Agoraphobia

About Agoraphobia, Its Causes, Effects & Treatment

What is Agoraphobia?

Agoraphobia literally means “fear of the marketplace” and is therefore often misunderstood as fear of crowds or fear of open spaces.

In clinical terms Agoraphobia is defined as the fear of situations or places "from which escape might be difficult (or embarrassing) or in which help may not be available in the event of a Panic Attack. The term is used to describe an irrational and often disabling fear of being out in public.

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Panic Attacks are a common feature of Agoraphobia. A Panic Attack is a sudden unexpected attack of intense fear and anxiety that can make you feel as if you are dying, losing control or going crazy. Owing to the unpredictable nature of Panic Attacks, you often worry about them happening in a public place. This results in your avoiding situations where Panic Attack can occur.

Like Panic Disorder, Agoraphobia is one of the several Anxiety Disorders. It may or may not occur with Panic Disorder, but more often than not, it is seen with Panic Disorder.

If you have Agoraphobia you will frequently also experience Panic Attacks, but Panic Attacks, or Panic Disorder, are not a requirement for a diagnosis of Agoraphobia. Figures suggest that Panic Disorder progresses to Agoraphobia for about one-third of the people with Panic Disorder.

Agoraphobia usually begins in the late 20s and is more common in women than men, (although that may be because fewer men seek help). Approximately 5% of adults develop Agoraphobia.

Agoraphobia sometimes starts suddenly and sometimes it develops slowly. Often there is no obvious cause. Without treatment, Agoraphobia can continue for years and may become more severe with time.

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The severity of Agoraphobia is quite variable. Some people with Agoraphobia live essentially normal lives as they avoid potentially anxiety-provoking situations. However, in severe cases of Agoraphobia, people are homebound. These people work very hard to avoid any and all situations that might cause them to become anxious.

How does Agoraphobia begin?

Agoraphobia may start after the very first Panic Attack, which sets off in, for example, a crowded mall. Your mind gets conditioned to associate panic with the place or situation in which you experienced the Panic Attack and you start avoiding it.

Subsequent to the first Panic Attack, you become scared of having another one. This fear leads to a nagging, all-pervasive anxiety about when and where the next Panic Attack might happen. You now begin to “fear the fear.”

This obsessive worry triggers more frequent Panic Attacks and you get conditioned to associate panic with each new situation or place where you have had a Panic Attack. Because unexplained Panic Attacks are horrifying experiences, most people start avoiding all the places they have Panic Attacks.

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Causes of Agoraphobia

The causes of Agoraphobia have not yet been clearly defined nor have they been fully understood. In spite of the numerous studies that have been conducted on Anxiety Disorders, the answer to what really causes them still remains vague.

Genetic

It has long been suspected that genes have a role to play in the development of Anxiety Disorders.

Recent research in the area states that if one twin suffers from an Anxiety Disorder in there’s a good chance that the other will too.

Another research by scientists at Yale University on human genes affrims that Anxiety Disorders such as Agoraphobia can be inhertied. If one of your family members has been diagonosed with Agoraphobia, then your chances of having Agoraphobia increase threefold.

Life Events

Nearly 42% of patients having Agoraphobia have a background of real or feared separation from their parents or other caretakers in childhood. This figure had led researchers to conclude that Agoraphobia in adults is the result of unresolved childhood Separation Anxiety.

Furthermore, the fact that many people with Agoraphobia report that their first episode happened after the death of a loved one, and also observation that Agoraphobics to feel safe when someone close accompanies them, support the separation anxiety hypothesis.

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Learned Behavior

There is a theory about human learning that explains Agoraphobia.

It is thought that your first experience of panic-like symptoms in a particular situation— for example, traveling alone by train— may lead you to associate physical symptoms of panic with all train journeys. And hence you will start avoiding train journeys altogether to get respite from the feeling of discomfort it casues.

Unfortunately, the avoidance strengthens the phobia because you are unlikely to have the opportunity to test whether train journeys actually cause that feeling of discomfiture.

Inherent Temperament

Your own temperament also plays a role in the development of Agoraphobia. Possibly, you are simply more sensitive and react more intensely to certain life situations.

Studies also point out that babies and children who manifest “behavioral inhibition” will have a propensity to develop an anxiety disorder in their adult years. Behavioral Inhibition is characterized by withdrawal, crying, and seeking comfort when confronted with unfamiliar surroundings or strangers.

Physiological Reactions to Illness

Another interesting factor emerged from research studies carried out, has traced a link between history of respiratory disease and development of Panic Disorder and Agoraphobia.

Researchers have deduced that repeated episodes of respiratory disease would predispose a child to PD / Agoraphobia by making the breathing labored and lowering the threshold for feeling suffocated.

It is also possible that respiratory diseases could give rise to fearful beliefs in the child's mind that would lead him or her to exaggerate the significance of respiratory symptoms.

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Symptoms of Agoraphobia

Panic Attacks or Panic-like Symptoms

These are characterized by periods of intense fear, usually lasting for about ten minutes or longer. During a Panic Attack you experience some or all of these

Palpitations
Excessive Sweating
Chest Pain
Feeling of Choking
Nausea / Dizziness,
Fear of Losing Control / Going Crazy
Dying

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Avoidance Behavior

Avoiding places and situations that are hard to escape from or that might be embarrassing to to suddenly leave.

Most commonly, this is because you fear having a Panic Attack or unexpected catastrophe and not being able to get help or get away. However, in some cases when you are not avoiding the situations, then you are enduring it with great discomfiture.

Your ability to perform in or enjoy these situations will be drastically reduced. Complete avoidance is not necessary for diagnosis of Agoraphobia. Also, there may be situations you avoid completely and others, which you endure with immense anxiety.

The “Safe” Person

Sometimes it may be possible for you to face a feared situation or go to a feared place if you are accompanied by a particular person, who is referred to as ‘safe’ person. You trust and are close to this person / persons and feel confident that this person can take you to safety in the event of a Panic Attack.

“Safe” people are usually parents, spouses, children, or close friends and relatives.

Developing "Safe" Places

Places in which you feel psychologically comfortable. The most common safe place for someone with Agoraphobia is his or her own home. And that’s why in extreme cases of Agoraphobia you may become completely ‘housebound’.

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Treatment of Agoraphobia

As with other mental disorders, Agoraphobics respond well to a treatment that included a combination of Medication and Psychotherapy.

Medications

Antidepressant and Anti-Anxiety medications are commonly used to treat Agoraphobia and Panic Symptoms. Anti-anxiety medications often work immediately to reduce symptoms, while Anti-Depressants may take a couple of weeks before you feel effective relief.

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Psychotherapy

There are many types of Psychotherapy or Counseling that can be used to treat Agoraphobics.

Amongst all, Cognitive Behavioral Therapy has been used extensively for treating many types of Anxiety Disorders. This approach involves learning more about Agoraphobia and Panic Attacks and how to control them. You also learn what factors trigger a panic attack and what makes them worse.

Mindset of Agoraphobics

Many people with Agoraphobia ( or even other Anxiety Disorders) have a thinking pattern that is totally irrational and contributes to anxiety, panic and fear:

Catastrophic Thinking

Blowing negative events or feelings out of proportion and magnifying small mistakes into major catastrophes through exaggerated thinking. Extreme negativity arising from this leads to fear, anxiety and panic

Black or White Thinking

Perceiving everything in terms of extremes or absolutes. Things are good or bad, right or wrong. There’s nothing in-between.

Perfectionism

There is a tendency towards perfectionism and in the process putting oneself under great deal of pressure because of setting unrealistic expectations. This increases anxiety and the fear of failing.

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Over Generalizing

Assuming something that happened one time in one place or situation (usually a negative event) will continue to happen in all places and situations. If you have Agoraphobia, you will be familiar with over-generalization because over generalizing after your first Panic Attack is probably what led to Agoraphobia

Personalizing

Assuming the blame for something that you might have influenced but was not totally under your control. This leads to anxiety that comes from feeling too responsible for other people’s emotions, decisions or behavior.

Fatalistic Thinking

Thinking of yourself as powerless to make choices or affect the outcome of your own life. Fatalistic thinking is holding the belief that the forces that govern your life circumstances lie completely beyond your control. This is a way of not taking responsibility for your decisions and behavior.

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Statistical Data on Mental Disorders in America