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Introduction Until recently agoraphobia was defined as a fear of open spaces. It now also includes several other related fears such as a fear of entering shops, fear of crowds and public places, or of travelling alone on trains, buses or aeroplanes. It also includes the anxiety associated with being unable to reach a place of safety (eg home) quickly. Panic attacks are a common feature of agoraphobia. A panic attack is an unpredictable attack of intense fear and anxiety. Because panic attacks can be unpredictable, people often worry about them happening when they have to go into a public place. This can cause the person to start avoiding any situation where a panic attack might happen. In extreme cases, people with agoraphobia may be unable to leave their home unless accompanied by another trusted person. Agoraphobia usually begins in the late 20s and is more common in women than men, (although that may be because fewer men seek help). Approximately 5% of adults develop agoraphobia. Agoraphobia sometimes starts suddenly and sometimes it develops slowly. Often there is no obvious cause. Without treatment, agoraphobia can continue for years and may become more severe with time. Many agoraphobics have other phobias too (see article on phobias). This is described as a complex phobia.

Symptoms People with agoraphobia may experience some or all of the following symptoms when in public places: shaking,, rapid heart beat, intense sweating, chest pain, difficulty breathing, feelings of choking, nausea, dizziness, feelings of losing control, fear of fainting, and fear of dying. It is rare for a person to have all of these symptoms at once. However, if someone experiences several of these symptoms together this suggests it is a panic attack. In extreme cases, the symptoms can make the person flee from where they are to a place where they feel safe. This can make them avoid the situation that brought on the symptoms in the future. Although some people with agoraphobia will feel marked anxiety or distress on leaving home or being in public places the symptoms do not develop into a panic attack. Some agoraphobics may experience little anxiety because they can avoid the situations that cause their phobia. Agoraphobia is also linked to some other conditions like depression and obsessive-compulsive disorder.

Causes The root cause of agoraphobia is not known. Research studies have found that agoraphobia tends to run in families, but it is not clear if this is because of a genetic link or for some other reason.

Diagnosis A diagnosis is usually made by a healthcare professional based on a description of the symptoms. However, the following need to be considered: The symptoms must be due to anxiety and should not be secondary to other symptoms, such as delusions or obsessions; The anxiety should occur mainly in at least two of the following situations: crowds, public places, travelling away from home, and travelling alone; and Avoiding the situation where anxiety occurs must be, or have been, a prominent feature.

Treatment Agoraphobia can be treated using drugs or by using talking treatments like cognitive-behavioural therapy, psychotherapy and group therapy. Drug treatments: Antidepressants (especially the type known as Selective Serotonin Reuptake Inhibitors - SSRI). SSRIs are the most commonly prescribed drugs for panic attacks. They usually result in an improvement in about 6-8 weeks. SSRIs should not be prescribed to the under 18s, although fluoxetine can be prescribed if specialist advice is obtained. Benzodiazepines are only used for the short-term relief of more extreme cases as they can be addictive. Courses of the drugs are usually less than four weeks and the drug should be withdrawn gradually to avoid a rebound effect. Non-drug treatments: There is evidence to support the use of cognitive behaviour therapy (CBT) in treating agoraphobia and panic attacks. Cognitive behaviour therapy combines two types of psychotherapy: cognitive therapy and behaviour therapy. It is based on the theory that most emotional and behavioural responses are learned and the goal is to unlearn unwanted responses and learn new ways of reacting to situations. Talking and sharing experiences in individual and group psychotherapy can help understanding and recovery from agoraphobia.

Support organisations The information below has been added to the NHS Direct Health Encyclopaedia as part of a pilot project to make data used by NHS Direct call centres available to the public on our website. If you have any feedback relating to this pilot please contact us.

Triumph Over Phobia UK Telephone: Mon-Fri 9am-5pm TOP UK runs a national network of self-help groups to help adults with a phobia, or obsessive compulsive disorder (OCD) to overcome problems using graded self-exposure. This involves learning how to face up to fears in a very gradual and structured way, so that eventually the anxiety should decrease. Who for: Adults aged over 16 years. Referral: Self, GP, social services. Cost: No charge. Address http://www.triumphoverphobia.com/ Contacts General Number : 08456009601

Beyond Fear Helpline: Mon-Fri 7.00pm-8.30pm (answering machine available) Beyond Fear provides information and support to those who have a dental phobia and helps them discover what stops them from going to the dentist and to overcome those obstacles. Beyond Fear helps people seek the professional assistance they require and offers support thoughout. Also offers phobia coaching and mentoring. Who for: Anyone with a dental phobia Referral: Self Cost: Free information. Charge applies for phobia coaching and mentoring. Access: No drop-in facilities. Address http://www.beyondfear.org/ Contacts Helpline : 08453456961

National Phobics Society Helpline: Mon-Fri 9.30am-5.00pm, answerphone available. NPS provides a listening service and information on phobias and all anxiety disorders including Obsessive Compulsive Disorder. Members can be put in touch locally with other members via a contact list if they wish and have access to a helpline manned by staff who have extensive knowledge of anxiety disorders. Therapy available with home visits includes, cognitive behavioural therapy, counselling, clinical hypnotherapy and complimentary therapies. Cognitive behavioural therapy and counselling is also available via telephone and on-line. Members also receive newsletters, factsheets, self-help information packs and therapy tapes. Who for: Anyone affected by anxiety disorders, including family members, carers and friends. Referral: Self. Cost: 15 for annual membership. Premises have accessible entrance and toilet. Weekly drop in support group. Provides a range of information tapes. There is a complaints procedure. Address http://www.phobics-society.org.uk/ Contacts Helpline : 0870 7700 456 Helpline : 01612279862

No Panic Helpline: 7 days, 10.00am-10.00pm (recorded message out of hours) Aims to aid the relief and rehabilitation of people affected by panic attacks, phobias, obsessive compulsive disorder, related anxiety disorders and tranquilliser withdrawal. Offers support to patients their families and carers. Provides telephone support, literature, books, audio and video cassettes and a contact service for members wishing to make phone-friends and pen pals. Who for: Anyone affected by or with an interest in anxiety disorders. Referral: Any method. Cost: Optional membership fee. Information is also available in large print and on audio cassette. Address http://www.nopanic.org.uk/ Contacts Helpline : 08088080545

Glossary   Heart The heart is a muscular organ that pumps blood around the body.

Psychotherapy Psychotherapy is the treatment of mental and emotional health conditions, using talking and listening.

Genetic Genetic is a term that refers to genes- the characteristics inherited from a family member.

Delusions If someone is suffering from delusions, they have lost touch with reality and may experience hallucinations.

Pain Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Depression Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.

Anxiety Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.

Nausea Nausea is when you feel like you are going to be sick.

Panic To panic is to be quickly overcome with a feeling of fear or worry.

Antidepressant Antidepressant medicine is used to treat depression. For example Fluoxetine, Paroxetine. Benzodiazepines Benzodiazepines are a group of medicines used to help sleep, reduce anxiety and as a muscle relaxant. For example, temazepam.

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