Agoraphobia

What is Agoraphobia? | Symptoms | Causes | Diagnosis | Treatment | FAQ

Agoraphobia is a type of phobic disorder, the most common type of anxiety disorder.

People with agoraphobia usually go to great lengths to avoid a variety of feared situations that may cause them to worry or panic, such as:

• Open spaces (e.g. streets and carparks)
• Crowded areas (e.g. shopping malls and market places)
• Taking the public transport (e.g. buses, trains and planes)
• Enclosed spaces (e.g. cinemas and shops)
• Standing in line or being in a crowd

The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms.

Agoraphobia sufferer are also typically frightened by their own bodily sensations [1], causing them to avoid activities that might lead to physiological arousal. Activities include:

• Exercising
• Watching horror movies
• Getting angry
• Games/ activities that might increase their heart rate
• Drinking caffeine
• Sexual activities

These agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. If someone with agoraphobia finds themselves in a stressful situation, they’ll usually experience the symptoms of a panic attack, such as:

• Chest pain or pressure
• Rapid heart rate
• Rapid breathing (hyperventilating)
• Lightheadedness or dizziness
• Trembling or feeling shaky
• Feelings of losing control
• Excessive sweating

In more severe cases of the condition, people with agoraphobia might even be anxious to leave their home alone. Agoraphobia can heavily interfere with a person’s daily life, given that many places tend to be inevitable and difficult to avoid.

Agoraphobia usually develops as a complication of panic disorder [2], an anxiety disorder involving panic attacks and moments of intense fear. It can arise by associating panic attacks with the places or situations where they occurred and then avoiding them.

A minority of people with agoraphobia have no history of panic attacks. In these cases, their fear may be related to issues like a fear of crime, terrorism, illness, or being in an accident.

Psychological factors that increase your risk of developing agoraphobia include [3]:

• a traumatic childhood experience (e.g. the death of a parent or being sexually abused)
• experiencing a stressful event (e.g. bereavement, divorce, or losing a job)
• a previous history of mental illnesses (e.g. depression, anorexia nervosa, or bulimia)
• alcohol misuse or drug misuse
• being in an unhappy relationship, or in a relationship where your partner is very controlling

Occasionally, a person can develop symptoms of agoraphobia even though they don’t have a history of panic disorder or panic attacks.

A number of different irrational phobias may trigger this type of agoraphobia, such as the fear of [4]:

• becoming a victim of violent crime or a terrorist attack if you leave your house
• becoming infected by a serious illness if you visit crowded places
• doing something by accident that will result in you embarrassing or humiliating yourself in front of others

According to standards created by the American Psychiatric Association, you could be diagnosed with agoraphobia if you feel extreme fear, panic or anxiety in at least two of the following situations [5]:

1. Using public transportation (e.g. automobiles, buses, trains and ships)
2. Being in open spaces (e.g. parking lots and marketplaces)
3. Being in enclosed places (e.g. shops, lifts and cinemas)
4. Standing in line or being in a crowd
5. Being outside of the home alone

Mental health professionals typically prescribe agoraphobics with prescribed anxiolytics (anti anxiety medications) from the benzodiazepine category such as alprazolam (Xanax) or clonazepam (Klonopin). Consumers frequently show some symptom relief from these medications, and many can function more effectively.

An advantage of these drugs is that they act very quickly (30–60 minutes), and so can be useful in acute situations of intense panic or anxiety. However, anxiolytic medications can also have undesirable side effects such as drowsiness and sedation, which can lead to impaired cognitive and motor performance.

Cognitive Behavioural Therapy (CBT) is based on the idea that unhelpful and unrealistic thinking leads to negative behaviour. CBT aims to break this cycle and find new ways of thinking that can help you behave more positively.

For example, many people with agoraphobia have the unrealistic thought that if they have a panic attack it will kill them. CBT encourages the reframing of that thinking into something more positive – for example, although having a panic attack may be unpleasant, it is not fatal and will pass. This shift in thinking can lead to more positive behaviour in terms of a person being more willing to confront situations that previously scared them. A course of CBT usually consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Mental health professionals also use exposure therapy in conjunction with CBT. Your therapist will set relatively modest goals at the start of treatment, such as going to your local corner shop. As you become more confident, more challenging goals can be set, such as going to a large supermarket or having a meal in a busy restaurant.