A phobia is defined as excessive and irrational fear induced by a situation or an object which is oftentimes, harmless. As such, agoraphobia is the fear of feeling trapped in a particular situation where the individual feels that escape might be difficult or that help might not be available. The word ‘agoraphobia’ translates into ‘fear of the marketplace’. This literal meaning would imply that individuals with agoraphobia are fearful of busy public places.

 

However, the fear is not limited to only hectic and chaotic spaces but also includes being fearful in quieter public places like a park or a religious institute. Even then, the assumption that being agoraphobic entails being afraid of open spaces is quite narrow. Using public transport and engaging in daily activities which require them to leave their homes tends to evoke fear in them as well. Daily social interactions also present itself as a major challenge evoking stress and panic.

 

Often categorized as a kind of anxiety disorder, someone who is agoraphobic is afraid of leaving environments which they consider or know to be safe. In extreme cases, an individual considers their home to be the only safe place and avoids leaving their homes for days or months or even years. The condition initially appears as mild anxiety or hesitation about a specific event or place and gradually escalates over time. This mild anxiety or hesitation develops into a generalized fear of being in public.

 

Agoraphobia is a complex and layered condition. Individuals might fear that ‘unsafe’ places might cause them to lose control of the situation or embarrass themselves. The unfamiliarity of their surroundings induces physical and mental sensation of anxiousness, nervousness, panic and fear.

 

CAUSES OF AGORAPHOBIA

Agoraphobia develops over time. Usually a stressful event, the loss of a loved one, relationship problems, unemployment and similar situations in which an individual feels distressed acts as the initiation point. It causes them to avoid the external world and gradually, these individuals begin to consider outside places and socializing as something outside their grasp. Eventually, confine themselves socially in the one place they feel safe.

A stressful life can also cause panic disorders. In some cases, a stressful life event triggers a panic attack. Since panic attacks are so unpleasant, the person may avoid any situation or place that they think might trigger another attack. This causes individuals to eventually be afraid of and avoid many situations and places.

In most cases, agoraphobia stems from panic disorder. Like any mental health condition, it is difficult to pinpoint the exact cause of agoraphobia. Most experts believe that the causes of panic disorder and by extension, agoraphobia are a combination of both biological and psychological factors.

 

Biological causes of panic disorder include —

• ‘Fight or flight’ reflex: This reflex is the body’s natural way of protecting oneself from stressful and dangerous situations.  It is thought that in people with panic disorder, this reflex may be triggered wrongly causing a panic attack.
• Neurotransmitters: Imbalanced neurotransmitter levels can affect one’s mood and behavior. This can cause more aggressive responses in various situations and trigger a panic attack.
• Spatial awareness: It is the ability to assess one’s position in relation to the objects and people in their surroundings. Sometimes, when individuals are unable to be properly aware of their surroundings and lack the awareness of space, it causes them to feel disoriented and overwhelmed in certain situations. This can also lead to panic attacks.

Such symptoms of panic attacks tend to contribute to agoraphobia. The individual begins to fear panic attacks and avoid these triggers. Eventually, it progresses into an extreme fear of public and open spaces and social and self-isolation.

In cases, an individual can show symptoms of agoraphobia without having a history of any panic disorders or panic attacks. It can be triggered due to several reasons. For instance, irrational fears like —

• Facing danger, being attacked or being victimized upon leaving the house
• Fear of illness
• Fear of humiliation
• Claustrophobia

Other causes may also include —

• History of sexual and/or domestic abuse
• Depression
• Obsessive compulsive disorder or general anxiety disorder
• Substance abuse
• Family history of agoraphobia

 

SYMPTOMS OF AGORAPHOBIA 

Usually, symptoms of agoraphobia include being fearful of —

• Enclosed spaces like elevators, small stores, any kind of transportation or vehicle etc. where it would be difficult to escape
• Open and/or crowded places
• Leaving their homes or safe places for extended periods of time
• Losing control in public
• Being alone in the social setting

Agoraphobic individuals may experience panic attacks under stressful or uncomfortable situations. Consequently, their fear of being in an uncomfortable situation where they have no control is justified.

As agoraphobia tends to coincide with panic attacks, there is also a wide range of physical symptom accompanying agoraphobia including —

• Chest pains
• Tingling sensations
• Nausea
• Trembling
• Lightheadedness
• Shortness of breath
• Trouble breathing
• Choking sensation
• Racing heart or rapid heart rate
• Upset stomach

 

The cognitive symptoms of agoraphobia may or may not be related to the physical symptoms. These may include fears and thoughts like —

• A panic attack in public would attract negative attention and be embarrassing
• One’s heart will stop beating due to a panic attack
• Unable to escape

Other psychological symptoms may include —

• Feeling unable to function alone in social settings
• Monophobia: fear of being isolated or lonely
• Feeling of paranoia

 

Agoraphobia also impacts one’s behavior. Such behavioral symptoms include —

• Avoiding crowded places
• Avoiding ‘unsafe’ places and staying close to home
• Avoiding any situation which could cause panic attacks
• Being housebound
• Inability to function alone in public places and needing someone to accompany them

 

Agoraphobia impacts one’s physical health and social life and takes a toll on one’s mental health. It is necessary that when such symptoms arise and it becomes difficult to perform daily activities, adequate treatment should be sought out.