While it’s normal to have anxious experiences from time to time, routine anxiety about being in public begins to restrict one’s way of living life. A chronic concern about being in public places that it becomes so overwhelming that it limits socialization and normal functionality is agoraphobia.
Throughout this article, we’re going to explore agoraphobia, understand what it is, how it manifests, and the ways in which to treat it.
Agoraphobia is a fear of being in public places or situations that could create panic, embarrassment, or helplessness. The crux of the concern isn’t the place or species themselves but rather that there is no help or escape once the trigger begins.
Those with agoraphobia might have issues going to events, being in crowds, or feeling isolated in large spaces. Furthermore, these individuals may not go out often – opting instead to stay in a place and with people that are recognizable and safe. ¹
When one considers the effects of agoraphobia the obvious effect that comes to mind is anxiety. However, there is actually quite a bit more that goes with the disorder. Agoraphobia as well as its symptoms are broken into three distinct subtypes. These subtypes are: ²
1.) Physical Symptoms
Most of the physical symptoms listed below resemble those that are common with panic attacks. Although those that suffer from agoraphobia will avoid situations that can cause a trigger. Still, if a physical symptom response is present, here are the most common experiences:
- Rapid heartbeat
- Chest pain
- Feeling faint
2.) Cognitive Symptoms
A major component of agoraphobia is the thoughts and emotions going on in your mind. Given that this disorder can not only reflect fears of the outside world but also severely limit what sufferers can do and where they’ll go, it’s important to understand what’s occurring in the mind. Common cognitive symptoms are:
- Being self-conscious
- Looking stupid or crazy in public
- Losing control of oneself while in a public place
- Being a public spectacle
- Fearing that a panic attack could be life-threatening
- Anxiety about being trapped, having no one to help during an episode, or losing sanity
3.) Behavioral Symptoms
The behavior of agoraphobia may seem strange or delusional, but the understanding of the other subtypes of symptoms paints a comprehensive picture.
From the outside looking in, it may seem as though an agoraphobic patient isn’t social or a shut-in. However, it’s important to understand that these symptoms are rooted in deep anxiety and sometimes debilitating paranoia.
Such cognitive symptoms could be:
- Avoiding straying too far from home or situations that could trigger a panic attack
- Being homebound for long stretches of time, trying to stay in an environment that is safe and familiar
- Needing to be with a safe person anytime leaving the house
Is Agoraphobia an Anxiety Disorder?
Given that the main component of agoraphobia is anxiety and that the manifestation is through anxiety attacks, the condition aligns with the definition of an anxiety disorder. The DSM-5 considers agoraphobia a distinct diagnosis, a part of the anxiety disorder family of conditions. ³
What Causes Agoraphobia?
The cause of agoraphobia isn’t distinct. As with many mental illnesses, the origin oftentimes isn’t from a single particular element. Agoraphobia can stem from a panic disorder, post-traumatic stress disorder (PTSD), or triggers from past trauma.
Some clinicians believe that responses such as agoraphobia are the result of environmental factors or genetic history. Although the unifying components between all of these factors are stress and anxiety. ⁴
How is Agoraphobia Diagnosed?
Most of those diagnosed with agoraphobia have had a long history of the disorder. Just following through with a check-up can be a challenge for patients as leaving the safety of home can be burdensome.
A diagnosis is often a three-step process with both a primary care doctor and a mental health professional such as a psychologist or therapist. This three-part process looks like: ⁵
- The first step is a questionnaire with the primary doctor in which the clinician will discuss several key symptoms, figure out if their patient has them, and gauge how severe their experiences are based of the answers.
- The second component is a physical exam where the doctor will take the time to rule out any other factors that could result in the behaviors and symptoms described. It’s in this physical exam where lab tests are taken, such as bloodwork.
- The third stage is consulting a psychotherapist to confirm the diagnosis if the physical exam doesn’t point to any other outside factors leading to such a response.
If the diagnosis is confirmed by both a mental health professional and the patient’s medical team, then a treatment plan will be put in place to ensure that the patient is getting the help they need and deserve.
Like diagnosis, the treatment of agoraphobia is multi-layered approach that includes both medical intervention and being seen by a psychotherapist. Above all the methods of treating the symptoms of agoraphobia, the largest thing that can break the cycle of concern is by confronting the fear head-on. From there medication and counseling can help in reducing the severity of the symptoms.
Confronting the concern is a key step in breaking the cycle of agoraphobia. Although to get to that point takes not only time but trust.
Oftentimes this process towards confrontation is through a therapist or a psychologist and done in a deliberately methodical fashion in order to build a rapport between mental health professional and the patient. Still, with enough time, there will be coaching and coping techniques put in place in order to initiate the confrontation.
This confrontation practice is called exposure therapy. Exposure therapy has been shown to be an effective treatment option for those with PTSD, phobias, obsessive-compulsive disorder (OCD), and specific kinds of anxiety or panic disorders, including agoraphobia. ⁶
There are different methods to get patients aware of their fears and find ways to overcome those fears in a safe space. However, the pacing of the coaching can be of one of three ways: ⁷
- Graded exposure: The psychologist helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.
- Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult tasks.
- Systematic desensitization: In some cases, exposure can be put together with relaxation exercises to make them feel more manageable and to associate the triggering objects, activities or situations with relaxation.
Exposure therapy doesn’t just expose sufferers to fears, it can also be beneficial in creating different coping techniques, building self-esteem, and building proper emotional processing to perceived threats and situations.
As for medicating agoraphobia, the most common method is through the utilization of antidepressants. There are several kinds of antidepressants. However, SSRIs and SNRIs are shown to be the most helpful in conjunction with continual counseling and monitoring from a mental health professional.
SSRIs for Agoraphobia
Selective serotonin reuptake inhibitors (SSRIs) are the most common form of antidepressants due to their effectiveness. SSRI antidepressants work by increasing serotonin in the brain, thus creating an uplifted mood and relieving stress within the brain chemistry. ⁸
They are the most common antidepressants prescribed for depression and anxiety and are often the first-choice medication for agoraphobia. The most recognizable and routinely used SSRI medications are Prozac, Lexapro, and Celexa.
Still, it’s important to note that antidepressants may result in the following side effects: ⁹
- Gastrointestinal issues
- Sexual side effects
SNRIs for Agoraphobia
Selective norepinephrine reuptake inhibitors (SNRIs) are a form of antidepressant. They work by increasing norepinephrine in the brain and regulating mood. As with SSRIs, SNRIs can elevate mood and help ease anxiety. But unlike SSRIs, SNRIs have more side effects with fewer reports of effectiveness. ¹⁰
Due to these complications, SNRIs are not as common as SSRIs for agoraphobia. Notable SNRI medications are Cymbalta and Effexor. Here are some of the most common side effects of this kind of antidepressant: ¹¹
- Heavy fatigue
- Weight gain
- Blurred vision
- Gastrointestinal issues
- Sexual side effects
Certain lifestyle changes and behavioral modifications can be put in place in order to reduce the severity of symptoms and help with coping during an agoraphobic episode. Specific calming methods like grounding practices and breathing exercises can aid in slowing an evolving panic attack.
Long-term healthy habits can ensure that the mind and the body are getting what they need and aren’t overburdened by the effects of bad habits which can hinder mental clarity and make panic symptoms more severe. Such health habits could be: ¹²
- Cessation of smoking as nicotine can increase heart rate as well as blood pressure, which can exacerbate panic attack sensations.
- Eating a well-balanced and healthy diet which can help in receiving the proper nutrients, vitamins, and minerals that are necessary to facilitate healthy mental and physical responses.
- Creating and sticking to an exercise regimen can increase blood flow, encourage healthy breathing techniques, and serves as a healthy outlet for stress.
- Abiding by a proper sleep schedule. A proper night’s rest can decrease stress and anxiety. Furthermore, sticking to a sleep schedule can help with balancing mood and increasing mental clarity.
Anxiety comes and goes, it’s a natural response to stress and worry. However, what is not natural or healthy is chronic and crippling anxiety. Agoraphobia can be an all-encompassing response to stress and anxiety. It can severely hinder someone’s ability to lead a normal life and limit their potential to spend time with family and friends.
Furthermore, if you or a loved one recognize the symptoms and responses of agoraphobia as behaviors that have been a problem in the past or continue to be in the present, the time to reach out is now. It is only through reaching out as well as asking for help that the suffering can become healing.
Do you still have questions about agoraphobia?
We invite you to ask them in the comments section below. If you have any further knowledge to share – whether personal or professional – we’d also love to hear from you.
¹ National Cancer Institution: Agoraphobia Definition
² National Health Services UK: Agoraphobia Symptoms
³ National Institue of Medicine: Agoraphobia Medical Classification Book
⁴ National Health Services UK: Agoraphobia Causes
⁵ National Health Services UK: Agoraphobia Diagnosis
⁶ National Library of Medicine: Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia
⁷ American Psychological Association: What Is Exposure Therapy?
⁸ GoodRx: Medications Used to Treat Agoraphobia
⁹ National Health Services UK: SSRI Side Effects
¹⁰ National Library of Medicine: SNRI drug treatment for panic disorder with agoraphobia
¹¹ Mayo Clinic: SNRI Side Effects
¹² Winchester Hospital System – Medical Library: Lifestyle Changes to Manage Panic Disorder