Agoraphobia

Agoraphobia is the abnormal fear of expecting or experiencing a difficult or embarrassing situation from which the person will not be able to find an escape.

As an introduction to fear, anxiety, and phobias, see the Fears and phobia and Phobia sections of this website.  You will learn about fear, the difference between fear and anxiety, what is a phobia, what causes phobias, the types of phobias, the most common symptoms of phobia, how a phobia  is diagnosed, the names of all the different phobias, and information on phobia treatment.

Agoraphobia is the abnormal fear of expecting or experiencing a difficult or embarrassing situation from which you cannot find an escape. The word is an English adoption of the Greek words agora and phobos, literally translated in modern Greek as "a fear of the marketplace".  This translation is the reason of the common misconception that agoraphobia is a fear of open spaces. This is most often not the case since people suffering from agoraphobia usually are not afraid of the open spaces themselves, but of public spaces or of situations where a person is afraid of having a panic attack and will not be able to receive help.

Another misconception is that agoraphobia is a fear of "crowded spaces" (which would be a social phobia). Once again, an agoraphobic does not fear people, but what they fear is being in an embarrassing situation from which escape might be embarrassing or difficult.  During severe bouts of anxiety, the agoraphobic is confined not only to their home, but to one or two rooms and they may even become bed-bound.

Many agoraphobics develop the disorder after first suffering a series of panic attacks, usually in public places.  The attacks seem to occur randomly and without warning, making it impossible for a person to predict what situation will trigger such a reaction. The unpredictability of panic attacks leads the person to anticipate future panic attacks and, therefore, to fear any situation in which an attack may occur. As a result, they restrict or avoid going out in public or they require a companion when in the situation.  Agoraphobia victims also are likely to develop depression, fatigue, tension, spontaneous panic and obsessive disorders.

As is the case with a similar phobia, social phobia, the precise cause of agoraphobia is not known.  Environmental and biological factor may both be involved.  Some people are born with a cautious personality style and have a tendency to be shy and sensitive to new situations. This may contribute to social phobia. Others may learn a cautious style depending on experiences they have, the way others react to them, or the behaviors they see in their parents and others.

Low self-confidence and a lack of coping skills to manage normal stress can also play a role in agoraphobia. Those who tend to be worriers, perfectionists, and who have a hard time dealing with small mistakes may also be more likely to develop it.  Certainly, biological and chemical brain processes may play a part.

Therapists can help people who have agoraphobia to develop coping skills to manage their fear and anxiety. This involves understanding and adjusting thoughts and beliefs that help create the anxiety, learning and practicing specific behavioral social skills to increase confidence, and then slowly and gradually practicing these skills in real situations.

Systematic desensitization, which is a type of cognitive behavioral therapy (CBT), is the preferred behavioral technique used to treat agoraphobia. It based upon having the person relax, then imagine the components of the phobia, working from the least fearful to the most fearful. Gradual exposure to real life phobias has also been used with success to help people overcome their fears.  According to the National Institute of Mental Health, about 75% of people with specific phobias overcome their fears through cognitive-behavioral therapy. 

Relaxation and stress relief techniques are frequently used in conjunction with other therapeutic approaches.  Relaxation techniques may include things like specific ways of breathing, muscle relaxation training, guided mental imagery, or soothing self-talk.

Worry and "self-talk" can play a significant role in social phobia and agoraphobia. A persons worry and thoughts are often in the form of a question that begins "what if . . ." and tend to be negative rather than positive. These self talk and worry "what if'"s" tend to get worse and worse, until the person having them expects not just bad things, but the worst possible outcome.  Therapists can help people identify, examine, and modify those these thoughts.

Anti-anxiety and anti-depressive medications are sometimes used to help relieve the symptoms associated with agoraphobia. Certain medications that help to regulate the function of serotonin (a brain chemical that helps to transmit electrical messages having to do with mood) are sometimes used. Though medication doesn't solve the whole problem, it can reduce anxiety so the person can more easily deal with their problem.

Hypnotherapy can also be effective.  This usually consists of systematic desensitization and other therapeutic techniques conducted under hypnosis by a clinical hypnotherapist.

In the treatment of agoraphobia it may be important that the therapist have a willingness to travel to be with the client. 

For more information about agoraphobia and other mental health problems, please click on the linked websites listed below.

For a list of the many phobias please visit the page List of Phobias.

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