Last updated date: 17-Nov-2021
14 mins read
Agoraphobia – overview
Agoraphobia is a type of anxiety disorder. Basically, agoraphobia is the fear of being in public, open spaces, where the person who has it evaluates the situation as being difficult to escape. For some people, it can even be difficult to leave their homes, making everyday life harder. While this mental health condition can significantly impair one’s quality of life, there is also a bright side – diagnostic and treatment options are available. Read on if you want to learn more about agoraphobia – what it is, what are its potential causes, how it is diagnosed and what are the treatment options for this condition.
Agoraphobia meaning. The term “agoraphobia” comes from the Greek language, translating into the fear of a marketplace. This means that a person living with agoraphobia fears being out in open and busy spaces (such as stores, crowds, restaurants, buses or trains etc.).
Agoraphobia definition psychology. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people with agoraphobia experience intense fear or anxiety caused by the exposure to certain situations (the anxiety can also be anticipatory – prior to the actual experience). These situations can range from being in an open space, such as a marketplace, a bridge, a parking lot, to being in a bus, a train, a restaurant, a cinema, a theatre, a crowd anywhere or even being alone outside of the home. The fear and anxiety then trigger other symptoms, such as irrational thoughts of being trapped or avoidance of certain situations. Put in simpler words, agoraphobia is a fear of being alone in public spaces (agoraphobia fear of).
Before we dive into the subject of agoraphobia even more, let’s first analyze what exactly are phobias.
What is a phobia?
In short, phobias represent an intense irrational fear reaction. This means that someone who has a phobia (or multiple) experiences a panic-like feeling when faced with the source of their fear. This “trigger” can either be a place, a situation or a specific object (hence the diagnosis of specific phobia conceptualized in the DSM). If by now you’re sensing some similarities with the general anxiety disorders, you’re not far off – but the main difference is that phobias are always connected to a specific trigger or phobic object.
The fact that this irrational fear can be triggered by something specific makes it difficult for people living with phobias in certain day to day activities. This fear can vary in intensity and can go from being annoying to being actually disabling.
What causes a phobia to develop?
This is the question on everyone’s mind when talking about phobias. We know that phobia means an intense irrational fear when confronted with the phobic object, but when exactly do a needle, an insect, a public space etc. become a trigger that can impair someone’s life? Apparently, there are some genetic and environmental factors that can lead to phobias. First off, having a family member with an anxiety disorder can be one of them. Experiencing stressful and/or traumatic events (e.g. drowning, being stung by an insect etc.) can also lead to phobia. Exposure to certain environments such as extreme heights or small spaces can also cause phobias (e.g. fear of heights or claustrophobia). What’s more, people with other mental health conditions, such as depressive disorders or substance use disorders can be more prone to developing different types of phobias.
What are the symptoms of a phobia?
The core symptom of any phobia is fear and all that fear entails for someone’s nervous system. The most intense and common symptom of phobias is the panic attack which will be described in detail later in this article.
Types of phobia
Given the fact that a lot of experiences that someone lives can lead to the development of phobias, there is an array of different types of phobias, corresponding to the phobic object. Some of the most common are:
- social phobia – also known as social anxiety disorder; it’s the fear of social interactions that can lead the person to self-isolate in order to avoid any kind of social situation that could trigger their panic;
- glossophobia – also known as performance anxiety; is the fear someone experiences when speaking in front of an audience;
- claustrophobia – the fear of tight, enclosed, small spaces;
- acrophobia – the fear of heights;
- homophobia – the fear of injury or blood;
- arachnophobia – the fear of spiders;
- cynophobia – the fear of dogs;
- nyctophobia – the fear of darkness or night (it’s typical during childhood years, but if it persists into adulthood, then it is considered a phobia).
While all of these can have a huge impact on someone’s day to day activities, agoraphobia remains a serious type of phobia that needs addressing on its own. The fact that in the DSM classification of anxiety disorders, agoraphobia is described separately from specific phobias is a fit indicator of the importance and seriousness of this mental health condition.
People with agoraphobia tend to avoid those situations or places that might make them feel scared, anxious, panicked, helpless or trapped. They can also sometimes experience panic attacks. So what are the exact symptoms of someone with agoraphobia? Some of these symptoms include:
- being anxious and afraid;
- detaching from others;
- being afraid of being alone or leaving their home;
- being afraid of being in situations that are difficult to escape from (for example, in a bus or an elevator).
As we’ve mentioned earlier, the symptoms triggered by agoraphobia can be accompanied also by panic attacks. But what exactly are panic attacks and why do we hear this term so much lately? Read on to get the answers to these questions.
What are panic attacks?
Panic attacks are episodes of feeling a sudden and intense fear when there is no real or at least apparent danger that could justify the reaction. Some people only experience one or a few panic attacks in a lifetime, but other people can have recurrent episodes that can in time lead to a panic disorder (we’ll talk more about this later in the article). What is also important to note is that the intensity of a panic attack can be so high that people who experience them can actually develop an anticipatory fear of panic attacks, meaning that they start to avoid certain situations or places just because they are fearful of triggering a panic attack.
What causes a panic attack?
While there hasn’t been discovered a specific cause for panic attack in most cases, in some other cases these episodes can be linked to other mental health conditions, meaning that they can either be a symptom or a consequence of them. Some of these conditions can be agoraphobia, other types of phobias, panic disorder, post-traumatic stress disorder (PTSD) or obsessive compulsive disorder (OCD).
What are the symptoms of a panic attack?
Panic attack are triggered suddenly and come without much warning. This means that the person who experiences them suddenly has their nervous system fired up with certain symptoms that correspond to the body’s response to danger. You’ve probably heard of the fight-flight-freeze response, right? Well, this is a prime example of this kind of response. The main thing to consider is that in the case of panic attacks, the threat is not apparent.
The symptoms of a panic attack show up gradually and peak in intensity about ten minutes from the start. Some of the most common symptoms of panic attacks include chest pain, having a hard time breathing, hyperventilating, rapid pulse (which is why many people think they are experiencing a heart attack and can even ask for medical assistance), shaking, nausea, pain in the stomach area, feeling dizzy, numbness and an intense feeling that they are losing control or are about to die.
From a medical point of view, panic attacks are not life threatening. However, they can be quite costly on your body and given the similarity in the symptoms department with other serious health conditions (such as heart attacks), it’s important to still visit a healthcare professional that can certify that you’re not actually having a heart attack.
Who gets panic attacks?
As we’ve mentioned before, panic attacks can sometimes come on their own or they can be linked with an underlying mental health condition, meaning that people with a depressive disorder, anxiety disorder or substance use disorder can also get panic attacks. In terms of demographics, women are more affected by panic attacks (this is also because prevalence for most of the disorders named before is higher among women). There are rare cases of children who have panic attacks, the rates of incidence increasing at puberty. Furthermore, the prevalence decreases among older people.
Can panic attacks be treated?
This is a question with a long answer, but we’ll treat it shortly here for the purpose of this article. Basically, it all depends on the cause of your panic attacks. Whether they are linked with another mental health condition (such as agoraphobia, panic disorder, PTSD or OCD) or they are singular episodes, a combination of psychotherapy, medication and lifestyle changes will be recommended by a healthcare professional. If left untreated and unaddressed, panic attacks can lead to intense anticipatory feelings of potential panic attacks and even to the intense feeling of fear experienced while being in public places (i.e. agoraphobia). Therefore, if you experience panic attacks, don’t hesitate to seek professional help that can help you in overcoming your fears.
Now that we’ve briefly covered one of the symptoms of agoraphobia, let’s get back to this condition and proceed to understand it better.
The one true cause of agoraphobia is not yet known, unfortunately. However, even though agoraphobia can occur on its own, most of the time it is associated with an underlying mental health condition. Some of the additional diagnosis in terms of comorbidity with agoraphobia are anxiety disorders (such as panic disorder, other phobias, social anxiety disorder), major depressive disorder, PTSD or substance use disorder (specifically alcohol). It’s important to know that in the case of anxiety disorders, agoraphobia is more of a consequence or a “later” addition to the list of symptoms, while in the case of depressive and substance use disorder, agoraphobia is already there when a diagnosis is declared.
It’s probably clear by now that agoraphobia is often associated with other underlying mental health conditions, the most common one being panic disorder. So naturally, you might be wondering what exactly is panic disorder? Well, look no further.
Agoraphobia with panic disorder
According to the DSM, the majority of people diagnosed with panic disorder report agoraphobia symptoms from before the onset of the panic disorder. Panic disorder is a mental health condition that implies the existence of recurrent and unexpected panic attacks. This means that an individual who experiences more than one panic attack in a time frame and these attacks occur when there is no obvious trigger (for example when the person is trying to go to sleep – in which case they are called nocturnal panic attacks), then that individual is passible for a panic disorder diagnosis.
The frequency of the panic attacks can very much vary. This means that someone can have one panic attack per week for several months, or one panic attack every day for some time, followed by panic-attack-free periods or even two panic attacks per month for several years. Apart from this, the symptoms are very much the same, but they can also vary in intensity.
Considering panic disorder is basically multiple panic attacks occurring in a time frame, the cause for this disorder is not exactly known. Some researchers found genetic links, others did not. However, one aspect that there seems to be some consensus about is that major life changes can trigger panic attacks. In terms of treatment options, psychotherapy, medication and lifestyle changes can improve the outcome for someone with panic disorder.
Agoraphobia risk factors
There are some individual and environmental risk factors for agoraphobia. Some of these can be:
- experiencing panic attacks or other types of phobias;
- having a high score of neuroticism;
- also testing high on anxiety sensitivity which is the belief that the symptoms of anxiety can cause harm to oneself;
- experiencing stressful and/or traumatic events during childhood;
- growing up in a cold and overprotecting family climate;
- having a family member with agoraphobia (there is an approximate 60% heritability for agoraphobia).
In terms of demographics, women are more likely to be diagnosed with agoraphobia than men. Every year, about 1 to 2 percent of teenagers and adults get this diagnosis. Even though agoraphobia can also occur during childhood, this is a rare case and the incidence peaks in adolescence and early adulthood – typically before the age of 35.
If you suspect you meet the criteria for a diagnosis for agoraphobia, the go-to medical professional that can further assess this is a psychiatrist. If your symptoms make it too difficult for you to go in person for a consultation, you should know that there are doctors who can perform a psychiatric consultation online so they can accommodate to your needs.
During the psychiatric consultation, the doctor will ask you about your symptoms: when they first started, how frequently do they occur, what is their intensity and in which situations do they come about. In addition, they will also ask you about medical history for you and your family. Considering the intensity of the physical symptoms in agoraphobia, your doctor can also indicate the necessity of having some blood tests and a routine physical consultation in order to rule out any physical conditions that might be responsible for your symptoms.
If it comes down to checking the boxes for a diagnosis of agoraphobia, the DSM offers a list of criteria that you need to check, the DSM being the go to manual for diagnosing a mental health condition. The DSM is a manual written by the American Psychiatric Association so it is primarily used in the USA and some other states as well. You should know that there is also another manual, the ICD – International Classification of Diseases that is produced by the World Health Organization that can also offer criteria for diagnosing agoraphobia. In this article, we will focus on the criteria listed by the American Psychiatric Association in the DSM for diagnosing agoraphobia.
According to the DSM, in order to get a diagnosis for agoraphobia, first of all, you need to experience intense anxiety and fear in two or more of these situations: using public transportation (e.g. a bus), being in open spaces (e.g. a marketplace), being in enclosed spaces (e.g. an elevator), being in a crowd or being alone outside of your home. The next criterion states that the person in question avoids public and open spaces because of the irrational thought of having no help escaping in case something happens to them. In addition, the person may require someone to accompany them in public situations and their fear cannot be justified by a real, apparent threat or danger. What’s more, this fear must be present for at least six months.
We’ve also talked a lot about agoraphobia with panic disorder. It’s important to know that even though one symptom of agoraphobia is panic attacks and this condition can co-occur with the panic disorder, they can also happen individually. Therefore, someone who checks the boxes for criteria for both conditions, should get a double diagnosis and receive a treatment plan according to their symptoms and signs.
In terms of tests that can be used to detect the presence of agoraphobia, they are not so much researched as we would like to. However, there are some tests that can measure the intensity of your symptoms which can prove useful for your doctor in deciding the best course of action. Keep in mind though that tests found online are not fool-proof and that a good test needs to be validated on different populations before it can give a good, trustworthy result (agoraphobia test). Therefore, if you have a hunch you might have agoraphobia, best to book an appointment with a professional than to take a survey online that cannot fully evaluate your situation.
Just like in the case of panic attacks, agoraphobia can be addressed with psychotherapy, medication and lifestyle changes. However, you’ll most likely benefit most from a combination of these. But let’s review what these treatment options can do.
- Psychotherapy. This requires regular sessions with a psychotherapist that will help you better cope with your symptoms as well as better understand its causes. For a better outcome, therapy is usually recommended while also taking prescription medication. In terms of the different types of psychotherapy, Cognitive behavioral therapy (CBT) has proven to be the most effective one in treating phobias, therefore agoraphobia as well. The core of this type of therapy lies in helping you understand the thoughts and feelings you experience and then aiming to improve your symptoms by changing your perspective on the disorder itself. Basically, what it does is that it takes your distorted thoughts, controlled by the disorder and it changes them into healthy and constructive thoughts that help you regain the control. Another type of therapy used in treating phobias is exposure therapy which means that you will be slowly exposed to the situations and places you fear. This can be done with the presence and help from the therapist as well. However, this can be quite difficult for some people which is why some shy away from this type of therapy. Ideally, if therapy (and medication) works, exposure over time will come as a way of regaining control of your life.
- Medication. The medication prescribed in this case are usually SSRIs (selective serotonin reuptake inhibitors), such as Prozac or antidepressants and anti-anxiety medications (such as Xanax). These are meant to help managing the symptoms of agoraphobia and especially the panic attacks. It’s important to keep in mind that medication doesn’t treat the cause of the disorder, but the symptoms, while therapy can help with the cause as well.
- Lifestyle changes. While these won’t cure agoraphobia, they can contribute to creating a more relaxing environment in which you will feel more comfortable and less anxious. Exercising, having a good and healthy diet and practicing meditation can help with your overall state of wellbeing.
Agoraphobia is a mental health condition that can seriously impair one’s quality of life. Somatic symptoms as well as cognitive ones can disrupt the day to day activities of someone with this type of phobia. Fortunately, there are treatment options available and specialists out there ready to help anyone in need so if you suspect you might have agoraphobia (or any other type of mental health condition) don’t hesitate to research and ask for help from a healthcare professional. The best thing you can do is to take care of yourself and sometimes that means asking for help.