Definition. Agoraphobia is a rather complex phobia, with a number of different (although all similar and related) definitions:
“… a morbid fear of having a panic attack or panic-like symptoms in a situation or place in which it is perceived as being difficult to escape …”
“… irrational fears that are related to things like leaving home; entering shops; being in crowds or public places; travelling alone …”
“… an intense fear of being in public places where you feel escape might be difficult …”
The common thread in all those definitions is that agoraphobia is more than a simple fear of open spaces! The main underlying fear seems to be a fear of being unable to escape to a place of safety (usually the person’s home). The sufferer may have a ‘fear of fear’ – a fear of suffering a panic attack in certain circumstances, although not all agoraphobics have panic attacks.
At the very least, the sufferer has a fear of the anxiety that he or she may feel when in the phobic situation. There are many other components to the condition, or other phobias that may co-exist: fear of being alone; fear of leaving a ‘safe place’; fear of being trapped; fear of being on a bridge (escape off a bridge is very difficult!); fear of being in a crowd; fear of large buildings.
Agoraphobia is actually quite common! It is estimated that about 3.2 million people in the USA suffer from agoraphobia, and the UK mental health charity ‘Mind’ estimates that about half of UK phobia sufferers have agoraphobia. The onset of the condition is usually between the ages 20 – 40, and is more common in females, although this may be because males are less willing to discuss their emotions! The onset of the condition can be quite sudden or can occur over a number of weeks, or months.
It is generally accepted now that there is no single cause of agoraphobia.
It is thought in some cases to be the result of a panic attack (although the panic attack may occur for an unknown reason). Having experienced a panic attack in a particular circumstance, the sufferer then fears repeated panic attacks in the same circumstance and then starts to exhibit all the normal symptoms of phobia, eventually avoiding the fear by remaining in the safe place (usually the sufferer’s home). However, almost half of agoraphobia sufferers have no history of panic attack. In these people, the phobia may be the result of other phobias such as fear of crime, or fear of accidents.
Social anxiety may be an underlying cause – sufferers avoid public and/or unfamiliar places.
As you might expect from the ‘definition’ above, the severity and range of symptoms of agoraphobia can vary widely from sufferer to sufferer. As with other phobias, people who suffer from agoraphobia may exhibit physical, psychological, and behavioural symptoms.
Agoraphobics may experience some of the usual range of physical symptoms: nausea; palpitations; sweating; feeling faint; rapid heartbeat; shortness of breath; tightness in the chest; abdominal pains.
The psychological symptoms experienced by agoraphobia sufferers include fear of having a panic attack; fear of danger when having a panic attack; fear of being unable to get away if a panic attack starts; fear of loss of control; fear of embarrassment. Sufferers may also experience feelings of low self-esteem; depression; and feelings of dread.
There will be a change in behaviour, with avoidance being a very profound and obvious behaviour. Sufferers avoid situations in which they might suffer a panic attack, and such behaviour can develop to the point of not leaving their ‘safe place’. Such avoidance behaviours can be rather limiting – ranging from only leaving the house with a friend or relative, to refusing to leave the house in any circumstance. Sufferers may also exhibit obsessive or depressive behaviours.
There is a range of severity. At one end of the scale, a person may be able to travel some distance, as long as it is within certain boundaries, while at the other end of the scale, a person may buy room-bound.
Drug treatments – especially SSRI antidepressants (such as Prozac), and benzodiazepines (such as Valium, which is diazepam) have been routinely used to treat agoraphobia. Although the SSRIs have been shown to be of some benefit in treating agoraphobia, the benzodiazepines (which were used to treat the anxiety component) are used less and less now because of side effects and dependence issues.
Cognitive behavioural therapy is increasingly used as a treatment – helping sufferers understand their condition and develop new ways to deal with it. Psychotherapy and group therapy have been used, but their effect seems to be rather limited.
‘Face the fear’ - being exposed to the phobic situation until the anxiety reduces. This is often done in a progressive manner. This process (real life exposure to the phobic situation) is the mainstay of treatment for many people, and there are certain principles that seem to underlie its success when used as a ‘self-help’ treatment: exposure must be long enough to ensure that the anxiety is sufficiently reduced (this may take several hours, and it has been shown that short periods of exposure in which the anxiety is not reduced can be harmful); exposure should be regular; involving friends and family in the first stages can be helpful, as long as this is part of a progressive process.
Hypnosis / self hypnosis. My recommendation with all phobias is that they are more successfully treated by a trained therapist with the use of self hypnosis as support, than by use of self hypnosis as the sole therapy. Within that constraint, the forms of therapy outlined on the ‘treatments of phobias’ page on this site (link below) can all be used successfully: positive phobia replacement; positive visualisation; Hypno desensitisation; flooding; regression.