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Agoraphobia, More Than a Fear of Leaving Your Home

During the pandemic, we’ve spent a lot more time at home. The fear of spreading and possibly getting COVID-19 has had many people understandably more cautious and anxious when being out in public. But, could growing less accustomed to feeling safe in public or leaving your home feed an anxiety disorder known as agoraphobia?

We spoke with Gagandeep Singh, MD, a psychiatrist at Banner Behavioral Health Hospital to learn more about agoraphobia, the potential impact COVID-19 is having on this disorder and ways to get help.

What is agoraphobia?

Many people believe that agoraphobia is the fear of leaving one’s home, thanks in part to its portrayal in media, but it is much more complex.

“The hallmark of agoraphobia is anxiety about or avoidance of places or situations from which escape might be difficult,” Dr. Singh said. “Someone with agoraphobia avoids places or situations where they believe escape or access to help may be impossible, very difficult or very embarrassing if they develop panic-like symptoms, symptoms of a panic attack or some other incapacitating loss of control.”

These irrational or disproportionate fears are so intense that people go to great lengths to avoid situations, such as using public transportation, being in enclosed spaces or standing in a line or being in a crowd. As time passes, they may consider more public places “unsafe” until they eventually are confined to their homes.

What causes agoraphobia?

While there is no definite cause for agoraphobia, it is likely related to a number of contributing factors that may put someone at greater risk. You may be at greater risk of developing agoraphobia if you live with other phobias or anxiety disorders, have a parent who also had the disorder or experienced a traumatic event or stressful situation.

“Events like the pandemic can set in motion neurobiological changes that make our anxiety worse, for others this may be related to dysfunctional learned behaviors ” Dr. Singh said. “Some, but not all, people may develop it after experiencing a panic attack. Since panic attacks are so unpleasant, they may avoid situations or places that might trigger them. As a result, worry about having a panic attack and attempts to control or avoid it can self-perpetuate their condition.”

In some cases, individuals may experience panic disorder with or without agoraphobia. Panic disorder is a type of anxiety disorder marked by panic attacks, which are sudden episodes of intense fear that peak within a few minutes and cause severe physical symptoms. Learn more about symptoms of a panic attack.

How does the pandemic play a role in agoraphobia?

While the mental health impact of the pandemic is still being evaluated, Americans are experiencing an uptick in mental health issues, such as anxiety, stress and depression. However, it’s unclear how the pandemic impacts the development of agoraphobia. Dr. Singh said this may start with rational fears of COVID-19 that over time become exacerbated.

“Agoraphobia is different from fears of leaving home due to COVID-19, because there are very real, rational elements to the fear, such as going out in public can increase our risk of disease,” he said. “These fears are also likely not incapacitating either, meaning we choose not to go out but, when needed, we can, and it hopefully won’t result in panic or a profound loss of control.”

How is agoraphobia clinically diagnosed?

Agoraphobia is diagnosed based on symptoms and signs. Your doctor will ask you a series of questions about your symptoms, medical history and family history and may perform a blood test to rule out other physical causes for your symptoms. For a proper diagnosis, symptoms must meet certain criteria listed by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

What treatment options are available?

“Treatment options are definitely available if you are diagnosed with agoraphobia,” Dr. Singh said. “These treatments can help with abnormal learned behaviors and the neurobiological changes that go with them.”

Options for treating agoraphobia include psychotherapy, especially cognitive behavioral therapy (CBT), and medications, such as selective serotonin reuptake inhibitors (SSRIs). Although, long-term outcomes are best done in combination.

Don’t wait to get help

While it may seem like you can handle this all on your own, therapy and/or medication can successfully help you manage your condition.

The main reason to get treatment is that agoraphobia is disabling. “It prevents us from being able to do normal activities for living and causes lots of distress,” Dr. Singh said. “Additionally, the longer it goes untreated the more difficult it is to treat.”

If you or a loved one are struggling with agoraphobia or another anxiety disorder, seek professional help. A mental health professional can help you get your life back on track.

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