Agoraphobia

Agoraphobia is an intense fear or phobia of being in a setting with no place to hide or means of escape. Agoraphobia is a form of anxiety disorder in which sufferers feel exposed and vulnerable triggering panic attacks. Agoraphobics develop avoidance behaviour for activities such as leaving the house, entering public spaces or travelling on their own. Treatment of agoraphobia includes drugs, cognitive behavioural therapy and psychotherapy.

In This Article

Did you know?	Causes of agoraphobia
Symptoms of agoraphobia	Diagnosis of agoraphobia
Related Terms

Did you know?

One in three people who have a panic disorder will develop agoraphobia
Agoraphobia commonly appears in people during their 20s.
50% of people with agoraphobia will suffer depression
5% of adults will experience agoraphobia during their lifetime
90% of patients with agoraphobia experience significant improvement once treated

Causes of agoraphobia

The exact cause of agoraphobia is unclear but research has discovered that combined psychological and genetic factors may trigger the condition.

Certain genes increase the chances of a person developing agoraphobia and this genetic predisposition can affect people in different ways. These genes may cause a brain chemical imbalance which alters mood and increases susceptibility to anxiety related disorders such as agoraphobia. Certain genes can increase sensory sensitivity to sounds, smells and sights. Excessive sensory input when in a crowded place may increase stress levels and cause anxiety.

The psychological factors that can lead to agoraphobia include:

Trauma during childhood – e.g. loss of parent, abuse
Drug or alcohol addiction
Stressful events – e.g. redundancy, divorce, bereavement
Mental illness – e.g. history of depression, anorexia
Relationship problems – marriage difficulties, domestic abuse

While research points toward these psychological factors, agoraphobia cases can sometimes have no contributory mental factors at all.

Symptoms of agoraphobia

Agoraphobia symptoms are classified by three types: physical, psychological and behavioural.

Physical symptoms
The physical symptoms are triggered when the sufferer is placed in a situation that increases anxiety levels. The symptoms are not always experienced because the sufferer will use avoidance tactics to ensure they don't put themselves into circumstances which make them anxious.

Should someone with agoraphobia find themselves in an environment that raises their anxiety levels they may experience some of the following symptoms:
•   Increased heart rate
•   Hyperventilation (rapid breaths)
•   Feeling hot
•   Feeling sweaty
•   Nausea
•   Feeling dizzy
•   Light headedness
•   Trembles or shakes
•   Ear ringing

Psychological symptoms
Psychological symptoms of agoraphobia can be related to physical symptoms but this isn't always the case. Typically the sufferer will experience negative feelings or thoughts which impact on their ability to cope with day-to-day life. These thoughts can include:

Fear of having a panic attack in front of people and embarrassing themselves
Fear that the panic attack will cause a life-threatening problem such as a heart attack
Fear that they're losing their sanity
Fear of being alone in the house

Symptoms that an agoraphobia sufferer can have but may not be related to panic attacks include:

Low self-esteem
Inability to cope or function alone
Anxiety
Depression

Behavioural symptoms
Someone with agoraphobia can display four types of behavioural symptoms: avoidance, reassurance, safety behaviour and escape.

Avoidance – This is a behavioural pattern whereby the sufferer will avoid any situations, environments or circumstances which make them feel anxious. This can be avoiding leaving the house, travelling on a crowded bus or going to a busy supermarket. Avoidance ranges from mild to severe.

Reassurance – This behavioural pattern is displayed as the sufferer requiring reassurance when in a situation which raises their anxiety levels. It could be an inability to go shopping without a friend or being unable to spend time on their own.

Safety behaviour – This is a reliance on substances (drink, drugs, tobacco) or objects in order to cope with a stressful situation. For example, a sufferer may be unable to go outside unless they've taken medication or has to drink alcohol in order to cope with crowded places.

Escape – When faced with a stressful situation or environment, the agoraphobia sufferer will leave immediately and return to their safe place (typically their home).

Diagnosis of agoraphobia

A GP is the first port of call for anyone experiencing psychological symptoms and the doctor will refer you to a mental health specialist. If you're experiencing physical symptoms, a GP visit will rule out any underlying problems that could be causing the symptoms.

If you are referred to a mental health specialist (typically a psychiatrist or psychologist) they will question you about your symptoms, thoughts and feelings and attempt to rule out any other mental health problems that may be triggering your agoraphobia. Until the underlying psychological problem is identified and addressed, agoraphobia symptoms can't be successfully treated.

People with Obsessive Compulsive Disorder (OCD) may display symptoms of agoraphobia such as avoidance of crowded places because they fear catching people's germs. People with social phobias remain at home for fear of embarrassment in social situations.

There is a classification system for diagnosing agoraphobia. The criteria is as follows:

The individual feels anxious about being in a place or situation where escape or help is difficult in the event of a panic attack or panic symptoms
The person avoids the above places or situations, or endures the anxiety, or needs the help of someone else to cope
Any underlying mental health problems (such as OCD) have been ruled out as an explanation for the symptoms

These criteria provide a classification system for psychologists and psychiatrists to work within but many mental health specialists find the system too narrow in its definition of agoraphobia as it doesn't take into account those who have never had a history of panic attacks. Nor does it take into account people with no symptoms of panic disorder or people whose agoraphobia is motivated by fears without association to panic attacks.

However, panic attacks or panic disorder do not have to be present in order to successfully diagnose agoraphobia.

Related Terms

Open spaces
Confined spaces
Anxious, Anxiety
Psychological
Fear
Panic
Depression
Depersonalisation
Serotonin

Therapies to consider

Colour Therapy	Counselling	EFT
Hypnotherapy	NLP	Psychotherapy
Thought Field Therapy

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Agoraphobia