Agoraphobia

Graphics courtesy of HealioOpens in new window Agoraphobia is a fear of being in stressful situations where escape might be difficult or that help wouldn’t be available.

Agoraphobia is typically characterized by the fear of leaving one’s house or an environment that is considered safe. The disorder develops later in approximately two thirds of patients with panic disorderOpens in new window. Many people assume agoraphobia is simply a fear of open spaces, but it’s actually a more complex condition. Someone with agoraphobia may be scared of:

• Travelling on public transport
• Visiting a shopping centre
• Leaving home

If someone with agoraphobia finds themselves in a stressful situation, they’ll usually experience the symptoms of a panic attack, such as:

• Rapid heartbeat
• Rapid breathing (hyperventilating)
• Feeling hot and sweaty.

The anticipation of panic attacksOpens in new window and the misconception that panic attacks are potentially dangerous medical conditions can often lead to agoraphobic avoidance of feared situations. These can be characterized as places in which patients fear that should they experience a sudden panic attackOpens in new window, they might need immediate medical treatment, which could be difficult to obtain.

Patients with agoraphobia therefore tend to avoid these situations. They do not go to public meetings, such as shopping malls, stadiums, restaurants, cinemas, parties, or churches. They avoid using trains, underground systems, buses and aeroplanes, fearing that in the case of a panic attackOpens in new window no doctor would be available.

Patients might restrict a walk in their city to within only a short distance of their general practitioner, or would rather take their bicycle or car with them in order to be able to get to the their doctor’s practice faster. Many patients prefer to be accompanied by their spouse, relatives, or friends when in these situations, so that these individuals could assist them by calling an emergency service.

In some cases of severe agoraphobia, patients become completely housebound, only feeling secure at home, because agoraphobia is severe and generalized to most situations.

Less commonly, agoraphobia can also appear without panic attacks. Panic disorder in the absence of agoraphobia is sometimes referred to as uncomplicated panic disorder. Approximately two thirds of patients with panic disorder develop comorbid agoraphobia.