What is Agoraphobia?
Agoraphobia is defined by an intense fear triggered by various situations where the individual is in public and is unable to escape. The American Psychiatric Association (APA) outlines in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) (2013) that agoraphobia is present if someone fears at least two of the following situations; fear of using public transport, such as planes, trains or buses, fear of being in large open spaces, like parking lots or parks, fear of being in an enclosed space such as shops or the cinema, fear of being in large crowds such as concerts or festivals, and, or fear of generally being outside of the home.
When a person is in one or more of the aforementioned situations, they feel a significant level of fear and anxiety and may experience panic like symptoms.
Panic like symptoms may involve a feeling of impending doom or danger, fear of loss of control or death. Physical symptoms can also include sweating, chills, increased heart rate, trembling or shaking and shortness of breath or tightness in the chest.
Individuals may fear experiencing the physical symptoms that accompany these situations and therefore avoid putting themselves in the situation again. They may opt to stay in their home where they feel safe which can in turn impact their day-to-day life.
We have had to stay home over several occasions during the pandemic and certain behaviours listed below may sound familiar. Nevertheless, it is important to highlight that individuals with agoraphobia exhibit these behaviours because they fear these situations and not because they have been imposed by government guidelines.
Individuals with agoraphobia may order food, groceries, and other items online in order to avoid going to shops, they may only take on work that allows them to work from home or that does not involve them taking public transport, they may avoid socialising with others if it involves being in certain spaces that are anxiety provoking or if it is generally outside of their home.
As with any mental disorder it is useful to think of agoraphobia on a scale, someone that occasionally experiences fear and anxiety in specific situations may not warrant a diagnosis of agoraphobia and be on one side of the scale whereas a person who experiences fear, anxiety and panic like symptoms often and whose daily functioning is impacted may warrant diagnosis and will be on the opposite end of the scale.
As with other phobias the response to the perceived threat is significantly greater than the actual danger. The anxiety or fearful response in phobias often occurs from thoughts that the individual may be having regarding the situation, such as “If I cross the bridge it might collapse”. It is important to remember that these are thoughts and that rationally people cross bridges everyday and they do not collapse. The avoidance of crossing the bridge can reinforce the initial thought as the individual does not have any evidence to refute that this may happen.
For diagnosis of agoraphobia to occur, the DSM-5 outlines that the fears should have lasted for at least six months, should severely impact the individual’s daily functioning and the symptoms are not better explained by any other disorder.
Nevertheless, an absence of diagnosis does not mean that what you may be experiencing is not distressing or valid. If you have noticed avoidance behaviours and increased distress in specific situations it may be important to ask for help.
Agoraphobia may be comorbid or coexist with other anxiety, depressive and substance use disorders. There is an increased comorbidity between agoraphobia and post traumatic stress disorder (PTSD).
Symptoms of Agoraphobia
The symptoms of agoraphobia can be split up into physical, cognitive, and behavioural.
The physical symptoms of agoraphobia tend to occur when the individual is in the anxiety provoking situation. However, individuals with agoraphobia tend to avoid these situations and therefore physical symptoms may not be experienced often.
These symptoms are like symptoms of panic attacks and can include increased heart rate, increased breathing, or hyperventilating, feeling hot or sweating, feeling sick, chest pain, shaking, dizziness, feeling faint and ringing in ears.
Cognitive symptoms include thoughts or feelings that may or may not be related to the physical symptoms. Cognitive symptoms may involve a fear of a panic attack, worrying of experiencing it in front of others for fear of judgement, worrying that the panic attack may be life threatening, worrying that you may not be able to leave or escape the place in which you may have a panic attack, worry about losing one’s sanity or worry about losing control in front of others.
Other symptoms that are not related to panic attacks may involve feeling that you are not able to cope without the help of other people, fear of being alone in your home or a general feeling of worry and dread.
Behavioural symptoms of agoraphobia include avoiding places or situations that may prompt a panic attack, not leaving your home, requiring a trusted companion to go anywhere and avoiding being a long distance away from your home.
What causes agoraphobia?
Agoraphobia often develops as a result of panic disorder. Panic disorder is an anxiety disorder that is described by panic attacks and incidents of significant fear. Agoraphobia can therefore develop when the individual links the panic attacks with the places or situations where they occurred and then subsequently starts to avoid them.
A faction of individuals with agoraphobia do not have a history of panic attacks. In these instances, the agoraphobia may be linked to fears of crime, terrorism or illness.
Traumatic events may also contribute to the development of agoraphobia.
Is Agoraphobia Common?
The prevalence of agoraphobia is approximately 1.7 percent with females being twice as likely as males to receive a diagnosis of agoraphobia.
In the UK, approximately two out of 100 people have panic disorder, and it is estimated that a third may go on to develop agoraphobia.
The onset of agoraphobia often is between the ages of 18 to 25.
To conclude agoraphobia is defined by significant fear prompted by situations like using public transport, being in large or enclosed spaces, being in large crowds or being outside of the home. Agoraphobia may develop as a complication of panic disorder and may be comorbid with other anxiety, depressive or substance abuse disorders. If you or someone you know is experiencing symptoms similar to what was presented in this article it may be important to ask for help. Sources
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Bridley, A. & Daffin, L.W. Jr. (2018). Essentials of Abnormal Psychology, 1st Edition. Fisher, L. M. & Wilson, T. G. (1985). A study of the psychology of agoraphobia, Behaviour Research and Therapy, Volume 23, Issue 2, Pages 97-107, ISSN 0005-7967. https://doi.org/10.1016/0005-7967(85)90018-X.