Agoraphobia is a serious type of anxiety disorder characterized by an irrational and intense fear of being trapped or unable to escape from a particular location. This fear can make a trip to the bank, grocery store, or a movie theater filled with so much anxiety that it becomes nearly unbearable for the person to endure.
In addition to fears about specific locations, agoraphobia can also generate anxiety about facing certain situations, like crossing a bridge or being in a large crowd.
While these situations may make someone only mildly uncomfortable, for someone with agoraphobia, these scenarios can trigger a disproportionate fear reaction that makes the individual feel like they’re facing a life-threatening situation.
This fear response can become so intense that afflicted individuals may become unwilling to leave the safety of their homes without the help of a trusted friend or family member.
In the most extreme cases, the emotional response can even become so severe that individuals are unable to step outside at all, instead choosing to remain housebound.
There are many physical symptoms associated with Agoraphobia, which can include:
In some cases, individuals with agoraphobia may even experience a panic attack when they are confronted with these scenarios; however, panic attacks are not a prerequisite to being diagnosed.
As with all anxiety and stress disorders, discovering the root cause is often difficult, and in some cases, it may even be impossible.
However, agoraphobia will at times exist alongside a panic disorder, and in some cases, panic attacks are one of the main causes of agoraphobia. An individual becomes so concerned with the idea of suffering a panic attack while in public, that they instead chose to avoid going out altogether.
Risk factors for developing agoraphobia include:
Agoraphobia affects about 0.9% of U.S adults and about 2.4% of all adolescents.
For adults, the prevalence of agoraphobia among males and females is relatively the same (0.8% vs 0.9%); however, the gap widens among adolescents.
Indeed, female adolescents tend to experience higher rates of agoraphobia compared to males (3.4% vs. 1.4%), though, the reasons for this discrepancy aren’t exactly clear. [i]
Additionally, agoraphobia tends to develop in late adolescence or early adulthood; however, agoraphobia, like any anxiety disorder, can certainly develop at any age.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to meet criteria for agoraphobia, an individual must experience an intense fear response to at least 2 of the following situations:
One thing that’s important to note here are the recent changes in the DSM that pertain to how agoraphobia is diagnosed.
In the previous version of the DSM (DSM-4), individuals under the age of 18 had to have experienced the disorder for at least 6 months prior to receiving a diagnosis; however, this period of 6 months now pertains to all individuals.
This change was made to help reduce the overdiagnosis issue, especially among individuals whose fears are short-lived and not considered chronic.
Additionally, the DSM-4 clumped panic disorders and agoraphobia into a single diagnosis, which is no longer the case in the DSM-5. While there certainly is some overlap when it comes to panic disorders and agoraphobia, a significant number of afflicted individuals suffering from agoraphobia do not experience any symptoms related to panic disorders, further necessitating the need for two separate diagnoses.
Finally, individuals afflicted with agoraphobia no longer need to state the excessiveness of their anxiety in order to be diagnosed.[ii]
Agoraphobia treatment usually encompasses a combination of medication and cognitive behavioral therapy.
However, while both of these treatment protocols have been shown to be effective, it's important that afflicted individuals receive help as soon as possible so that the fear response doesn’t become ingrained in the individual’s personality and chronic.
The longer someone suffers under the disorder, the harder it can become to treat it.
The two most commonly prescribed medications for treating Agoraphobia are antidepressants and anti-anxiety medications.
In general, antidepressants have been shown to be more effective than anti-anxiety medications in the treatment of agoraphobia; however, there are some undesirable side-effects that afflicted individuals should be aware of before starting this form of treatment.
For example, antidepressant medications such as Zoloft and Prozac have been linked with a number of unwanted side-effects, some of which are listed below:
One side-effect that might catch your eye is anxiety, and as a matter of fact, antidepressants can induce panic attack-like symptoms in some patients, which is why doctors may start afflicted individuals off on a low dosage before gradually increasing the prescribed amount.
As an alternative to medication, cognitive behavioral therapy (CBT) has been shown to be effective for some individuals suffering from agoraphobia.
Through CBT, afflicted individuals can learn to develop important skills that help them better manage and cope with their anxiety-related symptoms.
For example, by training an afflicted individual to recognize the warning signs of an oncoming panic attack, they can learn mental strategies with breathing techniques to prevent their mind from becoming overly anxious over the threat of future attacks.
A major component of CBT is the ability to think logically about the dangers associated with certain activities and to challenge maladaptive thoughts that are not based in reality. For example, individuals suffering from agoraphobia may find the prospect of crossing a bridge absolutely terrifying because, in their mind, a bridge is simply an accident waiting to happen. However, by thinking logically about this fear, they can come to the realization that a total bridge collapse, even during a powerful earthquake, is an extremely rare event thanks to modern engineering.
Finally, CBT may also include actually exposing the individual to the locations and situations that they fear the most. Called “exposure therapy”, individuals who are carefully and repeatedly exposed to the things that they fear the most will eventually become desensitized to those things and become able to face them more confidently.
For over 35 years, the Drake Institute has successfully treated anxiety and stress-related disorders, like agoraphobia, without the use of debilitating and addictive medications with unwanted side effects.
With the help of state-of-the-art qEEG brain mapping and advanced treatment protocols such as Biofeedback, Neurofeedback, and Neuromodulation, the Drake Institute is able to create custom treatment protocols on a patient-by-patient basis.
This means that every patient that goes through the Drake Institute treatment plan will receive individual attention that not only takes into account their own specific needs and family history but also their unique physiological findings.
Through biofeedback treatment/training, patients can gain mastery over rejuvenative psychophysiological relaxation that reduces anxiety and automatic irrational fear reactions. It enables the patient to regain a new, confident sense of being in control. In addition, by utilizing qEEG brain mapping with Neurofeedback and Neuromodulation, the Drake Institute is able to help patients return to a more normal state of homeostasis or balance by developing the brain’s natural ability to regulate more normalized brain activity.
What’s more, because our treatment protocols don’t rely on antidepressants or anti-anxiety medications, patients can enjoy long-term symptom relief due to their brain’s improved ability to self-regulate, which can reduce and may even eliminate the occurrence of agoraphobic symptoms.
If agoraphobia or other anxiety-related symptoms are significantly impacting your quality of life, please call us today to schedule a no-cost screening consultation.
Interview with Dr. David Velkoff
Interview with Dr. David Velkoff
Spanish News Feature
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“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Behavioral Medicine and received his initial training in biofeedback/neurofeedback in Behavioral Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Behavioral Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Behavioral Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”