Agoraphobia is a psychological condition that prevents people from living their lives to the fullest because of a specific fear of places and situations that leaves the person feeling trapped, self-conscious, and powerless.
It seems that the jury is still out on the cause of agoraphobia. However, recent research has honed in on the effects of psychological factors such as abuse on the development of agoraphobia.
Does Emotional Abuse Lead to Agoraphobia?
While it’s not possible to identify a causal link, some studies suggest that emotional abuse is a risk factor for agoraphobia.
Nonetheless, most research indicates biological factors and other forms of abuse may be more crucial components in the development of agoraphobia.
A Note on Causation: Often, scientific research can only find a correlation between two factors, not a causative link. This is because of the many interfering elements that may influence the relationship. So, we can’t conclude that emotional abuse causes agoraphobia. We can, however, identify whether the occurrence of emotional abuse leads to an increased risk of developing agoraphobia.
Adverse Childhood Events
Some research supports the idea that adverse childhood events lead to agoraphobia. For example, in an early study by Raskin et al, the findings were that 70% of participants with panic disorder reported that they grew up in a grossly disturbing childhood environment.
However, this evidence doesn’t necessarily find an association between emotional abuse and agoraphobia. For one, the study’s small sample size (17 subjects) limits its generalizability to the wider population.
Second, agoraphobia and panic disorder are widely viewed as two distinct psychiatric disorders, despite some experts believing that agoraphobia arises as a complication of panic disorder.
Therefore, we can’t be sure this relationship would still be apparent when looking at agoraphobia on its own.
Conflictual Family Environment
In a later study a correlation was found between emotional abuse and agoraphobia — it was found that a conflictual family environment was a risk factor for panic disorder with agoraphobia.
Again, this study doesn’t confirm a relationship between agoraphobia and panic disorder as it only focuses on individuals with panic disorder and agoraphobia.
In addition, the researchers use the umbrella term ‘conflictual family environment,’ which could include a whole range of things, not just emotional abuse.
Childhood Abuse
It’s been noted in prior studies that those who experience childhood abuse (physical, psychological, or sexual) are at a much higher risk of developing anxiety and depression as adults.
Furthermore, the academic medical center Mayo Clinic also asserts that abuse is a risk factor, alongside anxious/nervous temperament and the death of a parent.
Even so, it’s important to note that both sources focus on abuse as a whole, not just emotional abuse. This may suggest that other forms of abuse play a role in developing agoraphobia.
Can Any Trauma Cause Agoraphobia?
The idea that abuse causes psychological conditions isn’t new; Freud proposed that sexual abuse has a causative role in hysteria in 1895.
However, he didn’t present any evidence for the link between abuse and psychiatric disorders, but more recent research has.
Abuse and the Development of Psychiatric Disorders
In a 2008 study, it was found that there was no significant association between anxiety and emotional abuse (in isolation) or mixed abuse (emotional abuse and at least one other type of abuse).
Anxiety was significantly higher in the mixed-abuse group as compared to the emotional abuse-only group. This could suggest that other forms of abuse may influence the development of psychiatric conditions more.
Long-Term Childhood Trauma
Further evidence also states that any experience of long-term trauma in childhood may make individuals more prone to see present-day adverse events as particularly intense.
And while sexual and physical abuse are explicitly described as causes of agoraphobia, emotional abuse doesn’t get a mention.
A potential reason for the link between trauma and agoraphobia is described in the Penza et al. paper mentioned earlier.
Evidence suggests that childhood trauma is related to a range of chemical changes in the brain–higher levels of the hormone ACTH, elevated cortisol secretion, and abnormalities in the HPA hormone.
All of these components are thought to be related to our stress responses. Moreover, processes involved in the stress response, such as the fight, flight, freeze reflex, and the fear network, are believed to be biological factors that cause agoraphobia.
What is the Main Cause of Agoraphobia?
Dizziness
Throughout history, there have been numerous ideas about the cause of agoraphobia. For instance, in 1870, clinician M. Benedikt identified dizziness as the primary cause.
Vestibular Dysfunction
Then, later research suggested that agoraphobia arises due to abnormal vestibular functioning, the connection between the inner ear and the brain.
This is believed to be fundamental in controlling balance and understanding the spatial relationship between the self and other objects.
The idea that dysfunction of the spatial awareness system may cause agoraphobia is still supported.
Self-Reported Beliefs
However, research looking into patients’ beliefs about the cause of their agoraphobia sheds a different light.
Wardle and colleagues found that 38% of participants thought their agoraphobia was caused by recent stressful life events (including separation from a loved one, job change, pregnancy, etc.).
In contrast, 12% associated their agoraphobia with their naturally nervous disposition and 12% with staying at home too much, while 9% of participants related the condition to childhood experiences, which may show partial support for the impact of trauma.
Contributing Psychological Conditions
Other psychological conditions may also cause agoraphobia. For example, the severe anxiety and hypervigilant state associated with PTSD can create Agoraphobia.
However, it is important to note more research is required to understand the leading cause of this debilitating condition.
Conclusion
The current research shows that other forms of abuse, or multiple forms in combination, may be more likely related to agoraphobia than emotional abuse in isolation.
Biological factors such as vestibular dysfunction, recent stressful life events, and other psychological conditions like PTSD may also have a hand in the development of agoraphobia.
- Penza, K. M., Heim, C., & Nemeroff, C. B. (2003). Neurobiological effects of childhood abuse: Implications for the pathophysiology of depression and anxiety. Archives of Women’s Mental Health, 6(1), 15–22. https://doi.org/10.1007/s00737-002-0159-x
- Rich, D. J., Gingerich, K. J., & Rosen, L. A. (1997). Childhood emotional abuse and associated psychopathology in college students. Journal of College Student Psychotherapy, 11(3), 13–28. https://doi.org/10.1300/j035v11n03_04
- Raskin, M. (1982). Panic and Generalized Anxiety Disorders. Archives of General Psychiatry, 39(6), 687. https://doi.org/10.1001/archpsyc.1982.04290060047009
- NHS (2021, November 18). Causes—Agoraphobia. NHS UK. https://www.nhs.uk/mental-health/conditions/agoraphobia/causes/
- Laraia, M. T., Stuart, G. W., Frye, L. H., Lydiard, R., & Ballenger, J. C. (1994). Childhood environment of women having panic disorder with agoraphobia. Journal of Anxiety Disorders, 8(1), 1–17. https://doi.org/10.1016/0887-6185(94)90019-1
- Mayo Clinic. (2017, November 18). Agoraphobia—Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987
- Ezquerro, A. (2018). Sexual abuse: A perversion of attachment? Group Analysis, 52(1), 100–113. https://doi.org/10.1177/0533316418813435
- Johnson, M. R. M. C. (2021, November 24). Have you developed Agoraphobia? Counselling Directory. https://www.counselling-directory.org.uk/memberarticles/have-you-developed-agoraphobia
- Weeks, D.J., & Ward, K. (1989). Neuropsychological causes for Agoraphobia?. In: Crawford, J.R., Parker, D.M. (eds) Developments in clinical and experimental neuropsychology. Springer. https://doi.org/10.1007/978-1-4757-9996-5_25
- Wardle, J., Hayward, P., Higgitt, A., Brewin, C., & Gray, J. (1997). Causes of Agoraphobia: The patient's perspective. Behavioural and Cognitive Psychotherapy, 25(1), 27–38. https://doi.org/10.1017/S135246580001537X
- Mathew, H. (2015, April 21). PTSD and Panic Disorder, the huge difference. Psychology Today. https://www.psychologytoday.com/us/blog/unagoraphobic/201504/ptsd-and-panic-disorder-the-huge-difference-0
