Agoraphobia

The term agoraphobia was coined in German in 1871 by pioneering German psychologist Karl Friedrich Otto Westphal (1833–1890), in his article "{{lang|de|Die Agoraphobie, eine neuropathische Erscheinung}}". Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1871–72; 3: 138–161. It is derived from Greek {{lang|grc|ἀγορά}} ({{Transliteration|grc|agorā́}}), meaning {{gloss|place of assembly}} or {{gloss|market-place}} and {{lang|grc|-φοβία}} ({{Transliteration|grc|-phobía}}), meaning {{gloss|fear}}.{{cite web |title=Collins dictionary |url=https://www.collinsdictionary.com/dictionary/english/agora |access-date=17 September 2020}}{{cite book|last1=Elster|first1=Charles Harrington|title=Verbal Advantage: Ten Easy Steps to a Powerful Vocabulary|date=2009|publisher=Diversified Publishing|isbn=978-0-307-56097-1|page=PT717|url=https://books.google.com/books?id=aJxfrKSb7u4C&pg=PT717|language=en|url-status=live|archive-url=https://web.archive.org/web/20160821130114/https://books.google.com/books?id=aJxfrKSb7u4C&pg=PT717|archive-date=2016-08-21}}

Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of a known, controllable space, usually their home.

Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks".{{cite web|url=http://www.dictionary.nowok.co.uk/agoraphobia.php|title=Agoraphobia – Dictionary of Psychotherapy|url-status=dead|archive-url=https://web.archive.org/web/20160403100715/http://www.dictionary.nowok.co.uk/agoraphobia.php|archive-date=2016-04-03|access-date=2016-03-23}} In these cases, the patient is fearful of a particular place because they have previously experienced a panic attack at the same location. Fearing the onset of another panic attack, the patient is fearful or avoids a location. Some refuse to leave their homes in medical emergencies because the fear of being outside of their comfort areas is too great.{{cite web|url=https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/agoraphobia|title=Agoraphobia|website=betterhealth.vic.gov.au|access-date=21 March 2017|url-status=dead|archive-url=https://web.archive.org/web/20170322204034/https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/agoraphobia|archive-date=22 March 2017}}

The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making a diagnosis of panic disorder. Other syndromes like obsessive–compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome.{{cite web|url=http://psychcentral.com/disorders/sx29.htm|title=Agoraphobia Symptoms|work=Psych Central.com|date=2016-05-17}}

People with agoraphobia may experience temporary separation anxiety disorder when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends.{{cite web|url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987|title=Agoraphobia – Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-07-01}}{{cite web|url=https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders|title=What Are Anxiety Disorders?|website=psychiatry.org|access-date=2019-07-01}}

People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia".{{cite book|last1=Adamec|first1=Christine|title=The Encyclopedia of Phobias, Fears, and Anxieties, Third Edition|page=328|url=https://books.google.com/books?id=E2imSyZZDh0C&q=macrophobia|publisher=Infobase Publishing|year=2010|isbn=978-1-4381-2098-0}}

Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.{{cite book | year = 1999 | chapter = Chapter 4.2 | author = David Satcher | title = Mental Health: A Report of the Surgeon General | chapter-url = http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html | display-authors = etal | url-status = dead | archive-url = https://web.archive.org/web/20060427125157/http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html | archive-date = 2006-04-27 | access-date = 2006-03-07 }} Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report a fear of dying, fear of losing control of emotions, or fear of losing control of behaviors.

Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.

Research has uncovered a link between agoraphobia and difficulties with spatial orientation.{{cite journal |vauthors=Yardley L, Britton J, Lear S, Bird J, Luxon LM | title = Relationship between balance system function and agoraphobic avoidance | journal = Behav Res Ther | volume = 33 | issue = 4 | pages = 435–9 | date = May 1995 | pmid = 7755529 | doi = 10.1016/0005-7967(94)00060-W }}{{cite journal |vauthors=Jacob RG, Furman JM, Durrant JD, Turner SM | title = Panic, agoraphobia, and vestibular dysfunction | journal = Am J Psychiatry | volume = 153 | issue = 4 | pages = 503–512 | year = 1996 | pmid = 8599398 | doi=10.1176/ajp.153.4.503}} Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system, their visual system, and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds).{{cite journal |vauthors=Jacob RG, Furman JM, Durrant JD, Turner SM | title = Surface dependence: a balance control strategy in panic disorder with agoraphobia | journal = Psychosom Med | volume = 59 | issue = 3 | pages = 323–30 | year = 1997 | pmid = 9178344 | doi = 10.1097/00006842-199705000-00016| s2cid = 9789982 }} Likewise, they may be confused by sloping or irregular surfaces.

In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with subjects without agoraphobia.{{cite journal |vauthors=Viaud-Delmon I, Warusfel O, Seguelas A, Rio E, Jouvent R | title = High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality | journal = Eur. Psychiatry | volume = 21 | issue = 7 | pages = 501–8 | date = October 2006 | pmid = 17055951 | doi = 10.1016/j.eurpsy.2004.10.004 | s2cid = 6932961 | url = https://hal.archives-ouvertes.fr/hal-03411683/file/EurPsy2006.pdf }}

Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia.{{cite book |veditors=Palmer S, Dainow S, Milner P |title=Counselling: The BACP Counselling Reader |volume=1 |year=1996 |publisher=Sage |isbn=978-0-8039-7477-7 |pages=211–4 |chapter-url=https://books.google.com/books?id=wnIBEQKQi7IC |vauthors=Hammersley D, Beeley L |chapter=The effects of medication on counselling }} In 10 patients who had developed agoraphobia during benzodiazepine dependence, symptoms abated within the first year of assisted withdrawal.{{cite journal | author = Ashton H | title = Benzodiazepine withdrawal: outcome in 50 patients | journal = Br J Addict | volume = 82 | issue = 6 | pages = 665–71 | date = June 1987 | pmid = 2886145 | doi = 10.1111/j.1360-0443.1987.tb01529.x }} Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to the long-term effects of alcohol consumption causing a distortion in brain chemistry.{{cite journal |vauthors=Cosci F, Schruers KR, Abrams K, Griez EJ | title = Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship | journal = J Clin Psychiatry | volume = 68 | issue = 6 | pages = 874–80 | date = June 2007 | pmid = 17592911 | doi = 10.4088/JCP.v68n0608 }}

Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.{{cite journal |vauthors=Cosci F, Knuts IJ, Abrams K, Griez EJ, Schruers KR | title = Cigarette smoking and panic: a critical review of the literature | journal = J Clin Psychiatry | volume = 71 | issue = 5 | pages = 606–15 | date = May 2010 | pmid = 19961810 | doi = 10.4088/JCP.08r04523blu }}

{{Main|Attachment theory}}

Some scholarsG. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation). have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.{{cite journal | author = Jacobson K | year = 2004 | title = Agoraphobia and Hypochondria as Disorders of Dwelling | journal = International Studies in Philosophy | volume = 36 | issue = 2| pages = 31–44 | doi=10.5840/intstudphil2004362165}} Recent empirical research has also linked attachment and spatial theories of agoraphobia.{{cite journal | author = Holmes J | year = 2008 | title = Space and the secure base in agoraphobia: a qualitative survey | journal = Area | volume = 40 | issue = 3 | pages = 357–382 | doi = 10.1111/j.1475-4762.2008.00820.x | bibcode = 2008Area...40..375H }}

In the social sciences, a perceived clinical biasJ. Davidson, (2003). Phobic Geographies exists in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.{{cite journal | author = Holmes J | year = 2006 | title = Building Bridges and Breaking Boundaries: Modernity and Agoraphobia | journal = Opticon 1826 | volume = 1 | page = 1 | url = http://www.ucl.ac.uk/opticon1826/archive/issue1 | doi = 10.5334/opt.010606 | url-status=live | archive-url = https://web.archive.org/web/20160303233808/http://www.ucl.ac.uk/opticon1826/archive/issue1 | archive-date = 2016-03-03 | doi-access = free | url-access = subscription }} Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating a conflict in the mind of agoraphobic individuals.

Some evolutionary models propose that agoraphobia—like other specific phobias—may be rooted in adaptive mechanisms that helped early humans avoid threats in open or unfamiliar environments. From this viewpoint, fear and avoidance behaviors could have been selectively favored if they aided survival—for instance, by prompting individuals to steer clear of potentially dangerous surroundings or minimize exposure to predators and pathogens. According to preparedness models, human defensive systems are especially sensitive to cues linked to ancestral threats and can rapidly form strong, lasting fear associations with them. In modern life, such defenses might become mismatched to relatively low-risk environments, producing disproportionate anxiety responses.{{Cite book |last=Del Giudice |first=Marco |title=Evolutionary psychopathology: a unified approach |date=2018 |publisher=Oxford University Press |isbn=978-0-19-024684-6 |location=New York, NY |pages=335–342}}

An additional evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred.{{cite journal | author = Bracha HS | title = Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder | journal = Progress in Neuro-Psychopharmacology and Biological Psychiatry | volume = 30 | issue = 5 | pages = 827–853 | year = 2006 | pmid = 16563589 | pmc = 7130737| doi = 10.1016/j.pnpbp.2006.01.008 | url = http://cogprints.org/5013/1/2006_P.N.P._Neuro-evolution_of_fear_circuit_disorders.pdf }}{{cite journal|vauthors=Raffaello S, Alessandra SM, Alessandra S |year=2011 |title=[Primary agoraphobia specific symptoms: from natural information to mental representations] |language=it |journal=Italian Journal of Psychopathology |volume=17 |issue=3 |pages=265–276 |url=http://www.gipsicopatol.it/issues/2011/vol17-3/02%20Spiti.pdf |url-status=dead |archive-url=https://web.archive.org/web/20120426082624/http://www.gipsicopatol.it/issues/2011/vol17-3/02%20Spiti.pdf |archive-date=2012-04-26 }}

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.American Psychiatric Association, 1998 Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.{{cite book | year = 1988 | author = Barlow DH | title= Anxiety and its disorders: The nature and treatment of anxiety and panic | publisher = Guilford Press }} Early treatment of panic disorder can often prevent agoraphobia.{{cite web|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/|title=Agoraphobia – National Library of Medicine|last=pmhdev|access-date=25 January 2017|url-status=live|archive-url=https://web.archive.org/web/20140330112146/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/|archive-date=30 March 2014}} Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other mental disorders such as depression.{{cite web|last1=Kenny|first1=Tim|last2=Lawson|first2=Euan|title=Agoraphobia|url=http://www.patient.info/health/agoraphobia-leaflet|website=Patient.info|access-date=8 December 2014|url-status=dead|archive-url=https://web.archive.org/web/20150607021823/http://patient.info/health/agoraphobia-leaflet|archive-date=7 June 2015}}

Agoraphobia without a history of panic disorder (also called primary agoraphobia) is an anxiety disorder where the individual with the diagnosis does not meet the DSM-5 criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks. Agoraphobia can be caused by traumatic experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, generalized anxiety disorder, avoidant personality disorder and social phobia. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic".Barlow, D. H. & Waddell, M. T. (1985) Agoraphobia. Ch 1 in Barlow, D. H. (Ed) Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford. In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.{{citation needed|date=May 2024}}

According to the DSM-IV-TR, a widely-used manual for diagnosing mental disorders, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence.{{cite book |title=Diagnostic and Statistical Manual of Mental Disorders |edition=4th, text revision (DSM-IV-TR) |author=American Psychiatric Association |year=2000 |isbn=0-89042-025-4 |chapter=Diagnostic criteria for 300.22 Agoraphobia Without History of Panic Disorder |chapter-url=https://www.behavenet.com/diagnostic-criteria-30022-agoraphobia-without-history-panic-disorder |access-date=2007-06-28 |publisher= |location= }} The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be diagnosed together.{{cite web |last=Administration |first=Substance Abuse and Mental Health Services |date= June 2016|title=Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5 |url=https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/ |access-date=2023-11-04 |website=ncbi.nlm.nih.gov |language=en}}

Systematic desensitization can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.{{cite journal |vauthors=Fava GA, Rafanelli C, Grandi S, Conti S, Ruini C, Mangelli L, Belluardo P | title = Long-term outcome of panic disorder with agoraphobia treated by exposure | journal = Psychological Medicine | volume = 31 | issue = 5 | pages = 891–898 | year = 2001 | pmid = 11459386 | doi = 10.1017/S0033291701003592 | s2cid = 5652068 }} Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely.{{cite web | title = Agoraphobia – Diagnosis & Treatment | publisher = Mayo Clinic | date = 18 November 2017 | url = https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993 | access-date = 15 May 2020}} In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until the symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise.

A related exposure treatment is {{lang|la|in vivo}} exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects.{{cite journal |last1=Sanchez-Meca |last2=Rosa-Alcazar |last3=Marin-Martinez |last4=Gomez-Conesa|date=11 September 2008|title=Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis|journal=Clinical Psychology Review|volume=30|issue=1|pages=37–50|doi=10.1016/j.cpr.2009.08.011|pmid=19775792}} This treatment was largely effective with an effect size from d = 0.78 to d = 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment).

Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals. Further research showed there was no significant effect between using group CBT versus individual CBT.

Cognitive restructuring has also proved useful in treating agoraphobia.{{Cite journal |last1=Emmelkamp |first1=Paul M. G. |last2=Mersch |first2=Peter Paul |date=March 1982 |title=Cognition and exposure in vivo in the treatment of agoraphobia: Short-term and delayed effects |url=http://link.springer.com/10.1007/BF01185728 |journal=Cognitive Therapy and Research |language=en |volume=6 |issue=1 |pages=77–90 |doi=10.1007/BF01185728 |issn=0147-5916|url-access=subscription }} This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.

Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.{{cite web|url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993|title=Agoraphobia – Diagnosis and treatment – Mayo Clinic|website=mayoclinic.org|language=en|access-date=2019-07-01}}

Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method.{{cite journal|last1=Fernández-Álvarez|first1=Javier|last2=Fernández-Álvarez|first2=Héctor|date=2021|title=Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects?|journal=Frontiers in Psychology|volume=12|page=589536|language=English|doi=10.3389/fpsyg.2021.589536|pmid=33679513|issn=1664-1078|pmc=7933024|doi-access=free}} Similar to traditional face-to-face interventions, VCP can be used to administer CBT.{{cite journal|last1=Bouchard|first1=Stéphane|last2=Allard|first2=Micheline|last3=Robillard|first3=Geneviève|last4=Dumoulin|first4=Stéphanie|last5=Guitard|first5=Tanya|last6=Loranger|first6=Claudie|last7=Green-Demers|first7=Isabelle|last8=Marchand|first8=André|last9=Renaud|first9=Patrice|last10=Cournoyer|first10=Louis-Georges|last11=Corno|first11=Giulia|date=2020-08-21|title=Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial|journal=Frontiers in Psychology|volume=11|page=2164|doi=10.3389/fpsyg.2020.02164|issn=1664-1078|pmc=7472915|pmid=32973638|doi-access=free}}

Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).{{cite journal |date=20 July 2023 |title=Virtual reality could help people with psychosis and agoraphobia |url=https://evidence.nihr.ac.uk/alert/virtual-reality-could-help-people-with-psychosis-and-agoraphobia/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59108 |s2cid=260053713 |url-access=subscription }}

Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. benzodiazepines, monoamine oxidase inhibitors, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia.{{cite journal|last1=Lydiard|first1=R. Bruce|last2=Ballenger|first2=James C.|date=16 June 1987|title=Antidepressants in panic disorder and agoraphobia|journal=Journal of Affective Disorders|volume=13|issue=2|pages=153–168|doi=10.1016/0165-0327(87)90020-6|pmid=2960710}} Antidepressants are important because some have anxiolytic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy. A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.{{cite book | last1 = Gelder | first1 = Michael G. | last2 = Mayou | first2 = Richard. | last3 = Geddes | first3 = John | title = Psychiatr | year = 2005 | publisher = Oxford University Press | location = New York | isbn = 978-0-19-852863-0 | url-access = registration | url = https://archive.org/details/psychiatry0000geld }}

Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.

{{cite journal |author1=Goldstein, Alan J. |author2=de Beurs, Edwin |author3=Chambless, Dianne L. |author4=Wilson, Kimberly A. | title = EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions | journal = Journal of Consulting and Clinical Psychology | volume = 68 | issue = 6 | pages = 947–957 | year = 2000 | doi = 10.1037/0022-006X.68.6.947 |pmid=11142547 | citeseerx = 10.1.1.527.315 }} As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.{{cite web| last= Agoraphobia Resource Center| title= Agoraphobia treatments—Eye movement desensitization and reprogramming| url= http://www.agoraphobia.ws/treatment-emdr.htm| access-date= 2008-04-18| archive-url= https://web.archive.org/web/20080405230027/http://www.agoraphobia.ws/treatment-emdr.htm| archive-date= 5 April 2008| url-status=dead}}

Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.{{cite web |last = National Institute of Mental Health |title = How to get help for anxiety disorders |url = http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml |access-date = 2008-04-18 |url-status = dead |archive-url = https://web.archive.org/web/20080704192950/http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml |archive-date = 2008-07-04 }}

Agoraphobia occurs about twice as often in women as it does in men. Age of onset is typically mid to late twenties, though it can occur at any age.{{Cite journal |last=Tearnan |first=Blake H. |last2=Telch |first2=Michael J. |last3=Keefe |first3=Peter |date=1984-01-01 |title=Etiology and onset of agoraphobia: A critical review |url=https://www.sciencedirect.com/science/article/pii/0010440X84900221 |journal=Comprehensive Psychiatry |volume=25 |issue=1 |pages=51–62 |doi=10.1016/0010-440X(84)90022-1 |issn=0010-440X}}{{cite journal |vauthors=Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC | title = Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. | journal = Arch Gen Psychiatry | volume = 53 | issue = 2 | pages = 159–68 | date = Feb 1996 | pmid = 8629891 | doi = 10.1001/archpsyc.1996.01830020077009 }}

Panic disorder with or without agoraphobia affects roughly 5.1% of Americans, and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting with panic disorders as well.

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• Woody Allen, actor, director, musician{{cite magazine|url=http://www.vanityfair.com/culture/features/2005/12/woodyallen200512?currentPage=4|title=Reconstructing Woody|author=Peter Biskind|magazine=Vanity Fair|date=10 October 2006|issue=December|url-status=live|archive-url=https://web.archive.org/web/20121017064819/http://www.vanityfair.com/culture/features/2005/12/woodyallen200512?currentPage=4|archive-date=2012-10-17}}
• Kim Basinger, actress{{cite book|last1=Saul|first1=Helen|title=Phobias : fighting the fear.|date=2003|publisher=Arcade|location=New York|isbn=978-1-55970-693-3|page=6|url=https://books.google.com/books?id=10TAV1iAoiwC&q=Kim+Basinger+agoraphobia&pg=PA6|access-date=11 September 2015|url-status=live|archive-url=https://web.archive.org/web/20151016095110/https://books.google.com/books?id=10TAV1iAoiwC&pg=PA6#v=onepage&q=Kim%20Basinger|archive-date=16 October 2015}}
• Earl Campbell, American football player{{cite web|last=Murray|first=Jim|date=1991-08-15|title=Campbell Breaks Free Again|url=https://www.latimes.com/archives/la-xpm-1991-08-15-sp-633-story.html|access-date=2023-01-06|website=Los Angeles Times|language=en-US}}
• Macaulay Culkin, actor{{cite news|url=http://transcripts.cnn.com/TRANSCRIPTS/0405/27/lkl.00.html|title=CNN.com – Transcripts|publisher=CNN|date=2004-05-27|access-date=2009-08-07|url-status=live|archive-url=https://web.archive.org/web/20090720052649/http://transcripts.cnn.com/TRANSCRIPTS/0405/27/lkl.00.html|archive-date=2009-07-20}}
• Paula Deen, chef, author, and television personality{{cite news | newspaper=The New York Times | author=Julia Moskin | url=https://www.nytimes.com/2007/02/28/dining/28deen.html | title=From Phobia To Fame: A Southern Cook's Memoir | date=28 February 2007 | url-status=live | archive-url=https://web.archive.org/web/20170201112729/http://www.nytimes.com/2007/02/28/dining/28deen.html | archive-date=1 February 2017 }}
• H.L. Gold, science fiction editor{{cite encyclopedia|title=Horace L. Gold | encyclopedia=Encyclopædia Britannica|url=https://www.britannica.com/biography/Horace-L-Gold|access-date=2023-01-06|author= Erik Gregerson|year=2011}}
• Daryl Hannah, actress{{IMDb name|id=0000435|name=Daryl Hannah|section=bio}}. Retrieved 28 November 2007.
• Miranda Hart, actress and comedian{{cite news |last1=Ellis-Petersen |first1=Hannah |title=Miranda Hart: 'I used to think fame would justify my whole existence |url=https://www.theguardian.com/tv-and-radio/2017/may/26/miranda-hart-fame-would-justify-existence-comedian-interview |access-date=14 September 2023 |work=The Guardian |date=26 May 2017}}
• Howard Hughes, aviator, industrialist, film producer and philanthropist{{cite web|url=http://www.crimelibrary.com/criminal_mind/forensics/psych_autopsy/4.html |title=Psychological Autopsy can help understand controversial deaths|website= truTV.com|access-date=25 January 2017 |url-status=dead |archive-url=https://web.archive.org/web/20150214053314/http://www.crimelibrary.com/criminal_mind/forensics/psych_autopsy/4.html |archive-date=14 February 2015 }}
• Olivia Hussey, actress[http://www.oliviahussey.com/olivia_scrapbook/clippings/people.htm Olivia Hussey—People Magazine—March 16, 1992] {{webarchive|url=https://web.archive.org/web/20120318064857/http://www.oliviahussey.com/olivia_scrapbook/clippings/people.htm |date=18 March 2012 }}{{IMDb name|id=0001377|name=Olivia Hussey|section=bio}}
• Shirley Jackson, writer{{cite web | last=Churchwell | first=Sarah | title=Shirley Jackson: A Rather Haunted Life by Ruth Franklin review – beyond spooky | website=The Guardian | date=2017-02-10 | url=http://www.theguardian.com/books/2017/feb/10/shirley-jackson-ruth-franklin-review-a-rather-haunted-life | access-date=2021-03-09}}[http://www.salon.com/jan97/jackson970106.html/] essay by Jonathan Lethem {{webarchive |url=https://web.archive.org/web/20120429204027/http://www.salon.com/jan97/jackson970106.html/ |date=29 April 2012 }}
• Elfriede Jelinek, writer, Nobel Prize laureate in Literature in 2004{{cite web |author=Mike Conklin. |url=https://www.chicagotribune.com/2004/12/10/where-is-elfriede-jelinek/ |title=Where is Elfriede Jelinek? |work=Chicago Tribune |date=2004-12-10 |access-date=2013-05-08 |url-status=live |archive-url=https://web.archive.org/web/20130617035833/http://articles.chicagotribune.com/2004-12-10/features/0412090437_1_literature-social-phobia-place |archive-date=2013-06-17 }}
• Mike Patton, musician{{cite news |last1=Hatfield |first1=Amanda |title=Mike Patton discusses agoraphobia diagnosis, canceling Faith No More shows in new interview |url=https://www.brooklynvegan.com/mike-patton-discusses-agoraphobia-diagnosis-canceling-faith-no-more-shows-in-new-interview/ |access-date=21 July 2022 |work=Brooklyn Vegan |date=19 July 2022}}
• Bolesław Prus, journalist and novelistStanisław Fita, ed., Wspomnienia o Bolesławie Prusie (Reminiscences about Bolesław Prus), Warsaw, Państwowy Instytut Wydawniczy (State Publishing Institute), 1962, p. 113.
• Peter Robinson, musicianWhatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.
• Barbra Streisand, singer and songwriter{{cite web | last=V | first=Justin | title=Famous People With Agoraphobia | website=Morningside Recovery | date=2014-11-21 | url=https://www.morningsiderecovery.com/addiction-blog/famous-figures-suffered-agoraphobia/ | access-date=2023-07-26}}
• Ben Weasel, singer and songwriter{{cite web |title=Ben Weasel featured on Carson Daly |url=https://www.punknews.org/article/40202/ben-weasel-featured-on-carson-daly |website=punknews.org |date=14 October 2010 |language=en}}
• Brian Wilson, singer and songwriter{{cite web|last=McNair|first=James|url=https://www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html|title=Brian Wilson: Here Comes the Sun|archive-url=https://web.archive.org/web/20090120172307/http://www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html |archive-date=20 January 2009|work=The Independent|date=3 September 2007|url-access=subscription}}

{{colend}}

{{Portal|Psychiatry|Psychology|Medicine}}

• Hikikomori
• List of phobias

{{Clear}}

{{Reflist}}

• {{NIMH}}
• Balaram K, Marwaha R. Agoraphobia. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 January ([https://www.ncbi.nlm.nih.gov/books/NBK554387/])

• [http://www.jonmd.com/pt/re/jnmd/abstract.00005053-200209000-00008.htm;jsessionid=DWUu2lxfcN51EJB9baFHrQF0bkMOYK7vGUI0W4MSjYvLbUR56Jkv!-352798717!-949856145!9001!-1 Agoraphobia Without a History or Panic Disorder May Be Part of the Panic Disorder Syndrome.] Journal of Nervous & Mental Disease, 190(9):624–630, September 2002.
• [http://archpsyc.ama-assn.org/cgi/content/abstract/55/11/1017 The Relationship of Agoraphobia and Panic in a Community Sample of Adolescents and Young Adults].

{{Wikiquote|Anxiety}}

{{Wiktionary|anxiety}}

• [http://www.adaa.org/ Anxiety Disorders Association of America] Information for families, clinicians & researchers
• [http://www.anxietycanada.ca/ Anxiety Disorders Association of Canada] Registered Canadian non-profit organization, promotes prevention, treatment & management of anxiety disorders
• [http://www.anxietyuk.org.uk/ ANXIETY UK (Formerly the National Phobics Society)] Nationally registered charity in the UK; provides information, support & understanding
• [http://www.phobic.org.nz/ The Phobic Trust (Of New Zealand)] Registered charitable trust in New Zealand; provides information about treatment, education & support to people with anxiety disorders
• [http://www.sadag.co.za/ South African Depression and Anxiety group (National Charity)] Counseling, mental health awareness programs: media & public speaking outreach & rural outreach initiatives
• [https://web.archive.org/web/20091115190338/http://www.nhsdirect.nhs.uk/help/bodykey/questions/index.aspx?nodes=%2f7ddGPON8Ig%3d Self help guide] (NHS Direct)

{{Medical condition classification and resources| ICD10 = {{ICD10|F|40.0||f|40}}

| ICD9 = {{ICD9|300.22}} Without panic disorder, {{ICD9|300.21}} With panic disorder

|MedlinePlus=000923

| MeshID = D000379

}}

{{Mental and behavioural disorders|selected = neurotic}}

Category:Phobias

Category:Wikipedia neurology articles ready to translate

Category:Wikipedia medicine articles ready to translate