Agoraphobia

Agoraphobia Disorder

Agoraphobia is basically a fear of fear itself, based on the individual’s past experience. This means the affected person is extremely afraid of re-experiencing the fear and other emotions that they suffered in the past, and may go to great lengths to avoid that fear again.

Agoraphobia also involves an intense anxiety and dread of experiencing fear at a place when escape may be difficult or impossible, and because of that, the person believes it is highly likely or even inevitable for the distressing emotions to occur if they go to the identified place. For example, people with agoraphobia who are afraid of having an accident while traveling, often because of suffering from a previous accident or having high anxiety while traveling, may avoid driving or riding in a car, bus, airplane or other vehicle.

In another case, if the person has extreme fears of being unable to escape from a crowded area, sometimes because of suffering a panic attack in a crowded area, then the individual may avoid stadiums, theatres, political rallies or any other venues where large numbers of people are present. Often people with agoraphobia do not want to be reminded of their issue in any way. As a result, if people are agoraphobic with regard to airline travel (or travel in general), then they may avoid driving by an airport, even if such a drive is the most direct route to where they work.

In addition, some (but not most) people with agoraphobia have such extreme crippling fears that they cannot leave their own homes. If they try to do so, they are overwhelmed with extreme dread and anxiety. However, it is important to understand that treatment can help individuals with agoraphobia.

Many people with agoraphobia also have panic disorder, and a large portion of individuals with this diagnosis have other psychiatric conditions such as depression, generalized anxiety disorder, and substance use issues.

In a study reported in 2020 that compared 41 subjects with agoraphobia to 46 patients with panic disorder (who did not have agoraphobia), researchers compared features of the two groups.

They found that patients with agoraphobia were more likely to be younger (29 years) at the onset of their disorder than the panic disorder patients (35 years).

Agoraphobia stats

According to the National Institute of Mental Health (NIMH), agoraphobia is highly treatable in people of all ages. The diagnosis of Agoraphobia usually exists throughout a person’s life, with symptoms typically beginning in young adulthood. Often, the symptoms may not have been acknowledged in the early years. At times, the diagnosis can be overlooked altogether without an assessment like MindMetrix.

According to the National Institute on Mental Health (NIMH), about 1% of adults in the United States have agoraphobia, and the prevalence is about equal in men and women. Of those with agoraphobia, about 41 percent have a severe impairment, while 31 percent are moderately impaired and 28 percent are mildly impaired.

What it looks like

According to the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), for a diagnosis of agoraphobia, the individual must experience elevated anxiety or fear with regard to at least two of these situations for at least six months. All of them are very common daily occurrences for most people, and thus a fear of these situations may cause considerable distress to the lives of individuals with agoraphobia. These situations are as follows:

• The use of public transportation
• Being present in a crowd or standing in a line
• Being inside an enclosed area
• Being in outside open areas (such as the outside bleachers of a football game)
• Going outside one’s home by oneself

If the person does venture into one of the feared zones or even thinks about one of the feared situations, the individual’s brain and body may respond with extreme fear and accompanying physical symptoms, such as nausea, shortness of breath, sweating, racing heart, trembling, and dizziness. Most outside observers witnessing an individual in the midst of an agoraphobic attack can clearly tell that the person is highly distressed and upset.

Other symptoms the person may exhibit include the following, according to the National Institute of Health:

• Feeling dependent on others
• Feelings of helplessness
• Fear of being alone
• Fear of losing control in a public place
• Feeling that their body or their environment is not real (derealization)

Some researchers have found that cigarette smoking is a risk factor for the later development of agoraphobia as well as for panic disorder. In a study of 688 adolescents in New York who were followed up at age 22 years, the researchers found that heavy smoking, or smoking 20 or more cigarettes per day as teenagers, significantly increased the risk for the development of agoraphobia in early adulthood--by nearly seven times.

Having agoraphobia is nobody's fault

Many people with agoraphobia may have blamed themselves for their symptoms, thinking that they should be okay or should have been better able to control their emotions. They may have regrets about their situation. Yet knowing something is not the same as being able to readily change one’s behavior, and this is why treatment is so important — it really can help people with agoraphobia to become more effective in today’s demanding world. The right treatment can give a degree of control in one’s life that they might not have had access to in the past: people with agoraphobia who have their symptoms managed are no longer victims of their own fear, and are capable of going where they please.

Untreated agoraphobia

If agoraphobia is not treated, a person’s quality of life will not be as good as it would be if they were treated. Some individuals with agoraphobia are so overwhelmed by their symptoms that they cannot leave their homes, experience the world, or go to important events like weddings and graduations. In contrast, treatment may help considerably and allow the person to have a more vibrant life.

Outlook

While living with agoraphobia can present unique obstacles, treatment can dramatically improve one’s quality of life. The majority of people who are properly diagnosed and treated observe transformative results. In fact, people who have received treatment often say that it is one of the best decisions they’ve ever made. With treatment, people with agoraphobia tend to be able to go almost anywhere without fear holding them back.

In good company

Many prominent people reportedly have agoraphobia, such as singer Barbra Streisand, actor Macaulay Culkin, and actress Kim Basinger.

The current thinking on what causes agoraphobia

Why do some people have agoraphobia while others do not? No one knows for sure what causes this disorder, but most experts believe that it is brain-based and largely driven by genetics. Agoraphobia tends to run in families, and if an individual is diagnosed with this disorder, it is likely that someone else they are closely related to has it as well.