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By Sasha de Beausset Aparicio, MSc

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What is Agoraphobia?

Agoraphobia is categorized as an anxiety disorder. People suffering from this disease often feel anxiety in environments that are crowded or vast. Their anxiety makes them perceive these situations as life-threatening, causing them to have irrational behavior. Most likely, agoraphobia will manifest in places that are crowded such as airports, marketplaces, or malls, but may also be commonly experienced in wide-open spaces. The Diagnostic and Statistical Manual of Mental Disorders (short DSM) published by the American Psychiatric Association, lists agoraphobia under the panic disorder category. DSM is a framework designed to classify and provide descriptive data regarding a broad spectrum of mental disorders. According to the Diagnostic and Statistic Manual of Mental Disorders the agoraphobic fears may involve characteristic clusters of situations that may include, but are not limited to being in a crowd, standing in a line, being outside the home alone; being on a bridge or traveling in a bus, train, or car.

The name of the condition comes from the Greek “Agora,” which means marketplace, and “phobia” which means fear.

People who suffer from this disease usually fear of incurring a panic attack when found in wide-open or extremely crowded places, hence an inclination to avoid these situations as much as possible. People with agoraphobia will often adopt irrational behaviors in the attempt to avoid an agoraphobic episode and will prefer to stay indoors and avoid leaving their homes, restricting their social interactions to a minimum.

Additionally, the disease is clearly separated from other disorders that may list the fear of wide-open or crowded spaces as one of the symptoms. For instance, in social phobia patients, the avoidance behavior is related to various social situations out of a fear of embarrassment, while a person suffering from separation anxiety disorder will fear leaving home and a specific attachment figure with which strong emotional bonds have previously existed.

Studies revealed that women between 20 and 40 years old are more likely to develop this problem. There are currently 3.2 million people which are the equivalent of 2.2 percent of the adults in the United States whose ages are between 18 and 54 and are believed to suffer from this phobia. According to some sources, agoraphobia may account for somewhere around sixty percent of the phobias.


The exact causes that lead to the on the setting of this disease are currently unclear, although several theories exist, based on specific scientific observations. One hypothesis claims that agoraphobic behavior may be triggered by the presence of some other anxiety disorder or by substance abuse, listing it as one of the side effects. Sometimes, agoraphobia is thought to be a mere complication of some other panic disorder. When a panic attack history exists, some patients may perceive that, within a social context, the existing of eye-witnesses could further harm their condition, causing their irrational avoidance of these environments altogether.

Other theories acknowledge an association between this condition and spatial orientation difficulties. It has been noticed that healthy individuals, people who do not suffer from agoraphobia to say, are capable of maintaining balance, which is a function of three components: the vestibular system, the visual system, and the proprioceptive system. In case of agoraphobic people, the vestibular function may be impaired, causing the patient to feel disoriented and unsafe in environments where they cannot fully rely on their vestibular function, such as large crowds or wide open spaces.

It is very unlikely to develop agoraphobia without the presence of some sort of anxiety disorder. When this happens, there is no explanation for the phenomenon. However, in relation to other anxiety disorders, it has been noticed that the condition is most likely associated with the following disorders: social phobia, panic disorder, post-traumatic stress disorder, and other phobias – such as the fear of spiders for instance.

The agoraphobic episodes may also be related to a long history of medications or substance abuse. Tranquilizers, sleeping pills, and benzodiazepine dependence have sometimes been determined to cause agoraphobic episodes, if not a full establishment of the disease. Other factors include some traumatic event, especially during childhood, very stressful events such as an earthquake or an explosion, and a history of mental illness.

Signs & Symptoms

Agoraphobia’s relation and onset to other anxiety disorders makes it a symptom in its own right. However, agoraphobic episodes are known to be related to symptoms of their own, which are exaggerated when the patient is exposed to the possibility of being exposed to a crowded or open space. Some of the feelings frequently described by people who suffer from this condition include: rapid heartbeat and irregular heart rhythm, upset stomach, nausea, dizziness, hyperventilation, the need to flee and escape the inconvenient environment, heavy sweating, hot or extreme cold sensations, trembling, and shaking of hands among others. Other psychological symptoms of agoraphobia are fears linked to people noticing their panic attacks which in their minds causes embarrassment and humiliation, fear that the panic attack won’t stop at a proper time and the person would be incapable of breathing and the fear of going crazy because some don’t believe this is a serious problem and treat it just as something out of the ordinary and not normal.

When any of these symptoms are experienced, a person should consider seeking the advice of a specialized doctor because it can develop into something more serious and it is better not to be ignored. Furthermore, people that notice any of these symptoms at a friend or a relative should act on it and try to discuss this possibility with that individual in order for him or her to have the opportunity to get cured in the near future.

Diagnosing Agoraphobia

Diagnosing the disease is usually a process that begins with the primary care physician and ends with a specialist able to perform a full examination of the causality and severity of the disease. The general practitioner will first determine if there are any physical causes to the condition and will refer the patient to a psychiatrist for further analysis. Here, the specialist should determine if the patient suffers from another mental health disorder that might be associated to agoraphobic episodes, in order to appoint appropriate treatment. A treatment plan should be established taking into consideration a variety of factors, including such other underlying conditions, severity of the disease, frequency and intensity of manifestations, etc.
Panic attacks in situations that involve large crowds and open spaces are often a clear indicator of the disease, however, in some cases agoraphobia patients do not experience panic attacks. Additionally, there are some standardized tools which help specialists measure the degree of agoraphobia among which the most popular is Panic and Agoraphobia scale. These scales basically monitor the severity of the panic attacks as well as treatment development.

Basically, this phobia appears when the connection between the fear and the anxiety or panic attack occurs and once this connection has been made, the person doesn’t only view it as a fear and it becomes a real problem for him/her. The individual feels like the fear can’t be surpassed and that’s when the tension and inability to pursue daily tasks in which they may encounter overcrowded areas.

Treatment for Agoraphobia

Treatment for this condition is usually done through the means of medication and psychotherapy, designed not to cure the condition but to help patients manage it to the point where they are able to function socially.

Medications for the condition may include, from case to case anti-depressants (such as SSRIs) including Prozac or Zoloft, tricyclic antidepressants, benzodiazepines (Xanax or Klonopin), and other such appropriate medications. Side effects are usually associated to many of these powerful prescription drugs; hence a discussion with your healthcare provider is mandatory.

Therapy sessions should come as complementary to the medication treatment. The specialist aims at persuading the patient to treat his or her condition more realistically and incentivize him or her to wish to cope more effectively with the disease. The notions and concepts should be easily self-applicable by the patient in situations arising from the condition itself. Several forms of psychotherapy are available, including cognitive therapy, interpersonal or family therapy where needed. An important part of the therapy sessions revolve around understanding the condition and the often associated panic attacks in order to increase awareness and desire to be cured. For instance, one of the treatments is called EMDR or Eye Movement Desensitization and Reprogramming which represents a cognitive-behavioral approach generally done for agoraphobia that appeared as a result of a trauma. This therapy hasn’t shown impressive results so far and only few of the individuals that have tried it reported its success at the end.

People should also be aware of the fact that support groups can be helpful in these situations because if a person discusses the feelings of struggle and manages to feel comfortable within a group, chances are that she/ he may handle the problem in a different and more confident manner. While this sounds like an unusual approach given the fact that the individual may be exposed to gathered areas on the way to the center, the therapy can also be done via internet. It is a relatively new approach to the issue, but if the person has the right amount of support, the problem can be eventually resolved.

In addition, for those who decide to avoid prescribed medication treatment, natural supplementation treatment can represent an alternative. It is generally believed to have less side-effects and an overall smaller negative impact on the organism if the treatment is not suitable for the individual. When an individual decides to follow a natural supplementation treatment, some ingredients such as Skullcap, Passion Flower, Valerian, Lemon Balm, Chamomile Kava, St. John’s Wort, and Lavender should be taken into account. For example, Passion Flower’s sterns and leaves help individuals calm during their anxiety attack while Chamomile relaxes the nervous system due to its sedative and antispasmodic qualities. On the other hand, no matter the plants chosen as ingredient for dietary supplements, it is important to keep in mind the recommended daily dosage and don’t exceed it. Furthermore, if any type of side-effects occur, the treatment should be immediately stopped.


“Panic-Attacks and Panic Disorder Symptoms, Causes and Treatment” from helpguid.org
“Anxiety and its disorders: The nature and treatment of anxiety and panic” from Guillford Press