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Agoraphobia

Agoraphobia is a mental and behavioral disorder which comes under the category of anxiety disorders but is very different from it.


Historically it was thought to involve a fear of the agora (Open gathering place). Agoraphobia is the fear of a place where escape is not possible, including large open spaces or crowded areas, as well as various means of travel. People with agoraphobia may avoid situations like being alone outside of the home, traveling in a car, bus, or airplane, being in a crowded area, being in enclosed spaces such as theaters, shops, malls, stadiums, bridges, and cinemas.


People with agoraphobia fear such situations as they constantly think about thoughts that are hard to come out from. For example, in case of an emergency or when help might not be available, they might develop panic-like or other embarrassing symptoms. They feel a high level of discomfort and stress and may require another person's company in such situations.

The reason for fears are mainly bad past experiences and therefore they tend to change with more experiences we have: Children often fear becoming lost, adults may fear experiencing panic-like symptoms, or they may fear losing control of themselves, and older adults may fear falling or of heights. There are multiple types of fears and every fear has its own implications, some might make you feel trapped and helpless and some might just lead to panic attacks. Agoraphobia is very much different from anxiety or social anxiety, here the person himself/herself would fear the repercussions of the panic attack.


Symptoms

According to DSM-5, agoraphobia involves:

  • Fear or anxiety about:

  • being outside of the home alone

  • using public transportation

  • being in enclosed places (stores, movie theaters)

  • standing in line or being in a crowd

  • being in open spaces (markets, parking lots)

  • being in places where escape might be difficult

  • Active avoidance of all situations that provoke fear and anxiety

  • Becoming housebound for prolonged periods

  • Feelings of detachment or estrangement from others

  • Feelings of helplessness

  • Dependence upon others

  • Anxiety or panic attack (acute and severe anxiety)

An individual can be diagnosed as agoraphobic if other mental disorders or medical conditions do not provide any explanation for the symptoms they might be having. Agoraphobic people might abuse alcohol and sedative medication as a coping mechanism.


Causes

There can be multiple reasons for agoraphobia, such as:

  • Hereditary factors: having a genetic predisposition to phobia can lead to agoraphobia.

  • Past experiences: experience of being mugged or attacked or the death of a parent can make a person overly careful and stressed.

  • Comorbidity: having other mental health-related disorders such as anxiety, depression, eating disorder, panic attacks, and obsessive-compulsive disorder.

  • Abusive relationships or issues in relationships: these can lead to severe anxiety that can become a comorbidity to agoraphobia.


Impact of agoraphobia

Agoraphobia can have multiple severe effects on people that are:

  • Low self-esteem

  • Self-critical

  • Anxiety

  • Depression, and so on.


Comorbidity of agoraphobia

Agoraphobia often accompanies other anxiety disorders such as

  1. Panic disorder: panic attacks recur, and the person develops an intense fear of having another attack. This fear is called anticipatory anxiety or fear of fear, is present most of the time and can seriously interfere with the person's life, even when a panic attack is not in progress. Most people with panic disorder show signs of agoraphobia and anxiety, before developing panic disorder.

  2. Specific phobia: a specific phobia is an unrealistic fear of a single situation, object, or setting. This fear is persistent and can cause those people to avoid those settings. For example, one may have a phobia of medical or dental visits, heights, flying, elevators, or spiders.

  3. Depressive disorder: Depressive disorders can be characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities.

  4. Post-traumatic stress disorder (PTSD): PTSD is a mental health condition that develops in response to experiencing or witnessing a distressing event involving the threat of death or extreme bodily harm. Examples of traumatic events that can trigger PTSD include sexual assault, physical violence, and military combat.

Typically, people with agoraphobia restrict themselves to a zone of safety that may include only the home or the immediate neighborhood. Any movement beyond the zone of safety creates a lot of anxiety. People with agoraphobia can become housebound for years, resulting in impairment of their relationships.


Treatment

The treatment of phobias may include:

  • Systematic desensitization or exposure therapy: It is a behavioral technique in which the sufferer, under expert guidance, is gradually exposed to the feared situation and comes to understand that the feared outcomes do not materialize.

  • Graded real-life exposure: this technique involves exposure to real aversive situations, progressing from less to more extreme situations. For example, a person might be in contact with a few people before progressively spending time with larger groups of people to overcome a fear of crowds. This can also improve the quality of life of people with agoraphobia.

  • Relaxation techniques: Coping strategies such as relaxation, and breathing techniques are very effective in relieving stress.

  • Cognitive-Behavioral Therapy (CBT): CBT can help patients modify or eliminate thought patterns contributing to the symptoms and help them change behavior. It generally requires 8-12 weeks. It is highly effective in eliminating panic attacks or reducing their frequency.

Other types of therapy, such as biofeedback, hypnosis, meditation, relaxation, or couples therapy are helpful for some patients.


Coping strategies for Agoraphobia

In addition to seeking help from a mental health professional, there are also lifestyle changes that can help that is:

  • Practicing stress management techniques; such as deep breathing, visualization, and progressive muscle relaxation to help reduce anxiety

  • Eating a healthy and nutritious diet

  • Getting regular physical exercise

  • Avoiding drugs and alcohol

  • Limiting caffeine intake


Helplines

References
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