AGORAPHOBIA…WHAT WHEN AND WHY…

Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn’t be available if things go wrong.

Many people assume that agoraphobia is simply a fear of open spaces but it’s more complex than this. A person with agoraphobia may be scared of:

  • travelling on public transport 
  • visiting a shopping centre 
  • leaving home 

If someone with agoraphobia finds themselves in a stressful situation they’ll usually experience symptoms of a panic attack such as:

  • rapid heartbeat 
  • rapid breathing (hyperventilating) 
  • feeling hot and sweaty 
  • feeling sick 

They will avoid situations that cause anxiety and may only leave the house with a friend or partner. They will order groceries online rather than go to the supermarket. This change in behaviour is known as “avoidance”.

What causes agoraphobia?

Agoraphobia usually develops as a complication of panic disorder (an anxiety disorder involving panic attacks and moments of intense fear). It may arise as a result of 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 such as a fear of crime, terrorism, illness or being in an accident.

Traumatic events, such as bereavement, may contribute towards agoraphobia, as well as certain genes that are inherited from your parents.

Read more about the possible causes of agoraphobia.

Agoraphobia can manifest itself as a combination of fears, feelings and bodily symptoms.

anxious woman

People with agoraphobia can become housebound for long periods of time.

Common fears associated with agoraphobia are:

  • Fear of spending time alone
  • Fear of being in crowded places
  • Fear of open spaces
  • Fear of being in places where escape might be hard, such as public transport and elevators
  • Fear of losing control in a public place
  • Fear of death.

A person with agoraphobia may experience the following feelings:

  • Detachment from others
  • Helplessness
  • Agitation
  • Loss of control
  • As though the body is not real
  • As though the environment is not real.

People with agoraphobia may become over dependent on others, or remain housebound for long periods of time. In addition to these symptoms, people with agoraphobia can also experience the physical symptoms of panic attacks, such as:

  • Chest pain or discomfort
  • Dizziness
  • Racing heart
  • Shortness of breath
  • Sweating
  • Trembling
  • Upset stomach, nausea and diarrhoea 
  • Flushing and chills
  • Choking.

People who experience panic attacks may change their behavior and how they function at home, school or work. They may try to avoid situations that could trigger off further attacks. They may become sad, depressed or suicidal, and in some cases may abuse alcohol and other drugs.


Woman on public transport

Extreme fear regarding being on public transport is one of the Worse that sufferers encounter

Additional diagnostic criteria for agoraphobia include the following:

  • Fear or anxiety caused almost always by exposure to a particular situation
  • Fear or anxiety out of proportion to the actual danger of a particular situation
  • Avoidance of a particular situation or requiring a companion in order to deal with it
  • Endurance of a situation with extreme distress
  • Distress or problems in areas of life caused by fear, anxiety or avoidance
  • Long-term persistent phobia and avoidance.


TREATMENTS THAT ARE AVAILABLE 

Agoraphobia is usually treated with a combination of medication of psychotherapy. Most people with agoraphobia can get better through treatment, though it can become more difficult to treat if effective help is not found early on.

Medication

Health care providers can prescribe either one or both of the following types of medication.

A group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) can be prescribed to treat panic disorder with agoraphobia. Other types of antidepressants can also be prescribed, but they have a greater risk of side effects than SSRIs.

Anti-anxiety medications, also known as benzodiazepines, are sedatives that can relieve the symptoms of anxiety on a short-term basis. Benzodiazepines are a habit-forming medication.

A health care provider is likely to increase the dosage of prescribed antidepressants when treatment begins, and slowly decrease the dosage when the treatment is ready to finish. This caution is because starting and ending a course of antidepressants can sometimes lead to side effects that are similar to a panic attack.

Psychotherapy

Psychotherapy involves working with a therapist in order to reduce symptoms of anxiety and make a person with agoraphobia feel and function better.

One of the most common and effective forms of psychotherapy for anxiety disorders, including agoraphobia, is cognitive-behavioral therapy (CBT). It focuses on changing the thoughts that cause the condition.