Agoraphobia
Are you afraid of leaving your house?
Are you often apprehensive about going out? Are you fearful of crowds? Do you cringe in anticipation of settings you can’t fully control? Then you may have Agoraphobia, an anxiety disorder which is sometimes referred to as having uncontrollable fear of open spaces.
This compulsive fear can be extremely inhibitive, and patients suffering from it tend to develop avoidance of trivial scenarios such as going out shopping or attending a public show. Agoraphobia is usually grounded on a persistent worry about either having panic attacks or experiencing loss of control in public. Whichever the case, the actual diagnosis and treatment will vary.
Agoraphobia is not the same as Social Phobia
In social phobia, the focus of the worrying and fearing is the patient’s inability to cope with social setting. Agoraphobia is somewhat different. Agoraphobics are often quite capable of normal social functioning, and they don’t experience the same kind of difficulties interacting with others as patients with social phobia often do.
The focus of Agoraphobia is not as much the fear of public exposure, but rather the uncontrollable fear of having panic attacks or otherwise losing physical and/or emotional control in a setting where help may be unavailable, ineffective or simply embarrassing to get.
There are two documented types of Agoraphobia: with and without a history of panic disorder.
In layman’s terms, the distinction between the two types of Agoraphobia may appear somewhat subtle, but from a psychological perspective there are significant implications.
The actual course of treatment will vary depending on whether the patient is troubled by the prospect of experiencing an actual Panic Attack or if he/she has never had such a thing and is just afraid of losing control in public.
Panic Disorder with Agoraphobia
For this diagnostic to be applicable, the patient must have experienced Panic Attacks in the past, which induced fearfulness of having further Panic episodes in a public setting. Moreover, all of the three following criteria must be observed:
1 – Fear of public settings where one might be alone and helpless (such as standing in line at the bank, travelling in a bus or crossing a bridge).
2 – Resolute avoidance of such situations, especially when the company of a trusted person is not available.
3 – Such phobic avoidance is not attributable to substance abuse issues or specific mental disorders other than panic disorder.
The differential diagnosis between agoraphobia and other anxiety disorders is sometimes rather subtle and challenging even for experienced psychologists.
For example, if your feelings of awe seem to only manifest when riding a bus (or thinking about doing so), then you may have a specific phobia rather than agoraphobia. If your fears seem to hinge on the possibility of contamination while outside, then you may have OCD rather than agoraphobia.
Agoraphobia without a History of Panic Disorder
The key distinctiveness in this form of Agoraphobia is the non-existence of actual panic attacks, although you may still experience panic-like symptoms. This illness is actually quite rare compared to regular Agoraphobia sourced by Panic Disorder; only as little as 5% of all documented cases of Agoraphobia do not hinge on having panic attacks (although this is possibly because in the absence of panic, patients feel less inclined to seek professional help).
In the case of Agoraphobia without a history of Panic Disorder, patients will simply avoid certain public settings because they are afraid of losing physical control (such as fainting or having an uncontrollable bout of diarrhea – even if they’ve never actually experienced such a thing). While this avoidance is usually sourced by a panic-like suggestion, patients with this condition do not satisfy the full criteria that would justify a diagnostic of panic disorder.
Prevalence and treatments of Agoraphobia
As much as 2.2% of the population in developed countries is estimated to suffer from Agoraphobia at some point in their lives, with the onset commonly occurring between ages of 20 to 40 years old. The female population diagnosed with Agoraphobia is approximately twice that of the male population. While not yet confirmed by research, this is possibly due to social stereotypes, which could entice males to offer more resistance to seeking help over anxiety issues.
The most effective treatments for Agoraphobia are CBT (cognitive-behavioral therapy) and pharmaceutical treatments, both of which have proven more effective when combined. See the article on anxiety treatment options for details. In all circumstance, anxiety medications are best used as a last option for extreme scenarios of anxiety. You don’t really need pharmaceuticals to overcome this problem, and the little benefits they may provide will likely be offset by the possibility of experiencing unwanted side effects.
According to several studies developed at prestigious universities such as Oxford University and University of Pennsylvania, the effectiveness of CBT alone in the treatment of Agoraphobia over 20-25 sessions is 85% to 90%. Not only that, but follow-up studies indicated that almost all the patients who were treated this way still felt increased emotional stability 1 year after the end of treatment, which isn’t always the case when pharmacological treatments are involved.
The source of your fears will indicate the correct diagnostic
The correct anxiety disorder diagnosis will depend not on which fears you may experience, but rather what the source of those fears might be. You must be able to help your therapist understand exactly why you experience fear because that will allow reaching a correct diagnosis more quickly and improve the speed and success rate of your treatment.
| For example, let’s suppose you have a predisposition to having panic attacks whenever you have to climb a specific staircase in your office building. What are you afraid of, exactly? |
| A) Something about that staircase in particular? Then you may have a specific phobia. |
| B) Tripping down and being ridiculed? Then it may be social phobia. |
| C) Having a stroke on account of previously diagnosed heart problems? Then it could be Panic Disorder. |
