Agoraphobia and Medical Cannabis

What Causes Agoraphobia?

Agoraphobia is a type of anxiety disorder. Research is ongoing to better understand panic disorder, but experts believe a combination of biological, psychological and social factors contribute to the development and then persistence of agoraphobia.

Risk factors for agoraphobia vary between individuals and often a specific reason or cause for the onset of agoraphobia is not possible to identify. However, there are several psychological factors that may increase the likelihood of developing agoraphobia, these include:

• Traumatic or adverse childhood experiences
• Experiencing a stressful event in adulthood, such as bereavement, divorce, or redundancy
• A history of other psychological conditions, such as depression, anorexia, or bulimia
  • Agoraphobia affects 1 in 3 individuals with panic disorders
• Alcohol or drug abuse
• An unhappy relationship or a relationship with a controlling partner may also increase the risk of developing agoraphobia

Agoraphobia Symptoms

The severity of the symptoms of agoraphobia varies between cases and affects the symptoms one may experience. For those with severe agoraphobia, leaving the house may feel impossible whilst for those with mild agoraphobia, short journeys and visits to places nearby might not present a problem.

When presented with a situation that triggers their agoraphobia, patients may experience similar feelings to that of a panic attack. Symptoms include:

• Rapid heartbeat and breathing
• Perspiration
• Nausea
• Chest pain or tightness
• Stomach upset such as churning or diarrhoea
• Difficulty swallowing
• Shaking, dizziness or feeling faint
• Ringing in the ears

Individuals with agoraphobia become versed in avoiding triggering situations making behavioural symptoms the main indication they are living with agoraphobia. Behavioural symptoms include:

• Avoidance and isolation – avoiding crowded places and social gatherings, making excuses not to leave the house
• The need to be with a trusted person when leaving the house, not wanting to go anywhere alone
• Avoiding travelling far from home and ensuring they are in easy reach of their ‘safe place’

How is Agoraphobia Diagnosed?

To obtain a diagnosis of agoraphobia a GP will perform an assessment where they will ask about symptoms and any previous mental health issues. If there is any doubt about the diagnosis, a referral to a psychiatrist may be necessary.

In particular, they will assess for any fear or anxiety associated with the following situations:

• Public transportation
• Open spaces
• Being in shops, theatres, or cinemas
• Standing in line (queuing) or being in a crowd
• Being outside of the home alone in other situations

Agoraphobia Treatment

The treatment approach to agoraphobia depends on the severity of symptoms and impact on an individual’s life and may encompass medications, psychological therapies, lifestyle changes, or a combination of these approaches.

Self-help techniques and lifestyle changes are likely to be beneficial for all types of symptoms. Self-help techniques include practising coping strategies to during a panic attack, lifestyle changes include making healthy choices such as:

• Taking regular exercise
• Maintaining a healthy diet
• Avoiding or reducing alcohol (whilst alcohol may make symptoms feel better in the short term it can make problems worse)
• Reducing or avoiding caffeinated beverages such as coffee, tea, or caffeinated soft drinks

Talking therapies are a mainstay of treatment. Those which have the most evidence of their efficacy include cognitive behavioural therapy and exposure therapy.

Medications may be appropriate for some individuals, including anxiolytic medications for acute symptoms, as well as anti-depressant medications.