Agoraphobia

This is an anxiety disorder characterized by a fear of being trapped in any situation in which escape is difficult or rescue is unavailable if things go wrong.

What is it?

Agoraphobia is a complex phobia that is not, as many think, simply a fear of open spaces. The individual dreads being trapped, and avoids whatever triggers the terror of being unable to escape. The result can be a fear of traveling on public transport, being in an enclosed space or a crowd, going shopping or to health appointments, or leaving the house. The associated panic attack brought on by such an experience is accompanied by negative thoughts—for example, the person may think that as well as being trapped they are going to look ridiculous, because they are out of control in public. The symptoms, or fear of them, are disruptive and result in avoidance behaviors that make leading a normal life hard. Agoraphobia can develop if an
individual has a panic attack, then worries excessively about a repeat experience. In the UK, one-third of those who have panic attacks go on to develop agoraphobia. Biological and psychological factors are the probable cause. Experiencing or witnessing a traumatic event, mental illness, or an unhappy relationship may play a part. Treatment can help—about
one-third are cured and 50 percent find that symptoms improve. A GP first excludes other conditions that may be causing the symptoms.

Types of symptoms

SYMPTOMS

PHYSICAL Rapid heart and breathing rate, chest pain, dizziness, shaking, feeling nauseous, and breathing problems.

BEHAVIORAL Excessive planning to avoid crowds, lines, and public transport, or not going out at all or only with a trusted person.

COGNITIVE Predictions of shaming by others, overthinking potential disasters, catastrophic thoughts of being trapped or injured, and feeling out of control.

TREATMENT

• ❯ Intensive psychotherapy such as cognitive behavioral therapy to explore the thoughts that maintain the phobia; behavioral experiments to gather evidence that defuses strongly held beliefs.BEHAVIORAL Excessive planning to avoid crowds, lines, and public transport, or not going out at all or only with a trusted person.
• ❯ Self-help groups using safe visual material to work on exposure to the feared situation; teaching how to manage a panic attack by breathing slowly and deeply.
• ❯ Lifestyle management such as exercise and a healthy diet.

“Nothing diminishes
anxiety faster than action.”

Walter Inglis Anderson, American painter, writer, and naturalist