What is Agoraphobia?

You’ve heard of acrophobia or arachnophobia, but have you heard of agoraphobia? Deriving from the Greek word agora, used to describe an open space for assembly, agoraphobia is a disorder where one fears and avoids situations that could potentially cause him/her anxiety.

In layman’s terms, agoraphobia could be referred to as a fear of anxiety and the situations that cause it. Under American Psychiatric Association’s DSM-5 manual, agoraphobia is classified as an anxiety disorder, together with other conditions like Panic Disorder and Social Anxiety Disorder.

Situations that trigger agoraphobia generally involve having to go out in public. Common situations include taking public transport or being in a crowd. One does not have to be in the actual situation for agoraphobia to take effect – the mere anticipation of such situations can cause fear in those with agoraphobia.

Symptoms of Agoraphobia

Symptoms of Agoraphobia include experiencing feelings of fear and anxiety related to:

• Being away from home alone
• Crowds
• Waiting in a line
• Open spaces (e.g. parks and carparks)
• Crowded spaces (e.g. elevators and cinemas)
• Public transport

For a formal diagnosis, these fears have to:

• Exist for at least 6 months
• Effect one’s social and professional life significantly
• Be disproportionate to the actual danger of the situations
• Result in one being unable to be away from home without a companion, with significant distress experienced when a companion is absent

Causes of Agoraphobia

Unfortunately, there is no confirmed cause of agoraphobia. Instead, risk factors have been identified.

• Possible biological factors include having a history of other phobias or panic disorder
• Possible psychological factors include the experience of a traumatic childhood or a traumatic event, e.g. sexual abuse

Agoraphobia vs Panic Disorder

Agoraphobia refers to the fear of situations that cause anxiety. This is different from panic disorder, which is characterised by the experience of panic attacks. While these are two separate disorders, it is not unusual to see individuals with agoraphobia develop panic disorder as well. In such cases, the individual suffers from panic attacks in situations that cause him/her anxiety, and the fear of these attacks, in addition to the situation itself, feeds into his/her agoraphobia.

Treatment of Agoraphobia

Mental health professionals may suggest psychotherapy for individuals with agoraphobia. A common treatment method involves combining Cognitive Behavioural Therapy (CBT) and Exposure & Response Prevention Therapy (ERP).

CBT is used to reform an individual maladaptive thoughts regarding the stressful situation:

• For example, one may believe that being in a crowded area will cause him/her to contract COVID-19.
  CBT will be used to encourage the thinking that while a crowded area increases one’s chance of falling sick, it is not an inevitable scenario.
  This can then lead to more positive behaviour, such as the individual being willing to step outside the house.

ERP is then used to bolster these positive behaviours by exposing the individual to increasing levels of stimulation, leading to the individual being able to experience the full stimulus without a maladaptive response:

• Following the above example, the individual will be exposed to minor stimuli, such as a video of a crowd or a picture of a COVID-19 virus.
  These exposures will increase in stimulation until the person is able to be in crowds without experiencing fear.

For more about agoraphobia, check out the video attached!