What is agoraphobia?

Coming from Greek, the word agoraphobia literally means “fear of the public square or market place”, and is often said to refer to a fear of open spaces. However, this is somewhat misleading.  

Agoraphobia is actually an anxiety disorder in which you may perceive an environment as unsafe, disproportionately to the actual danger of the situation. People fear there is no escape, and the associated fear of such public places or situations could cause you to panic or feel helpless and embarrassed. Agoraphobia can often cause sufferers to go out of their way to avoid the places and situations they fear, such as: 

• public transport  
• open or enclosed spaces  
• queuing  
• crowded spaces 
• being alone in public  

In extreme cases, this can mean that they become unable to leave their homes. 

What causes agoraphobia?

Agoraphobia usually is a complication that arises from an existing panic disorder. 1 in 50 people in the UK have a panic disorder, and about a third of them will develop agoraphobia. It usually develops after a person has had one or more panic attacks and the fear of having another can cause agoraphobia. Panic attack symptoms include: 

• accelerated heart rate
• hyperventilation
• sweating
• nausea
• chest pain
• feeling faint

It can also be the result of entering an environment or situation that the patient fears. Other potential causes include genetics, nervous temperament, environmental stresses, and learning experiences. 

What are the symptoms of agoraphobia?  

On a cognitive level, agoraphobics may experience: 

• Fear of looking stupid or embarrassing themselves, perhaps due to a public panic attack.
• Fear of their heart stopping during a panic attack, or another fatal consequence.
• Fear of being unable to escape such a situation.
• Fear of losing control in public.
• Fear of losing their sanity.
• The sensation that people are staring at them.
• Fear of being left alone in the house.
• General anxiety or dread 

Behavioural symptoms, which are usually a consequence of the cognitive symptoms, include: 

• Avoiding situations associated with panic attacks.
• Avoiding travelling far from home.
• Needing someone with them wherever they go.
• Not being able to leave the house in extreme cases.

Generally, these behaviours will last for six months or longer.

What triggers agoraphobia?  

Agoraphobia usually begins in late adolescents or early adult years after the patient experiences one or more panic attacks, and starts to fear having more.  

In some cases, it is triggered by other events, such as traumatic experiences, stressful events, such as bereavement, or drug abuse. Other mental health conditions, such as depression, or irrational fears of being attacked or catching illnesses from other people can also cause agoraphobia. 

How can it be prevented?  

There is no guaranteed way of preventing agoraphobia, but it is true that fear breeds fear. If you notice that you are starting to feel afraid of going to places that are logically safe, it is best to face that fear before it grows into a full-blown phobia, by practising visiting the place again and again, perhaps with a trusted friend or family member. 

How is agoraphobia diagnosed?  

If you are experiencing anxiety or panic attacks, it is important to seek help from your doctor or a specialist as soon as possible. The longer the symptoms are left untreated, the more difficult it becomes to treat them. Speak to your GP, either in person or by telephone consultation. While it is difficult to talk about personal issues, like feelings, it is vital to be as open and honest with your GP so that they can accurately diagnose the condition, and help you get the treatment necessary. 

It is important to point out that the symptoms of agoraphobia are the same as the symptoms of conditions such as heart disease, stomach or breathing problems. GPs will run a series of tests to see if the symptoms are caused by a physical illness. If there is no underlying illness, they will be able to make a diagnosis from the following information: 

• your symptoms
• how often you experience them
• how severe they are
• what situations bring them on 

A GP may also refer you to a psychologist or psychiatrist for further evaluation or treatment.

What is the treatment?

Treatment can be challenging because it may mean facing your fears, but agoraphobia responds very well to it. Depending on the severity of the symptoms, the most apt treatment will be suggested, which might be a combination of different methods. It is always best to consult a doctor first. 

Cognitive behavioural therapy (CBT) or other psychotherapy techniques, such as applied relaxation may be recommended. There are also a number of support groups available, which many people with anxiety disorders find beneficial to contact.  

A number of self-help techniques exist, which may form part of your therapy, or may be recommended by your doctor. These include breathing exercises, grounding techniques, controlling your thoughts and challenging your fear (exposure therapy).

Lifestyle changes can have a positive impact also, such as exercising regularly, eating a healthy diet, avoiding alcohol and drugs, and reducing caffeine intake.  

In some cases, medication may be prescribed, if self-help or life style changes aren’t improving symptoms. Usually, a course of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) will be prescribed. These medications can treat depression and anxiety disorders. Courses of medication will last from six months to a year.  

What complications can arise from agoraphobia?

Agoraphobia, if left untreated, can lead to: 

• depression 
• alcoholism 
• drug abuse  
• anxiety disorders  
• personality disorders 

Does agoraphobia go away? 

Approximately, one in three cases of agoraphobia will go away completely and the person will remain symptom-free. Half of all people see an improvement in symptoms with treatments, but they might experience periods of flare ups. 20% of those with agoraphobia will continue to experience symptoms.  

Does agoraphobia affect men or women more? 

Women are more likely to be diagnosed with the condition than men are. In women, it is twice as common as in men.

How can you support someone with agoraphobia?  

By learning about the condition and offering support and encouragement, you can help a loved one who is suffering from agoraphobia.