Agoraphobia is an anxiety disorder in which an individual is afraid to go to crowded places or situations that may cause a panic attack. The individual has a fear of an actual or anticipated situation, like standing in line or being in enclosed spaces.
What Is Agoraphobia?
It is a rare form of anxiety disorder that leads to extreme fear and panic. People with this condition are afraid of stepping out of their homes and going out into the world. Hence, they avoid specific situations and places where they feel trapped and unable to escape. “Agoraphobia is the fear of being in situations where escaping may be difficult or embarrassing, or when aid may not be available in the event of panic symptoms,” according to the American Psychiatric Association. The fear experienced by the sufferer is usually out of proportion in regards to the real situation. The symptoms of this disorder may last for over 6 months and may affect their ability to function in daily life.
An agoraphobic person may be afraid of certain situations, like –
- Being in open or enclosed spaces
- Being in a crowd, shopping centers or standing in a queue
- Going out of home by themselves
- Using public transportation, elevators etc
Agoraphobia is a Greek term, derived from “agora” meaning place of assembly and “phobia” meaning fear. The disorder is characterized by symptoms of anxiety and panic that makes the sufferer feel helpless, trapped and embarrassed. The condition was not considered a distinct disorder until 2013, when the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorized it under phobias. Agoraphobia affects almost 1.7% of adults, with 1% of men and 2% of women having the condition during a period of 12 months.
Moreover, around 30-50% of individuals with this disorder also suffer from panic disorder. Onset of this rare phobia is usually by the age of 35. The condition begins in early adulthood and becomes less common with age. However, it is rarely found in children.
Agoraphobia is an irrational and intense fear of public places or open spaces. It is a negative behavioral outcome of persistent panic attacks and ensuing anxiety. “Agoraphobia is characterized by worry about being separated from a place or person associated with safety,” according to a 2012 study. After one or more panic attacks, the majority of agoraphobics develop agoraphobia. As the sufferer becomes preoccupied with these adverse emotions and attacks, they start to avoid situations that may trigger a panic attack. Agoraphobics may be afraid of situations that may not pose any real threat or may even feel anxious simply by anticipating a situation without any means of escape or access to help.
It is often considered as a progressive phobia that is primarily a fear of panic attacks. According to the American Psychiatric Association, “the individual actively avoids the situation, requires a companion, or suffers from intense fear or anxiety.” If left untreated, the condition can deteriorate to the point where the person refuses to leave their home. As a result, their quality of life is affected and their scope of living becomes smaller due to constantly being on alert and awaiting the next episode of panic attack. “According to the Anxiety and Depression Association of America, “some people create a set path or territory, and it may become hard for them to venture outside their comfort zones without experiencing significant anxiety” (ADAA).
Read More About Anxiety Here
Symptoms Of Agoraphobia
According to the National Health Service (NHS), UK, “Agoraphobia usually develops as a complication of panic disorder, an anxiety disorder involving panic attacks and moments of intense fear”. The symptoms of Agoraphobia occur every time this situation arises and lasts for more than six months. People affected by it can go to great lengths to avoid situations that make them feel unsafe.
A person suffering from Agoraphobia can experience the following common and specific symptoms:
- Being afraid of leaving their home for an extended period of time
- Afraid of being alone in a social gathering
- Afraid of losing control in a public place
- Being afraid of places where it can get difficult to escape like a car or an elevator
- Being anxious or agitated
- Avoidant behavior limiting life activities to avoid panic attacks
This disorder is often correlated to panic attacks. A panic attack is a series of symptoms that can occur due to extreme anxiety or other mental health conditions. This can involve a wide range of physical symptoms:
- Chest pain
- Heart racing
- Shortness of breath
- Being dizzy
- Sweating excessively
- Tingling sensations
People with this condition can experience panic attacks whenever they feel stressed or are in an uncomfortable situation. However, there are several other conditions that produce the same kind of symptoms, such as:
- Separation anxiety
- Post-traumatic stress disorder (PTSD)
- Major depressive disorder
People who are affected by this disorder are more susceptible to develop depression or substance abuse disorder as well.
Read More About Major Depressive Disorder (Depression) Here
Agoraphobia Vs Other Phobias
This disorder is different from the diagnostic criteria for other phobias. For example:
- A person suffering from agoraphobia may avoid traveling on an airplane due to the fear of having a panic attack on an airplane and not necessarily due to aerophobia or the fear of flying1.
- A person suffering from this disorder may avoid crowded places due to fear of having a panic attack in front of a crowd. This fear is not the same as a social anxiety disorder 2, which is a separate anxiety disorder that involves the anxiety of being negatively judged by others.
What Causes Agoraphobia
The exact cause of this condition hasn’t been found yet. The condition usually occurs due to a combination of genetic and environmental factors. It often runs in families and is usually triggered in stressful or traumatic situations, such as loss of a loved one or assault. However, there are several other factors that contribute to the risk of developing it. They include:
- Other related phobias like claustrophobia or social phobia
- Any other associated disorder, such as general anxiety disorder or obsessive-compulsive disorder
- History of physical or sexual abuse
- Substance abuse problem
- Family history
Research 3 indicates that “parental overprotectiveness, the presence of childhood fears or night terrors, experience of grief or bereavement early in life, unhappy or traumatic childhoods, or genetic predisposition,” may also cause the development of this condition. Moreover, people with highly-neurotic, obsessive-compulsive and dependent personalities may also become agoraphobic. This disorder is commonly found in women than in men. It usually begins in young adulthood. The average age for the onset of this disorder is 20. However, the symptoms can show at any age.
Read More About Obsessive-Compulsive Disorder (OCD) Here
How Agoraphobia Is Diagnosed
In order to diagnose this condition, you may experience extreme fear or anxiety in any two of the following situations as laid down by the DSM-5:
- Going out on public transportation such as a bus or train
- Being in open spaces such as a parking lot
- Being in enclosed spaces like an elevator or car
- Being in a crowd
- Being away from home alone
Moreover, you also need to experience anxiety, fear and avoidance for a period of more than 6 months. The fear must revolve around difficulty in escaping the situation or unavailability of help. The doctor may also consider the following while diagnosing Agoraphobia:
- Symptoms are out of proportion in response to the actual situation
- Symptoms impair daily functioning or cause serious distress
- Symptoms usually get triggered under the same circumstances
- Sufferers alter their behavior to avoid situations
- They need a friend or companion to cope with it
- Symptoms are not caused by other general medical or mental conditions
Treatment For Agoraphobia
The National Institute of Mental Health (NIMH) estimates that 0.8 percent of American adults suffer from this disorder. People suffering from this disorder realize that their fear is irrational but they are unable to do anything about it. If the condition is left untreated, it can pose serious health consequences. Hence, early diagnosis and immediate treatment is crucial for recovery.
There are several treatment methods that can be adopted for agoraphobia, which usually involves a combination of therapy and medication.
1. Counseling And Therapy
The following types of therapy options are available for the treatment of Agoraphobia:
This type of therapy involves interaction with a therapist or any other mental health professional on a regular basis. This allows the patient to talk about their fears and anxieties. The effectiveness of this therapy is seen when it is combined with medication. Psychotherapy is typically a short-term treatment that can be discontinued once the patient has learned to cope with their anxiety or dread.
B. Cognitive Behavioral Therapy (CBT)
CBT is the most commonly used treatment method for all anxiety disorders. One 2017 study 4 states “The standard psychological treatment for agoraphobia symptoms is cognitive behavioral therapy (CBT), which is also recommended by the UK National Institute of Health and Care Excellence.” In this therapy, the patient is made aware of their thoughts and patterns and how it affects their behavior. It also teaches you how to handle stressful situations by replacing anxiety-provoking thoughts with positive thoughts. This allows the individual to regain control over their life.
Read More About Cognitive Behavioral Therapy (CBT) Here
C. Exposure Therapy
Exposure therapy is the gradual process of exposing the patient to situations or places they fear. This therapy helps to overcome the fears the patient has about being in an unsafe environment.
There are certain medications that can help relieve the symptoms of Agoraphobia or panic attacks. A doctor may prescribe the following medications for this condition:
- Selective Serotonin Reuptake Inhibitors (SSRI), such as paroxetine (Paxil) or fluoxetine (Prozac)
- Selective serotonin and norepinephrine reuptake inhibitors, like venlafaxine (Effexor) or duloxetine
- Tricyclic antidepressants, such as amitriptyline (Elavil) or nortriptyline (Pamelor)
- Anti-anxiety medications, such as alprazolam (Xanax) or clonazepam (Klonopin)
3. Lifestyle changes
It is essential to derive a coping mechanism in order to deal with this disorder. Making a few modifications in your lifestyle may not heal agoraphobia but it can help reduce the associated anxiety. Here are a few recommendations that you could try:
- Exercising regularly can help to increase the production of brain chemicals that are responsible for making you calm and happier
- Eating a healthy diet that consists of whole grains, vegetables, and fruits
- Deep breathing exercises or meditation in order to reduce anxiety and fight the onset of panic attacks
- Avoiding drugs and alcohol
- Limited caffeine intake
It is advisable to not take herbal or dietary supplements. These supplements might interfere with the effectiveness of the prescribed medication.
Read More About Drug Abuse Here
Can You Heal From Agoraphobia?
It has been found that this disorder heals with age. However, getting the right treatment and medication can help to accelerate the process of healing and can ensure the quality of life for the patient. The patient has a good chance to have better health if the treatment is started early. This mental condition can be exhausting as it prevents the patient from participating in daily activities.
There is no cure for Agoraphobia but treatment can greatly contribute to the well-being of the individual suffering from it. The support from family and friends is of paramount importance when an individual is suffering from this disorder. Eventually, with therapy and medication, the panic attacks and the symptoms start to lessen.
Agoraphobia At A Glance
- Agoraphobia is a rare form of anxiety disorder that leads to extreme fear and panic.
- People with this condition are afraid of stepping out of their homes and going out into the world.
- Most sufferers tend to develop agoraphobia after experiencing one or more panic attacks.
- The symptoms of Agoraphobia occur every time this situation arises and lasts for more than six months.
- It often runs in families and is usually triggered in stressful or traumatic situations.
- It has been found that this disorder heals with age.
- Clark, G. I., & Rock, A. J. (2016). Processes Contributing to the Maintenance of Flying Phobia: A Narrative Review. Frontiers in psychology, 7, 754. https://doi.org/10.3389/fpsyg.2016.00754
- National Collaborating Centre for Mental Health (UK). Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society; 2013. (NICE Clinical Guidelines, No. 159.) 2, SOCIAL ANXIETY DISORDER. Available from: https://www.ncbi.nlm.nih.gov/books/NBK327674/
- Balaram K, Marwaha R. Agoraphobia. [Updated 2021 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554387/
- Christoforou, M., Sáez Fonseca, J. A., & Tsakanikos, E. (2017). Two Novel Cognitive Behavioral Therapy-Based Mobile Apps for Agoraphobia: Randomized Controlled Trial. Journal of medical Internet research, 19(11), e398. https://doi.org/10.2196/jmir.7747