Agoraphobia is a fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong.
Many people assume agoraphobia is simply a fear of open spaces, but it's actually a more complex condition. Someone with agoraphobia may be scared of:
travelling on public transport
visiting a shopping centre
If someone with agoraphobia finds themselves in a stressful situation, they'll usually experience the symptoms of a panic attack, such as:
rapid breathing (hyperventilating)
feeling hot and sweaty
They'll avoid situations that cause anxiety and may only leave the house with a friend or partner. They'll order groceries online rather than going to the supermarket. This change in behaviour is known as avoidance.
Agoraphobia usually develops as a complication of panic disorder, an anxiety disorder involving panic attacks and moments of intense fear. It can arise by associating panic attacks with the places or situations where they occurred and then avoiding them.
A minority of people with agoraphobia have no history of panic attacks. In these cases, their fear may be related to issues like a fear of crime, terrorism, illness, or being in an accident.
Traumatic events, such as bereavement, may contribute towards agoraphobia, as well as certain genes inherited from your parents.
Speak to your GP if you think you may be affected by agoraphobia. It should be possible to arrange a telephone consultation if you don't feel ready to visit your GP in person.
Your GP will ask you to describe your symptoms, how often they occur, and in what situations. It's very important you tell them how you've been feeling and how your symptoms are affecting you.
Your GP may ask you the following questions:
Do you find leaving the house stressful?
Are there certain places or situations you have to avoid?
Do you have any avoidance strategies to help you cope with your symptoms, such as relying on others to shop for you?
It can sometimes be difficult to talk about your feelings, emotions, and personal life, but try not to feel anxious or embarrassed. Your GP needs to know as much as possible about your symptoms to make the correct diagnosis and recommend the most appropriate treatment.
Self-help techniques that can help during a panic attack include staying where you are, focusing on something that's non-threatening and visible, and slow, deep breathing.
If your agoraphobia fails to respond to these treatment methods, your GP may suggest trying a guided self-help programme. This involves working through self-help manuals that cover the types of issues you might be facing, along with practical advice about how to deal with them.
Medication may be recommended if self-help techniques and lifestyle changes aren't effective in controlling your symptoms. You'll usually be prescribed a course of depression.
In severe cases of agoraphobia, medication can be used in combination with other types of treatment, such as CBT and relaxation therapy.
being in an unhappy relationship, or in a relationship where your partner is very controlling
Speak to your GP if you think you have agoraphobia.
If you're unable to visit your GP in person, it should be possible to arrange a telephone consultation.
Your GP will ask you to describe your symptoms, how often they occur, and in what situations. It's very important to tell your GP about how you've been feeling and how your symptoms are affecting you.
They'll also want to know how your symptoms are affecting your daily behaviour. For example, they may ask:
Do you find it stressful leaving the house?
Are there certain places or situations you have to avoid?
Have you adopted any avoidance strategies to help cope with your symptoms, such as relying on others to shop for you?
It can be difficult to talk to someone else about your feelings, emotions and personal life, but try not to feel anxious or embarrassed. Your GP needs to know as much as possible about your symptoms to make the correct diagnosis and recommend the most appropriate treatment.
Your GP may want to do a physical examination, and in some cases they may decide to carry out blood tests to look for signs of any physical conditions that could be causing your symptoms.
These side effects should improve over time, although some can occasionally persist.
If sertraline fails to improve your symptoms, you may be prescribed an alternative SSRI or a similar type of medication known as serotonin-norepinephrine reuptake inhibitors (SNRIs).
The length of time you'll have to take an SSRI or SNRI for will vary depending on your response to treatment. Some people may have to take SSRIs for 6 to 12 months or more.
When you and your GP decide it's appropriate for you to stop taking SSRIs, you'll be weaned off them by slowly reducing your dosage. You should never stop taking your medication unless your GP specifically advises you to.
If you're unable to take SSRIs or SNRIs for medical reasons or you experience troublesome side effects, another medication called pregabalin may be recommended. Dizziness and drowsiness are common side effects of pregabalin.
If you experience a particularly severe flare-up of panic-related symptoms, you may be prescribed a short course of benzodiazepines. These are tranquillisers designed to reduce anxiety and promote calmness and relaxation.
Taking benzodiazepines for longer than two weeks in a row isn't usually recommended as they can become addictive.
Antidepressant medicine is used to treat depression. For example Fluoxetine, Paroxetine.
Benzodiazepines are a group of medicines used to help sleep, reduce anxiety and as a muscle relaxant. For example, temazepam.
To panic is to be quickly overcome with a feeling of fear or worry.
Psychotherapy is the treatment of mental and emotional health conditions, using talking and listening.
'Even the thought of going into my garden made me panic'
Claire Ledger was diagnosed with agoraphobia after having a panic attack in the street while shopping.
Claire, who was 26 at the time of this interview, was unable to explain the experience. She initially thought it may have had something to do with where she was, so she stopped going there and began to shop elsewhere. When she had a similar panic attack in another location, she stopped going there, too.
Within five months she'd stopped going to so many places she only felt truly safe at home. She left her job as a nurse and spent the next 2.5 years indoors. She read, watched TV, surfed the web and cared for her husband, who is in a wheelchair, and never went outside.
"When I had the first attack, I didn't know what was happening," says Claire, who lives in Bradford, West Yorkshire. "I was in a shop and felt faint all of a sudden, and had to crouch down to avoid collapsing. I was shaking and felt sick."
Claire went to her GP, who initially thought she was suffering from stress. Claire had just started a new job, recently got married, and was having IVF treatment.
"Every time I went out after that I got this feeling again," she says. "Everywhere it happened, I avoided that place. Instead of thinking it was me, I associated the panic attack with the place where it happened. I was such an outgoing person, the idea that it was all in my head never occurred to me."
Claire was eventually diagnosed with agoraphobia. "I got to a point where my stomach dropped as soon as I woke up," she says. "It's like a feeling of grief and despair. You're shaking, tired, and you don't really feel there. It's like you're watching yourself.
"I tried to get through it, but I reached a stage when even the thought of going into my own garden made me panic. It was like coming up against an invisible wall.
"It was hard on my husband. He's a big sports fan and likes going out to watch live events."
The couple's elderly neighbours would help out with getting food and household supplies. "I felt ashamed that someone in their 70s was doing my shopping," says Claire.
Claire became determined to seek treatment and went on a course of cognitive behavioural therapy (CBT). She found the treatment helpful, but it didn't change her thought process.
What made the difference was talking to other people with agoraphobia, who she contacted through online support groups. "You feel like a freak," she says. "Talking to other people in the same position was what helped me the most. We worked on breaking down our boundaries together."
She became friends with a woman in another town and they would make the same trips together in their respective neighbourhoods, slowly increasing the length of their journeys.
"We would call each other before leaving the house and would remain on the phone to each other until we got back in," says Claire. "Even though she wasn't there in person, her voice was really reassuring."
For the next two years, this was how Claire expanded her boundaries from her doorstep. "My husband changed our mobile provider when he saw the monthly bills I was running up!"
Claire has learned to cope with her moods and has now regained enough confidence to go back to work. "It's important for people to know that you can recover," she says. "You may think it's like a death sentence, but the treatments do work. I never thought I'd return to work.
"I still have my down days, but I've learned to accept that you can't feel your best every day."