Agoraphobia is a type of anxiety disorder characterized by an intense fear of being in situations, such as open public spaces, where the person thinks it is difficult to escape or get help. Agoraphobia comes from the Greek words “agora” (public open space or marketplace) and “phobos” (fear).
When a person with agoraphobia is in a place or situation where they do not feel safe, such as while in a shopping mall, airport, field, or on a bridge, this will often lead to significant distress and anxiety symptoms, such as feelings of dread, shortness of breath, nausea, trembling, increased heart rate, dry mouth, and panic attacks. While not all people with agoraphobia have panic attacks, many people do have panic attacks and are also diagnosed with panic disorder. In fact, many people with agoraphobia fear that they will have another panic attack in public and will be embarrassed or unable to receive help. After a panic attack people will often start going out of their way to avoid feared locations and may even become homebound and refuse to leave their house. This psychological distress and avoidance can significantly interfere with a person’s normal routine, educational, occupational, and social functioning. For example, a person may avoid traveling, crowds, grocery stores, outdoor markets, and even leaving their home.
Celebrities who have reportedly battled with agoraphobia include Macaulay Culkin, Kim Basinger, Howard Hughes, Paula Deen, Rose McGowan, and Woody Allen.
While experts do not know the exact cause of agoraphobia, a number of theories have been put forth to explain agoraphobia. One theory suggests that agoraphobia with and without panic disorder (presence of panic attacks) are caused by different mechanisms. For those without panic attacks, the fear of being in open areas without protection may be an exaggerated adaptive response designed to keep a person safe from predators. However, for those with agoraphobia with panic attacks, the person may simply learns to avoid any situations associated with having panic attacks. Further, after people have a panic attack in a public space, they not only want to avoid the location but also any public embarrassment associated with losing control in front of other people. Research has also found that agoraphobia is associated with substance use (e.g., tobacco, benzodiazepines, alcohol) and difficulty with spatial orientation. There is also a genetic component as those with agoraphobia are much more likely to have a family relative with either agoraphobia and/or panic disorder than those without agoraphobia. It is likely a combination of these factors that contributes to the development of agoraphobia.
Agoraphobia generally develops in the late twenties to early twenties with mean onset at age 25. It is twice as commonly diagnosed in women than men. The most common disorders that may also co-occur with agoraphobia include panic disorder, depression, substance abuse, and other anxiety disorders (e.g., social phobia, generalized anxiety disorder, and posttraumatic stress disorder).
There are a number of effective treatments for agoraphobia. These include cognitive-behavioral exposure treatments, such as systematic desensitization and cognitive restructuring, relaxation techniques, antidepressants, and self-help methods. Treatments using virtual reality have also been found to be effective for some people with agoraphobia. Many people do not seek professional treatment for agoraphobia unless urged by friends and family. Those struggling with agoraphobia should discuss treatment options with a trusted healthcare professional.
For more information on agoraphobia:
Mayo Clinic article on agoraphobia
National Institute of Mental Health statistics on agoraphobia
For more information on panic disorder and panic attacks:
National Institute of Health website on panic disorder
Mayo Clinic article on panic disorder and panic attacks
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