Reviewed by Lauren Guilbeault
Agoraphobia is an anxiety disorder with a complex and unique series of symptoms. Although many people associate some of the symptoms of agoraphobia with claustrophobia, Social Anxiety Disorder, or even Panic Disorder, agoraphobia is a unique disorder, with its own set of symptoms, treatment methods, support groups, and treatment outlooks
Agoraphobia Definition And Background
Agoraphobia has a substantial history, with its first mention found in 1871. Originally, agoraphobia was defined as a condition characterized by a fear of open spaces, leading to the term “agoraphobia,” which means “fear of markets.” The history of agoraphobia slowly unfurled, garnering greater interest and a broader range of symptomology and categorization; soon after the term was first coined, the meaning expanded to include more than just a fear of open spaces; after all, agoraphobia can also mean experiencing fear of enclosed spaces.
The current established definition of agoraphobia differences from the original identification, primarily in how broad symptoms are. Instead of describing a fear of open spaces, the term is currently used to describe a set of symptoms involving fear of finding oneself in a situation in which escape is impossible, help is unlikely, and embarrassment is almost guaranteed. This definition is more widely understood and received because it demonstrates a far easier concept, namely, the idea that agoraphobia is not a fear of an exact thing or situation but fear of experiencing anxiety and its consequences.
Standard Agoraphobia Symptoms
Agoraphobia’s most significant symptom is avoidance; people with agoraphobia routinely work to avoid putting themselves in any situation that might trigger an intense fear response and subsequent feelings of panic or a sense of being trapped. Although there are many different symptoms unique to agoraphobia that will be identified shortly, the most significant symptom and the most frequently identified symptom is the presence of avoidance—avoiding certain places, times, or situations, to stave off additional symptoms.
The symptoms agoraphobic people seek to avoid include, but are not limited to:
- Feeling as though you are not able to escape. Being in crowded spaces, in small areas, or surrounded by large numbers of people can all trigger the feeling of not escaping.
- Feeling as though help is impossible. People with agoraphobia are afraid of finding themselves in situations in which help is not possible. Being in long lines, crowded spaces, and enclosed spaces can all make getting access to help difficult (if not impossible).
- Feeling as though embarrassment is inevitable. Embarrassment can trigger intense feelings of fear and shame in people with agoraphobia, and any situation that might lead to embarrassment may be avoided. Embarrassing situations can include social situations and include being in large crowds of people, entering new situations, or being alone. Agoraphobic people are likely to work hard to avoid anything that could lead to embarrassment.
Although these are the standard symptoms to be avoided in people with agoraphobia, many specific situations are frequently avoided by agoraphobic individuals. These situations might include (but certainly are not limited to):
- Social situations. Social situations are unique positioned to cause embarrassment, which can trigger intense feelings of anxiety for people with agoraphobia. Although this does not quite translate to a fear of leaving the house, as is so often thought of when agoraphobia is mentioned, seeking out and maintaining friendships difficult could mean staying at home more than is considered typical.
- New places or experiences. New places and experiences can trigger intense anxiety for several reasons: novelty is uncertain, which increases the possibility of doing something wrong and causing subsequent embarrassment. It presents the danger of not knowing how to find help if help is needed.
- Popular destinations. Popular destinations are common triggers for agoraphobic people, as they are often extremely crowded. Common vacation spots, popular coffee shops, and busy dining establishments can cause a surge of anxiety.
- Enclosed spaces. Enclosed spaces can be large or small—an elevator, for instance, or a big-box store—and can be equally capable of triggering anxiety. This is because enclosed spaces suggest the possibility of becoming trapped.
- Wide-open spaces. While it may at first seem counterintuitive, wide-open spaces can also trigger anxiety because seeking help in an open space can prove difficult, and being alone can prove dangerous. Parking lots, open markets, and warehouses can all trigger anxiety symptoms in someone with agoraphobia.
- Being alone. Being alone, whether at home or out and about, can also trigger anxiety because it too presents a challenge in securing help or a means of escape. People often act as immense sources of comfort for agoraphobia, and it may verge on impossible to get out and about without someone to get out and about with.
Agoraphobia Causes: Common And Uncommon
Agoraphobia can have a complex series of causes and underlying issues, some genetic, and some of them environmental. As an anxiety disorder, agoraphobia is known to function as a co-morbid condition, accompanied by a host of other mental health issues, including additional anxiety disorders, PTSD, depressive disorders, phobias, and even substance abuse disorder, all of which have the potential to perpetuate the other disorders’ symptoms. The approach to treatment, then, is typically varied and diverse and implements multiple modalities and focuses.
Environmental causes of agoraphobia often include a history of violence or trauma. In a similar vein to Post Traumatic Stress Disorder, people with agoraphobia may find that they react negatively to certain stressors and triggers, including anything that could incite feelings of fear, anxiety, or distress. Environmental triggers can occur at any time and may be traced back to childhood, adolescence, or adulthood. Other environmental triggers include situations that are not frequently recognized as overtly traumatic, such as negative experiences in social situations or witnessing an attempted abduction. Agoraphobia can also develop without a distinct source of trauma, as is often the case in young children.
People with a family history of anxiety or depressive disorders may be at increased risk for agoraphobia, as people with a family history of any anxiety disorder are at increased risk of developing anxiety disorders themselves. Some of this may be genetic, and some of it may be more muddled, involving learned thought and behavior patterns.
There are two standards of treatment for agoraphobia, one of which is medication. Anti-anxiety medication is the preferred method of treatment. With good reason, because agoraphobia is often identified in conjunction with other anxiety disorders, using anti-anxiety medication to treat agoraphobia can pull double duty and treat multiple disorders are once.
Agoraphobia is often typically treated with therapy. Cognitive Behavioral Therapy can be a useful type of therapy in treating agoraphobia, as it teaches people to restructure their thought patterns. Exposure therapy can also be useful in treating agoraphobia. It exposes people to their triggers in safe, controlled environments, essentially training their brain to no longer recognize the situations as sources of danger or anxiety.
A dual approach is the standard of treatment for agoraphobia, fusing medication, and therapy modalities such as exposure and CBT. When used together, people with agoraphobia can reasonably expect a reduction in symptoms and often go on to lead fulfilling, productive lives, even when symptoms rise.
Agoraphobia: Coping And Outlook
Agoraphobia is an anxiety disorder, which means that a diagnosis is typically expected to linger throughout an individual’s life. This is not to say that agoraphobia symptoms cannot be managed or overcome, but instead acknowledges the likelihood for symptoms to linger even after treatment—and particularly in times of stress or change. Coping with and managing agoraphobia symptoms can essentially function as an agoraphobia “cure,” in that symptoms may retract, and life may seem to go back to normal periodically. After going off of medication or discontinuing therapy, however, symptoms may return. To cope with having agoraphobia effectively, continued treatment or maintenance treatment is essential.
In some cases, agoraphobia may shift and take on different manifestations or make way altogether for other anxiety sources. Because anxiety disorders often come in groups, the symptoms of agoraphobia can subside in favor of other types of anxiety, such as Social Anxiety Disorder, General Anxiety Disorder, and even Panic Disorder. Taking an online test for agoraphobia symptoms can help differentiate between anxiety disorders and shared symptoms.
While agoraphobia frequently has a reputation as being the disorder that involves not wanting to leave the house, the actual disorder involves far more than a simple desire to remain inside of one’s home—and indeed, can even involve wanting to get out of one’s home, if it is crowded or a source of embarrassment or panic. Agoraphobia may not be a common disorder, affecting only 1-2% of the population, but it is a highly treatable disorder with a positive long-term outlook.