What is Agoraphobia?
The word derives from the Greek, the agora being the market place, or place of assembly, and a phobia being an irrational fear. Sufferers typically experience intense fear in a range of situations where they perceive escape is not easily possible or help is not readily available. Examples of such situations are crowded shops, trains and tubes, lifts, motorways and being away from the security of home or a trusted companion. In turn, there may be abnormal worry about possible loss of control, socially inappropriate behaviour, physical illness such as heart attack, incontinence, fainting, going mad or dying. Sufferers may therefore often avoid a whole range of situations and day to day activity and may become housebound.
Panic attacks may be limited to specific phobic situations, but sometimes occur more generally. Many people often experience depressive symptoms, but generally these improve when the agoraphobic problem has been treated.
The Extent of the Problem
There are various estimates, but probably 1% of the population suffer agoraphobia of such severity as to cause considerable distress and significant impairment of day to day function. However, up to one in ten of the population may hae difficulty dealing with one or two of the situations mentioned above.
No single cause of agoraphobia has been identified. It tends to appear in early adulthood and is triggered in the first instance by an unexpected panic attack. The first panic is reported to occur "out of the blue." The person then begins to fear the occurence of another such attack and begins to avoid those situations which they believe may cause or worsen these attacks. The cause of the initial panic is only just beginning to be investigated systematically. Some relevant factors may be: life stressors, early experience with loss of control, a tendency to breathe too quickly, fluctations in various brain chemicals and the misinterpretation of normal anxiety symptoms.
Treatment for agoraphobia has traditionally involved the use of medications such as tranquillizers e.g. Lorazepam (Ativan). In the last 25 years psychological treatments (involving behavioural and cognitive behavioural methods) achieve 70% of greater reduction in the problem.
There is no doubt that the central component of effective treatment is helping the sufferer to face their fears in graduated doses of difficulty. This treatment is commonly called exposure therapy and may sometimes require a therapist to help the sufferer enter the situation they fear. However, exposure therapy can often be carried out with a small amount of guidance from a professional or with a self help method. The principle underpinning this therapy is very simple, i.e. that if you stay in the situation and this exposure is repeated systematically, the anxiety fades away. In some cases the therapist may use methods which help the client re-evaluate their anxious thoughts by the use of cognitive techniques, i.e. to learn, for example that "everyone is not watching me." In addition some attempt can be made to deal with unexpected panic attacks using breathing exercises and cognitive methods.
Therapy may be carried out by suitably trained mental health professionals, i.e. clinical psychologists, psychiatrists, nurses and social workers, but increasingly these methods can also be used within self help programmes. Books containing such methods may be helpful.