common co-morbid condition with agoraphobia?