Fear Of Crowds? Here Is How To Define Agoraphobia

Reviewed by Laura Angers, LPC

Published 12/29/2020

Essentially, we can define agoraphobia as an anxiety disorder. Patients report feeling trapped, optionless, and embarrassed or humiliated upon the prospect of facing a triggering situation. The situation could involve dealing with a crowd, spending time in an open or enclosed space, or even simply having to perform some kind of public function.

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While agoraphobia could present itself in a number of mundane social situations, patients report finding themselves getting more anxious when faced with a triggering situation. This is especially problematic given that a number of people report they're afraid that their anxiety will intensify.

It's important to recognize that these symptoms appear in people anticipating panic attacks as well. In fact, agoraphobia sometimes develops after the patient has experienced a few different panic attacks. Typically, patients will want to avoid places and situations that may trigger an attack. Most often, people report a lingering sense of apprehension and just a general inability to relax in public. Additionally, a number of patients may find it challenging to even leave their homes, whereas others may look toward trusted individuals such as family and friends to accompany them to public places.

Proper treatment can be challenging as individuals have to confront their fear to come forward. As with most disorders, a combination of psychotherapy and medication is the prescribed course of treatment. At the very least, with proper treatment, individuals can subdue their most aggressive symptoms. These symptoms may include:

  1. Fear of leaving home without anyone else for a company.
  2. Apprehension with dealing with crowds or getting in a queue.
  3. Fear of enclosed spaces
  4. Fear of open spaces, including parks and malls.
  5. Panic with getting on public transportation.

The underlying theme behind all of these symptoms comes from a feeling of helplessness should a panic attack ensue. The patient feels that they would not be able to get the help that they may need or even escape the situation, leading to an embarrassing outcome.

There are certainly other unique characteristics associated with agoraphobia symptoms. For example, individuals with agoraphobia will likely experience anxiety when exposed to their triggering situations (such as those mentioned above). Secondly, the magnitude of the anxiety felt may have nothing to do with how complicated a public situation may be in real life. Thirdly, the enormity of the symptoms is often such that the patient goes the extra mile in order to have someone they trust with them to tackle these situations.  If no one is available, having to face these situations can bring on extreme distress. Social situations end up becoming a significant source of distress owing to the amount of fear of anxiety that they generate. Lastly, these symptoms often last for six months or may stay with the patient over the long term.

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In this way, we can define agoraphobia as similar to an extreme version of social anxiety disorder fused together with panic disorder. It's also important to note that as with many disorders, agoraphobia is usually accompanied by a second condition as well.

Agoraphobia Causes

Most research points at genetics as being the primary cause behind the condition. However, there are also additional health factors that may be at play. Personality, temperament, the stressors in the immediate environment, and experiences with learning can all go into the development of agoraphobia.

Risk Factors Associated With Agoraphobia

Agoraphobia can be developed at any stage of life, including childhood. However, the condition is seen to appear during the late teen years or young adulthood. Most likely, you will see symptoms before age 35. It has also been found that women are more likely to develop this condition than men. The following risk factors have been observed:

  • Pre-existing conditions: patients suffering from panic disorder or other phobias.
  • Intense panic: if the intensity of such panic attacks is significant, together with a very high degree of fear.
  • Dealing with excessive stress: including the loss of a parent or protracted suffering abuse.
  • A nervous temperament: or being prone to anxiety.
  • Agoraphobia runs in families.

Complications Associated With Agoraphobia

Left unchecked, agoraphobia can wreak havoc in your social life. For example, patients have found themselves homebound for years on end. Needless to say, this will have a terribly negative impact on the quality of your life. Individuals with agoraphobia are also likely to miss out on friends and family functions and social activities. They may even find they are unable to go to school or to work. What is supposed to be your normal daily regimen ends up being severely curtailed. Finally, you may find yourself dependent upon others at all times.

Complications associated with agoraphobia have included substance abuse, alcoholism, and depression. Suffering from this disorder may also lead to other mental health complications. The most commonly observed complications include the development of personality and anxiety disorders.

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Can You Prevent Agoraphobia?

There is consensus among experts that there is no real way of preventing agoraphobia. It has also been well documented that symptoms intensify the more you give in to your fear and avoid public situations. In any situation, you have to work to not let fear get the better of you or increase to unmanageable levels. If you start to experience fear in going to mundane public spaces, you have to figure out a way to continue doing so with ease. Somehow, you have to bring yourself to visit those places over and over again until you start to feel very familiarized. The way some people do this is by asking a friend or a family member to accompany them when they are going to be most vulnerable.

As with any other mental health condition, you do not want symptoms to aggravate as they will become harder to manage. You should look into speaking to a doctor as soon as possible if you are experiencing anxiety visiting socially or engaging in public.

Diagnosis Of Agoraphobia

Diagnosing agoraphobia can only be done by a medical professional. In order to arrive at a diagnosis, your doctor is going to need to discuss your symptoms, get testing, and exams. Your doctor will:

  • Evaluate whether your signs and symptoms align with agoraphobia.
  • Conduct a thorough, comprehensive interview.
  • Order medical tests and physical exams to ensure symptoms are not being caused by other medical conditions.
  • Determine whether criteria listed in the Diagnostic And Statistical Manual of mental disorders (DSM – V) to define agoraphobia have been met.

Agoraphobia Treatment Methodologies

As with nearly every other mental health disorder, your best bet is in treading the middle path, with psychotherapy and medication on each side. The treatment may end up taking a little while, but it is worth it in the end, particularly in the management of symptoms.

PSYCHOTHERAPY

The interpersonal nature of psychotherapy can be very promising in agoraphobia. One of the most well-known forms of psychotherapy is Cognitive Behavioral Therapy (CBT), which is commonly used with a variety of different anxiety disorders. Two of the most important things accomplished with CBT are the set of periodic goals and learning practical techniques to temper down symptoms.

Oftentimes, psychotherapy is indulged in for a small period of time. The needed duration changes from person to person, but the goal of learning how to tolerate anxiety remains the same. Essentially, you have to learn to stay in the game, even as you deal with anxiety. Eventually, patients move to address their worries before they engage in activities they've been avoiding because of anxiety. Repeated participation in CBT can help individuals reduce their symptoms to an extent.

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A licensed counselor or therapist can help you figure out your triggers and help you develop proper coping methods. They can also help you work on your unhealthy obsessions using exposure therapy, gradually desensitizing you.

Understandably, agoraphobia often makes it difficult for patients to even go and see their psychotherapists. In such cases, your professional should be able to meet you in a safe zone or even at your home in the initial sessions. This is where online counseling can be extremely beneficial.

MEDICATION

As part of your treatment plan, your doctor may recommend using medication to help manage symptoms. With agoraphobia, both anti-depressants and anti-anxiety medications may be used. However, anti-depressants have been found to be much more effective.

ALTERNATIVE MEDICINE

Another option is to consider alternative medicine. Often these have fewer or less severe side effects. Alternative medicine may include herbal supplements or dietary additions that can have a soothing or calming effect. However, it is essential that you talk with your health care professional before taking these and that you make sure that you have looked into all possible risks associated with them.

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A number of herbs and mushrooms have been touted as effective, with varying claims as to the extent of the calming impact. Likewise, there is the herbal supplement kava kava.  However, with both of these, there have been instances of serious liver damage. While sales are often not banned, warnings have been taken out by the Food and Drug Administration. Therefore, the utmost caution must be used when pursuing such treatment methods and only taken under the direct supervision of a medical professional.

The information found in the article is not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health providers with any questions you may have.

Coping With Agoraphobia

Agoraphobia causes major disruptions in your lifestyle. Even still, there are plenty of things that you can do to keep yourself going. Here are a few steps that can help you cope with agoraphobia:

  • Commit to your treatment plan and take medications as prescribed.
  • Make a conscious effort to engage with situations that trigger you.
  • Get a trusted friend or family member to help you manage the fear and support you.
  • Learn new skills to keep calm in aggravating situations.
  • Stay away from substance abuse or even recreational drugs.
  • Practice self-care. This includes building positive habits, getting quality sleep, exercising, eating well, etc.
  • Get support via a support group of peers to help you cope with your fear and build your self-esteem.

If you think you may be suffering from agoraphobia, this free test can help you determine whether your symptoms match and if it is time to talk to your doctor.