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Agoraphobia

Agoraphobia is an anxiety disorder that involves an extreme and irrational fear of being unable to escape a difficult or embarrassing situation. People fear they will experience panic or other incapacitating symptoms when trapped in a public and inescapable setting.

Agoraphobia is sometimes mistaken as a fear of leaving the house, but it is more complex. The disorder is marked by anxiety that causes people to avoid situations where they might feel panicked, trapped, helpless, or embarrassed. It can occur on its own or alongside another mental health condition, such as panic disorder.

This fear often leads to persistent avoidance behaviors, in which the person begins to stay away from the places and situations in which they fear panic may occur.1 For example, a person with agoraphobia may avoid driving a car, leaving the comfort of home, shopping in a mall, traveling by airplane, or simply being in a crowded area.

Due to these avoidance behaviors, the life of a person with agoraphobia can become very restrictive and isolated—greatly affecting their personal and professional life. For example, heightened fears and avoidance behaviors can make it difficult for a person with agoraphobia to travel for work or to visit with family and friends. Even small tasks, such as going to the store, can become extremely difficult.

Fear and avoidance can become so severe with agoraphobia that the person with the phobia becomes confined to their home. Fortunately, agoraphobic symptoms can be treated.

Agoraphobia and Fear of Leaving the House

Symptoms of Agoraphobia

Symptoms of agoraphobia may include:

  • Being afraid of leaving home

  • Being afraid of open spaces, bridges, or shopping centers

  • Fear of enclosed spaces or buildings

  • Fear of leaving home or being in social situations alone

  • Fear of losing control in a public place

  • Fear of places where escape might be difficult

  • Fear of public transportation

These situations almost always trigger an anxiety response that is out of proportion to the actual danger presented by the situation.

Panic attacks often precede the onset of agoraphobia. When forced to endure a feared situation, a person may experience a panic attack that causes symptoms including:

  • Chest pain

  • Chills

  • Diarrhea

  • Dizziness

  • Feelings of choking

  • Feelings of unreality

  • Nausea

  • Numbness

  • Rapid heartbeat

  • Shortness of breath

  • Sweating

  • Trembling


Types of Agoraphobia

Although many people with agoraphobia will also have panic disorder, it is possible to be diagnosed with agoraphobia without having a history of panic disorder. When this occurs, the person still has a fear of being stuck in a situation where escape would be difficult or humiliating. However, they generally do not fear having full-blown panic attacks.

Rather, they may be afraid of having some other type of distressing anxiety symptom or other intense physical issues, such as vomiting or having a severe migraine. For instance, the person may be afraid that they will lose control of their bladder in public or faint without any help being available.

Approximately one-third to half of those diagnosed with panic disorder will also develop agoraphobia. The National Institute of Mental Health (NIMH) reports that agoraphobia occurs in approximately 0.9% of adults in the U.S. population in any given year. This condition typically develops in adulthood, though it can emerge earlier in adolescence.

Agoraphobia vs. Other Phobias

The avoidance behaviours present in agoraphobia differ from the diagnostic criteria of a specific phobia. For instance:

  • A person with agoraphobia may avoid travelintravellingg by airplane due to a fear of having a panic attack on a plane and not necessarily due to aerophobia, or the fear of flying.

  • A person with agoraphobia may avoid crowds, fearing the embarrassment of having a panic attack in front of a lot of people. Such fear is not the same as social anxiety disorder, which is a separate mental health condition that involves anxiety about being negatively evaluated by others.

Causes of Agoraphobia

The exact causes of agoraphobia are not known, but there are several



risk factors that may increase your risk of developing this condition. These include:

  • Having another anxiety disorder, such as generalized anxiety disorder or social anxiety disorder

  • Another phobia

  • A family history of agoraphobia

  • A history of abuse or trauma

  • Brain chemistry

  • Low self-esteem or depression

Learned associations can also play a role in the development of agoraphobia. Experiencing a panic attack in a certain situation or setting can lead to a fear that such a reaction will occur again in the future.

In some cases, post-traumatic stress disorder (PTSD) can contribute to the development of agoraphobia. PTSD can occur following a traumatic event and lead to hypervigilance and anxiety symptoms, which can lead to the onset of agoraphobia.


Treatment for Agoraphobia

If a person does develop agoraphobia with panic disorder, symptoms typically begin to occur within the first year that the person starts having recurring and persistent panic attacks. Agoraphobia can get worse if left untreated.

For the best outcomes in managing agoraphobia and panic symptoms, it is important to seek treatment as soon as symptoms arise.

Psychotherapy

The therapeutic approach may include some systematic desensitization, in which the person gradually confronts avoided situations with the support and guidance of their therapist. Some research has shown that integrating exposure therapy with psychodynamic treatment has been beneficial in panic disorder with agoraphobia.



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