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What is Agoraphobia? An anxiety disorder characterized by extreme fear in certain situations where the sufferer perceives his/her current surroundings/situation as being difficult to escape or get help. While the term agoraphobia literally mean the fear of open spaces this is somewhat misleading. Someone who experiences agoraphobia tends to have a number of fears of various places and situations both busy and quiet such as shopping malls, airports, public places, elevators, bridges etc.. The underlying fear that causes this feeling of panic is the fear of being in a place where help will not be available or where you feel it may be difficult to escape to a safe place. Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven.

The condition is more common in women (up to two thirds) and often begins in the early or mid twenties. It is estimated that agoraphobia without panic disorder affects around 4% of women and 2% of men during any 12-month period. Some people do not develop the condition until the mid-thirties. Typically the condition first presents with a panic attack in a public place, when there is no obvious precipitating factor preceding illness.

Sometimes it begins after the birth of a child, moving house or after a physical illness. Not all people with agoraphobia have panic attacks (panic disorder); some people experience marked anxiety and fear but can endure the situation, other people always take steps to avoid being in the situation in which the distressing symptoms arise.

Untreated, agoraphobia typically runs a chronic course.

Symptoms of agoraphobia may include:

  • Anxiety in response to being away from an environment that is seen as safe.
  • Physical symptoms of significant anxiety such as breathlessness, sweating, dizziness, fast heart rate, sensation of choking, nausea and feelings of extreme fear or dread.
  • Anticipation of anxiety if the person is required to leave their safe place.
  • Low self esteem and loss of self confidence as well as depression.
  • Reluctance to leave the house or familiar surrounds.

Common complications: Untreated agoraphobia can severely reduce a person's quality of life. For example Activities outside of the home such as work, school, socializing, hobbies and many forms of exercise can be considered impossible to attain by the person experiencing agoraphobia. The person experiencing agoraphobia may realize that their fear is irrational but feel powerless to do anything about it. Feelings of angry and frustration may be common. These negative feelings affect self confidence and self perception.

What causes agoraphobia? The exact cause of agoraphobia is not known. Agoraphobia and other phobias are thought to be the result of a number of physical and environmental factors. For example: Biochemical imbalances in brain neurotransmitters (chemical nerve messengers) Some individuals develop an irrational fear about a certain situation and experience a panic attack. Their brain then associates the panic with that situation and learns to avoid it. Genetic factors. Research studies have found that agoraphobia tends to run in families (especially when it occurs with panic disorder), but it is not clear if this is because of a genetic link or for some other reason. A number of links have been found between agoraphobia and spatial awareness. Some people with agoraphobia have a weakened system of balance and space, which causes an imbalance and a need to rely heavily on visual signals. Unresolved emotional conflicts or past experiences may play a role All of these factors may play a role in the development of agoraphobia.

Treatment seems to be most effective if instituted early in the development of the disorder, when the person is encouraged to return to the situation, which provokes the symptoms. CBT is thought to be one of the most effective forms of treatment for panic disorder with or without agoraphobia. CBT is a type of psychotherapy that is based on the principle that the way you feel is partly dependent on the way you think about things. CBT teaches you to behave in ways that challenge negative thoughts. Medication is sometimes used in combination with CBT to help treat the symptoms of agoraphobia. Medicines that may be used to treat agoraphobia include: antidepressants, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and beta-blockers. Although people may continue to experience some mild anxiety, they are able to function normally again with treatment e.g. go shopping alone. Relapse is common but people should be offered further treatment if this occurs. People however with established symptoms lasting over one year have a poorer prognosis. These who have the condition over 5 years are likely to have life long problems, even with prolonged treatment.

20% of patients eventually achieve spontaneous remission.

90% of patients experience significant improvement with treatment.

Agoraphobia Related Web Sites

Internet Mental Health - Agoraphobia
American and European descriptions of this condition; information about diagnosis, treatment, and research; and booklets and magazine articles.

Agoraphobics Building Independent Lives
ABIL is a non-profit group with a mission to provide hope, support and advocacy for people suffering from debilitating phobias, panic attacks and/or agoraphobia by establishing self-help groups and providing public education.


Agoraphobia- Social Phobia World


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