What is Agoraphobia (Fear of Situations): Types, Causes, Symptoms & Treatment

Agoraphobia is a type of anxiety disorder in which people try to avoid places or situations in which they feel helpless, trapped or embarrassed. A person with this disorder often feels embarrassed in public and has frequent panic attacks. Thus, they don’t move out of their comfort zone and prefer places they feel safe in.

This fear can be so intense that one may not leave the premises, even during medical emergencies. To learn more, keep reading!

Individuals with agoraphobia fear:

• To be left alone in the house
• Confined spaces like an elevator, small stores, movie theatres, etc.
• Crowded place
• Open spaces like bridges, malls and parking lots
• In humiliating situations
• Travelling on public transport

ccording to psychiatrists and psychologists, there are two main types of agoraphobia. 

• Agoraphobia with Panic Disorder: This is when the phobia accompanies a panic attack.
•  Agoraphobia without Panic Disorder: This type does not involve panic disorders. 

Apart from these two types, there are other types of agoraphobia too, which are discussed below:

Other Types:

• Paranoid Agoraphobia: It involves a combination of two conditions, i.e., agoraphobia and paranoia. Paranoia is when an individual has many false beliefs, which causes them to feel threatened or endangered. 
• Claustrophobia: This is a fear of getting stuck in a closed and small space. Individuals with this disorder feel so anxious that it forces them to avoid confined places. 
• Catatonic Agoraphobia: It causes an inability to move, ordinarily, when forced to face a situation or place. In this case, people find it challenging to rise from a sitting situation, enter a room, pick up a jar, etc. 
• Disorganised Agoraphobia: In this type of agoraphobia, people find it difficult to maintain physical and mental balance. As a result, they rely on tactical and visual senses to perform activities. Moreover, since the sense of balance is inaccurate, it disrupts the communication between the five senses, further disorganising the brain. 
• Enochlophobia: This disorder causes an irrational fear of a large crowd among individuals. The percentage of people suffering from enochlophobia is more in females and less in males. As a result, they tend to avoid places where people accumulate, like a concert, sporting events, etc. 

Symptoms of agoraphobia often coincide with panic attacks. For example, exposure to an uncomfortable situation triggers the feeling of anxiety, but when forced to endure it, the physical symptoms of panic attacks become visible prominently. 

These include:

• Chills
• Chest pain
• Dizziness
• Rapid heartbeat
• Numbness
• Sweating
• Trembling
• Shortness of breath

There is no exact cause of agoraphobia, but doctors feel that it is somehow connected with heredity and runs in the family. In addition, it can also develop after one undergoes panic attacks. However, for those who have agoraphobia without panic disorder, it can be triggered by the following instances of irrational fears:

• Getting infected from a severe illness when visiting crowded places.
• Being a victim of a terrorist attack or any other violent crime, if you leave the house.
• Accidentally doing something which will result in humiliation or embarrassment in front of the public. 

The following are the risk factors of agoraphobia that increase the chances of an individual developing this disorder:

• Having another associated phobia like a social phobia.
• Suffering from depression.
• Having a family history of agoraphobia.
• Suffering from a Substance Use Disorder (SUD).
• Having a history of sexual or physical abuse.
• Having another type of anxiety disorder like Obsessive-Compulsive Disorder (OCD) or Generalised Anxiety Disorder (GAD).

Though agoraphobia is a significant distress in itself, it can lead to further complications like:

• Making a person bound to their home.
• Becoming more and more dependent on others.
• Turning to self-medication by using non-prescribed drugs.
• Developing major depressive disorder.
• Developing Substance Use Disorder (SUD).

Individuals with agoraphobia also restrict themselves from visiting their family or friends, running errands, going to school, and performing daily outside activities. As a result, they cannot keep up with their work and maintain social ties.

Diagnosis of agoraphobia is based on the signs and symptoms visible in a person. A mental health expert will ask you when the phobia started and how often you experience it. Also, you may have to answer a few questions regarding your medical and family history. 

Apart from this, your doctor may also perform a few blood tests to rule out the possibility of having symptoms due to a physical cause that may aggravate the phobia.

There are several treatment procedures that a doctor can suggest depending on the symptoms one experiences. These include:

1. Therapy

You can benefit from the following types of therapy:

• Psychotherapy

Psychotherapy or talk therapy requires individuals to regularly meet therapists or mental health professionals. It allows them to discuss issues and fears that may have caused the phobia. Moreover, in addition to psychotherapy, doctors often suggest medications for optimum effect.

It is generally a short-term process of treatment that you can discontinue once you are able to cope with your fear. 

• Exposure Therapy

Exposure therapy is another treatment doctors suggest to overcome your fear. Here you gently expose yourself to a situation or place of fear. As a result of continuous exposure, the fear factor gradually begins to diminish with time. 

• Cognitive Behavioural Therapy

Cognitive Behavioural Therapy, or CBT, is a common psychotherapy procedure people with agoraphobia undergo. This treatment method helps one to understand better the distorted view-points or feelings associated with the phobia. In addition, it also teaches one to replace unpleasant situations or negative thoughts with healthy and positive ones. 

As a result, one can regain control of life.

2. Medications

Few medications help to cope with the symptoms of agoraphobia or panic attacks. A few such medications are discussed:

• Tricyclic antidepressants like nortriptyline (Pamelor) or amitriptyline (Elavil).
• Norepinephrine reuptake inhibitors and selective serotonin like duloxetine (Cymbalta) or venlafaxine (Effexor).
• Anti-anxiety medications like clonazepam (Klonopin) or alprazolam (Xanax).
• Selective Serotonin reuptake inhibitors like fluoxetine (Prozac) or paroxetine (Paxil).

3. Lifestyle Changes

Doctors also suggest a few lifestyle changes. Remember, it will not cure the disorder, but it will significantly help reduce the symptoms and anxiety associated with the disorder. The positive habits involved are:

• Adopting a healthy diet consisting of vegetables, whole grains, and lean protein will make you feel healthier and better overall. 
• Practising deep-breathing exercises and daily meditation will reduce the feeling of stress or anxiety. In addition, it also prevents instances of panic attacks. 

Agoraphobia generally develops in one’s childhood but can also start in teens or late adolescence. It hardly develops after the age of 35 years, but in some cases, individuals may also catch it at an older age. This, if not treated, the phobia can last for years and even a lifetime. 

During this period, an individual may suffer from panic attacks of 10 to 15 minutes in duration, sometimes extending up to 1 hour. 

Agoraphobia has been seen to limit people’s ability to socialise, attend essential functions, perform daily chores and manage their lives. So, as soon as you identify this disorder, consult a therapist or a mental health expert immediately. 

Consider this as a detailed guide to identify if you have symptoms of this type of phobia and, if yes, how to treat it. In order to avoid it affecting daily life, one must seek proper and sustainable treatment.

Besides the medical treatment procedure, here are a few coping tips that you can follow to manage agoraphobia:

• Follow and keep track of your treatment plan while maintaining contact with your therapist regularly. 
• Use calming techniques like meditation, yoga and massages to reduce anxiety and panic. 
• Avoid consuming caffeine, alcohol and recreational drugs, as these can increase anxiety. 
• Increase exposure to such situations that seem scary and might generate panic. This way, you can gain control of this disorder. 
• Maintain a fixed sleep time, and include healthy food items like fruits and vegetables in your daily diet. 
• Consider regular exercising and physical activities. 
• Take help from others or join a support group.