away rapidly may be difficult. Because of these fears the sufferer will
deliberately avoid such places - which may include crowded areas, special events, queues (standing in line), buses and trains, shops and shopping centers, and airplanes.
A person with agoraphobia may find it hard to feel safe in any type of public place, especially where large numbers of people gather.
Some people may have it so severely that the only place they feel really safe in is their home, and rarely ever go outside.
Agoraphobia is not the opposite of claustrophobia (fear of closed spaces, such as elevators) - it is not simply a fear of open
spaces. Agoraphobia may result in a fear of being outdoors, a kind of open space - but it is not a fear of there being too much openness and no walls, ceilings or boundaries, etc. The fear of going outdoors results from a dread of becoming embarrassed, trapped and helpless somewhere while having a panic attack - this never happens inside one's own home.
According to the National Institute of Mental Health (NIMH), USA, about 3.2 million American adults are living with agoraphobia. The median age of onset of agoraphobia is 20 years.
What are the symptoms of agoraphobia?
Physical symptoms of agoraphobia
Sufferers will usually only experience the symptoms when they find themselves in a situation or environment that causes them anxiety. Physical symptoms are rare because most people with agoraphobia avoid situations that they believe will trigger panic.
When symptoms do occur, they may include:
-Accelerated heart beat.
- Rapid and shallow breathing (hyperventilating).
- Feeling hot, flushing.
- Stomach upset.
- Trouble swallowing.
- Breaking out in a sweat.
- Feeling light headed, as if one were about to faint.
- Ringing in the ears.
Psychological symptoms of agoraphobia
These symptoms are sometimes related to the physical symptoms:
Fear that people will notice a panic attack, causing humiliation and embarrassment.
Fear that during a panic attack their heart might
stop, or they won't be able to breathe, and may die.
Fear that the sufferer himself/herself is going crazy.
The following psychological symptoms are also possible:
Low self-confidence and self-esteem.
Feeling a loss of control.
General feeling of dread and anxiety.
Thinking that without the help of others the sufferer himself/herself would never be able to function or survive.
Dread of being left alone.
Behavioral symptoms of agoraphobia
Avoidance - avoiding environments and situations that may trigger anxiety. In some cases this may be mild, where the sufferer
avoids going in a crowded train. In extreme cases the person finds it very hard to leave the house.
Reassurance - the sufferer needs to be reassured by another person. Going out to the shops may only be possible if a friend comes along too. In extreme cases the sufferer finds being alone unbearable.
Safety behavior - needing to have or to take something in order to confront situations or places that trigger anxiety. Some sufferers have to have an alcoholic drink before going into a crowded place,
while others cannot go outside unless they are sure they have their tablets with them.
Escape - leaving a stressful place or situation straight away and going back home.
What are the causes of agoraphobia?
Experts are not completely sure what the exact causes of agoraphobia are. Most believe that they are a result of physical and/or psychological factors.
A complication of a panic disorder
Agoraphobia is thought to be a complication of a panic disorder - a disorder characterized by regular episodes of panic attacks (intense fear) which trigger severe physical reactions for no apparent reason. Panic attacks can be extremely frightening - causing people to think they are losing control, or even dying.
Some people may link their panic attacks to one or two situations in which they occurred. By avoiding those places or situations the sufferer believes he/she may be preventing future recurrences of panic attacks. If a situation or place has people - perceived as potential witnesses to a panic attack by the sufferer - they are more likely to avoid it.
Agoraphobia very rarely develops without an accompanying panic disorder. When it does, nobody knows what caused it.
Some medications and substances
Long-term use of tranquilizers and sleeping medications,
such as benzodiazepines, have been linked to agoraphobia. Health care professionals report that when benzodiazepine dependence is treated agoraphobia symptoms eventually improve.
Difficulties with spatial orientation
Some studies have found a link between agoraphobia and problems with spatial orientation. Most people without agoraphobia can maintain balance by combining data from their vestibular (components in the inner ear) and visual systems, as well as their proprioceptive sense (the sense of the relative position of neighboring parts of one's own body). A higher percentage
of people with agoraphobia have weak vestibular function, compared to the rest of the population, and consequently rely more on tactile and visual signals. When visual signals are overwhelming, as may be the case in a crowded place, the sufferer is more likely to become disoriented.
Some other factors
-A history of alcohol abuse.
-A history of drug abuse.
-A traumatic childhood experience.
-A very stressful event, such as bereavement, loss of a job, an explosion, war, or devastating earthquake.
-A history of mental illness, such as an eating disorder or
According to the DSM-IV Diagnostic Criteria for Agoraphobia, a patient suffers from agoraphobia if:
-The person is anxious about being in a place or situation where escape or help may be difficult in the event of a panic attack, or panic like symptoms. Examples are being in a crowd or travelling on a bus.
-The person avoids these places (described above).
-The person endures these places (described above) with extreme anxiety.
-The person endures these places (described above) only with the help of a friend or companion.
-There is no other underlying condition that may explain the person's symptoms.