Reviewed by Lauren Guilbeault
Germophobia (clinically known as mysophobia) and arachnophobia are common phobias that few people would be hard-pressed to identify. However, phobias are frequently difficult to explain or quantify, as they are often irrational responses, though no less real and debilitating in their application. Agoraphobia might conjure an image of a hermit in a far-away country home or might elicit a series of blank stares.
What exactly is Agoraphobia?
What is Agoraphobia: Definition And Diagnosis
Agoraphobia can be difficult to understand for those who have not ever experienced its effects. Because the exact effects of agoraphobia can differ from person to person and are not closely defined by psychologists, landing on a precise definition can be problematic. Fortunately, as with most anxiety disorders, agoraphobia has a range of possible symptoms, and exhibiting a portion of them is all that is required to receive an official diagnosis. The most common definition for agoraphobia is this: a disorder characterized by avoidant behaviors focusing on the fear of being trapped or stuck. Symptoms of agoraphobia include:
- Difficulty facing situations alone. People with agoraphobia might, at first glance, appear to be codependent, as they may struggle to go places on their own. Grocery trips, clothes shopping, and using public transport might trigger intense fear or anxiety, and these concerns may only be alleviated by bringing a friend or loved one along.
- Avoidance of enclosed spaces, such as movie theatres. Agoraphobia often manifests as a chronic avoidance of any enclosed spaces, whether avoiding movie theatres or choosing stairs to avoid being enclosed in an elevator.
- Difficulty using public transportation, such as buses and trains. People with agoraphobia are often triggered by enclosed spaces, even if they are progressive in their movement, and may prefer to drive themselves or avoid such forms of transportation altogether, preferring to walk or bike as often as possible.
- Being triggered by exposure to certain places or situations. Agoraphobia does not merely cause anxiety but is often accompanied by intense feelings of fear and panic. Exposure to enclosed spaces, crowded rooms, or large groups of people can trigger panic and terror symptoms.
- Social difficulty and avoidance. Because social situations often involve large groups of people—going to movies, going out to eat, and going dancing, to name a few—some people with agoraphobia prefer to avoid social situations as often as possible to minimize exposure to unpleasant symptoms of anxiety.
- Persistence of symptoms that lasts for over six months. Agoraphobia is not an occasional flare-up or an experience that occurs with only one specific situation. For a condition to qualify as agoraphobia, it has to be persistent and diverse in its triggers, spanning at least six months or more.
Diagnosing agoraphobia usually comes only after a thorough background survey has been taken, including a detailed history of potential sources of anxiety and triggers. Typically, a therapist will ask for general symptoms and any increasing frequency or disruption to general functioning before moving on to targeted questions to narrow down anxiety sources. An agoraphobia diagnosis may be given in tandem with a Panic Disorder, as the two are often linked.
The Effects: Agoraphobia Treatment And Demographics
Agoraphobia is not a discerning condition and can affect people of all ages and backgrounds, but is most commonly diagnosed in individuals under 35 and is more common among women than men. Agoraphobia, as an anxiety disorder, is frequently accompanied by other diagnoses, such as other anxiety disorders or depressive disorders. Agoraphobia may go undiagnosed for a long time, as new situations and uncertainty can prohibit stepping out and asking for help.
Fortunately, many of the treatments designed to ease symptoms of agoraphobia simultaneously treat co-morbid conditions; anti-anxiety medications are generally prescribed for general anxiety issues, rather than targeting a specific type of anxiety, and can be useful in treating depression (though antidepressants may also be prescribed for a robust treatment plan). Treatment also typically involves some type of psychotherapy, whether that be general talk therapy, Cognitive Behavioral Therapy (CBT), or targeted trauma therapies, such as EMDR (Eye Movement Desensitization and Reprocessing). Used in conjunction, therapy and pharmaceuticals are typically successful in managing agoraphobic symptoms. Support groups and exposure therapy are also common methods of treatment.
What Agoraphobia Is Not
Portrayals of agoraphobia in television and film often suggest that agoraphobia is far more akin to a fear of going outside or leaving the house than it is about escape or being trapped, but this is an erroneous portrayal. Agoraphobia is neither characterized nor diagnosed by the presence of a fear of leaving the house. Plenty of people with agoraphobia enjoy leaving their homes—and some may even struggle to remain in their homes if the home is frequently a gathering place for large crowds and parties.
Agoraphobia is also not necessarily fear, as some might think of fear. When the word "phobia" is used, it may conjure an image of screaming and running away or begging for deliverance. Instead, agoraphobia is anxiety, which triggers feelings of helplessness and panic, leading not to screaming and begging for mercy but to avoidance, a racing heart, and an overwhelming desire to find a means of coping. Coping for agoraphobia can look like avoidant behavior. Still, it can also look like taking a partner or friend everywhere, enlisting the help of a therapy animal to ease symptoms, or taking deep breaths and practicing grounding techniques amid an agoraphobic trigger.
Is It Real? Debating Agoraphobia And General Anxiety
Although agoraphobia is a recognized phobia, its similarities to some anxiety disorders have raised whether it is a true phobia or a manifestation of Generalized Anxiety Disorder. There are some significant differences between GAD and agoraphobia, however, including the narrow focus of agoraphobia. GAD can be triggered by many things, including personal health, finances, friendships, and living situations. At the same time, agoraphobia symptoms arise in response to very specific triggers and situations; each of them is related to a feeling of being "stuck" or trapped. It differs, too, from claustrophobia because claustrophobia stems from a fear of small, enclosed spaces. At the same time, agoraphobia can be triggered by any situation that feels like being trapped, including merely being in a crowded room or taking a subway train.
Learning how to suss out the nuances of agoraphobia can be an important part of therapy. Knowing how to identify your symptoms and own your triggers can be incredibly liberating. Knowing how agoraphobia works, why it affects the people it affects, and how to cope with an agoraphobia diagnosis can all encourage enormous strides in treatment and growth. Far from being a "fake" or "over diagnosed" condition, agoraphobia is a very real anxiety disorder with its own unique set of triggers and symptoms. Consequently, it requires a unique treatment plan.
Learning To Cope: Living With Agoraphobia
Although agoraphobia is often considered a lifelong condition, receiving a diagnosis of agoraphobia is not a death sentence; people with an agoraphobia diagnosis can lead relatively normal lives while in treatment and often experience significant relief agoraphobic symptoms. Because agoraphobia symptoms are unique to the individual experiencing them, two cases of agoraphobia often manifest in very different ways. For some, fear of crowds is the biggest source of anxiety, and crows are routinely avoided. For others, fear of being unable to escape an awkward social encounter triggers the greatest feelings of anxiety, and others' interactions are kept to a minimum. Still others, symptoms are somewhat scattered and range from the fear of taking an elevator to the fear of saying something wrong and being unable to escape the repercussions. In each of these cases, though, anxiety is the common thread tying them all together. The thread that makes treating the condition straightforward, if not simple: a consistent mix of psychotherapy and medication is usually adequate to effectively treat agoraphobic symptoms.
Coming to terms with having agoraphobia is the first step in seeking help. Whether symptoms have become unbearable or an online agoraphobia test demonstrated a high likelihood of having the condition, agoraphobia treatment is often readily available when treatment is sought out. Knowing where to begin can be difficult because agoraphobia can mimic so many different disorders, including Generalized Anxiety Disorder, Social Anxiety Disorder, and claustrophobia. Despite its commonalities with other disorders, agoraphobia is a distinct entity with a specific set of treatment methods. Learning to live with agoraphobia means recognizing agoraphobia, including seemingly unrelated symptoms, such as reluctance to make friends and difficulty embarking on new pursuits.
Living with agoraphobia can feel overwhelming after first receiving a diagnosis, but take heart: having agoraphobia does not mean being constrained to a lifetime of being sequestered at home, too terrified to go out. Instead, with treatment, effort, and time, agoraphobic people can lead to healthy, full lives, with friends, fulfilling jobs, and the ability to navigate triggers. Although it may never be easy to step into an elevator, and stepping into a crowded grocery store may always give you pause, symptoms need not dictate every moment of your life.