What is Agoraphobia?

QUESTION: What is agoraphobia? Can it be successfully treated?
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ANSWER: A person with agoraphobia suffers from undue anxiety that interferes
with the usual activities of daily living. It is more common in women than
men. The most frequent description of the person with agoraphobia is that she
is most afraid of fear itself. The symptoms of fear are especially upsetting
to the agoraphobic.
Some experts estimate that between 3 and 6 percent of Americans suffer
from this problem, and 75 percent of agoraphobics are women. Most of the
time, agoraphobia first shows symptoms in late adolescence or early adulthood.
A common symptom is panic attacks, during which the agoraphobic becomes very
agitated, feeling quite certain that she is going to die. In the panic
attack, the symptoms of fear are magnified, and the patient feels her heart
race, her breathing increase, and her body feel out of control. The panic
attack is often the problem that first brings the patient to the attention of
the physician.
Physical complaints are a common problem to agoraphobics for several
reasons. Sometimes, they focus their anxiety on their bodies. They know the
symptoms of fear are very real, and they may see a physician because of the
symptoms of increased heart rate and hyperventilation. Another reason for
many physical complaints may be because they find it easier to see a physician
for a physical problem than for an emotional one. The astute physician may
hear the unvoiced problem--one of anxiety--and treat it instead of the
perceived physical problem.
This is tricky for the physician, because the physical problems may or
may not be real, and the patient may not be able to recognize the emotional
component of her physical complaints. Unchecked anxiety can in fact cause
physical problems, and physical problems can cause anxiety. It is important
for the physician to sort through the sometimes confusing situation and
establish trust with the patient so that effective communication occurs. In
this way, the real root of the problems can be discovered and treated.
Sometimes an agoraphobic patient goes to many different physicians, and this
complicates diagnosis and treatment. If a doctor does not see the patient
regularly and for all complaints, the pattern of anxiety may not be
identified.
You ask whether there is a successful treatment for agoraphobia. Some
physicians prescribe medications alone, but this is rarely effective without
therapy. Antidepressant medications in combination with counseling that
involves a spouse or other family member is most effective. The most
important part of the therapy involves gently exposing the agoraphobic to
situations she finds frightening, and supporting her while she finds that the
situations hold no real danger for her. The best results are obtained when
spouses are included in the therapy, and even better results are achieved when
several agoraphobics from the same neighborhood or social group are treated
together.