Agoraphobia: Causes, Symptoms and Treatment

Agoraphobia is an anxiety disorder that causes intense fear in situations from which you can’t easily escape.

Many people think that agoraphobia is simply a fear of enclosed spaces.

This is certainly true in some cases, but agoraphobia can include fears of a wider range of situations such as being trapped, panicking or losing control, or being humiliated in a public setting.

Situations people with agoraphobia fear may include:

• Elevators
• Public transport
• Crowded places such as shopping centres
• Meetings, movie theatres, classrooms and other places you cannot leave without drawing attention to yourself
• Leaving the safety of home.

For many individuals with agoraphobia, their fears become so intense that living a normal, functioning life becomes very difficult.

Symptoms of Agoraphobia

Mental Symptoms

Agoraphobia produces a range of physical and mental symptoms. Mental symptoms of agoraphobia include:

• Intense anxiety around being in, or thinking about, a feared situation or place
• Fears of having a panic attack, losing control or making a fool of yourself in public
• Reduced confidence and self-esteem
• Feelings of shame and guilt around your inability to live a normal life.

Physical Symptoms

The anxiety caused by agoraphobia can lead to physical symptoms such as:

• Racing heart
• Trembling
• Sweating
• Tightness in the chest
• Nausea
• Dizziness
• Shortness of breath or difficulty breathing.

Secondary Symptoms

Agoraphobia can often lead to panic attacks: sudden and intense bursts of fear which can be very distressing to experience.

Panic attack symptoms typically include:

• Extreme anxiety
• Feeling dizzy or faint
• Uncontrollable trembling
• Racing heart
• Chest pain
• Thinking you are having a heart attack
• A feeling of impending doom or that your life is in danger
• Feeling unreal or detached from yourself.

These physical and mental symptoms go on to affect how a person with agoraphobia behaves. They may start to:

• Avoid the situations or places in which they feel unsafe
• Only feel safe in their feared situations if accompanied by a friend or a service dog.
• Become preoccupied with the possibility of a future panic attack
• Withdraw from situations or responsibilities with which they no longer feel able to cope
• Stay at home and withdraw from others.

Causes of Agoraphobia

Agoraphobia often develops as a complication arising from panic disorder—a condition in which a person experiences multiple or recurring panic attacks.

In fact, until recently agoraphobia was considered a subtype of panic disorder rather than a separate condition.

Panic attacks and agoraphobia develop in a cycle of escalating symptoms.

Agoraphobia and Panic Attack Cycle

Because panic attacks are so intense and distressing to experience, once a person has experienced a panic attack, they may become very fearful of experiencing more.

They may become very vigilant for any signs of panic in themselves, such as changes to their breathing or heart rate, and start to avoid situations or places they believe are linked to their panic attacks.

This increased anxiety and hypervigilance actually increases the likelihood that a person will experience future attacks.

At the same time, withdrawing from situations perceived as fearful can reduce their confidence and ability to de-escalate feelings of anxiety, further increasing the likelihood of subsequent attacks.

Certain life events and traits can also increase your risk of developing agoraphobia (with or without panic disorder). These include:

• History of physical, sexual or emotional abuse
• A very anxious or inhibited personality
• A highly neurotic or introverted personality
• The death of a parent or loved one or being separated from them
• Being raised in an over-protective household.

Agoraphobia Comorbidity

Agoraphobia is also commonly experienced alongside other mental health disorders: in fact 87% of individuals with agoraphobia will be diagnosed with an additional condition during their lifetimes.

The most common comorbid disorders include:

• Panic disorder (12%)
• Other phobias (8%)
• Social anxiety disorder (7%)
• Generalized anxiety disorder (6%)
• Substance abuse disorder (2%)

How is Agoraphobia Diagnosed

Agoraphobia can be diagnosed by a GP or clinical psychologist.

Since its symptoms have a lot of overlap with other anxiety disorders, medical professionals will ask you a series of questions to carefully analyze and understand your experiences.

They may ask about how you feel in the situations about which you are fearful, how long your condition has lasted, and any family history of anxiety disorders, among other things.

Your answers to these questions will be compared to the diagnostic criteria listed in the Diagnostic and Statistical Manual (DSM-V) to see if they meet the requirements for an agoraphobia diagnosis.

These criteria include:

• Intense fear in two or more situations in which escape is difficult
• The fear is out of proportion to the actual danger presented by the situation
• The fear of these situations causes a strong desire to avoid encountering them
• The fear has lasted for 6 months or more, causes significant distress or impairment, and is not better explained by another disorder.

Treatment for Agoraphobia

Below are listed common therapeutic techniques and treatment methods to help deal with agoraphobia.

If you’d like to connect with a mental health professional so they can help you implement some of these techniques, then you can try finding a therapist using platforms such as BetterHelp or Open Path.

Note: If prescribed medication is your desired treatment method, always ensure the platform you subscribe to has psychiatric support.

Cognitive Behavioral Therapy (CBT)

CBT is a form of therapy that analyses the link between our thoughts and how we feel and act.

During CBT, clients learn to identify and challenge unhelpful or distorted thoughts (known as cognitions), which also changes the way they feel and act.

CBT therapy involves examining the thoughts that cause you to fear and avoid certain situations.

Often these thought processes greatly exaggerate the actual danger, and by learning to think more realistically, you can face them more confidently.

Through regular in-person or online CBT therapy for agoraphobia, clients can learn to challenge and change the negative thoughts which cause the condition.

Exposure Therapy

A subtype of CBT specifically designed to treat phobias such as agoraphobia, exposure therapy works by asking clients to face the situations they fear head on.

This enables clients to see first hand that their beliefs and cognitions around these situations are exaggerated and unrealistic.

In agoraphobia treatment, clients may also be asked to deliberately induce physical sensations they normally associate with panic in order to feel less threatened by them (a process known as interoceptive exposure).

Though daunting, exposure therapy is highly effective in treating agoraphobia.

Research shows that patients who completed a self-help exposure course for Agoraphobia were experiencing 77% less symptoms one year later.

Medication

A doctor may prescribe medication to help you manage the symptoms of agoraphobia.

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help reduce symptoms and panic attack frequency if taken regularly.

Anti-anxiety medication such as benzodiazepines can also be prescribed—these medications are taken on an as-needed basis to relieve symptoms.

A doctor may recommend taking medication for between 6 and 12 months before reviewing your symptoms.

Breaking the cycle

Once the cycle of panic attacks and increased fear and avoidance starts, it rarely stops on its own.

This means that unless you seek professional treatment, agoraphobia is unlikely to get better.

agoraphobia can be an extremely debilitating condition that causes your life to shrink inwards until there are very few places you feel safe.

But it isn’t something you need to live with. Speak to your GP or psychologist to get started finding the right treatment path for you.