Agoraphobia and Panic Attacks (What Causes Agoraphobia?)

Today's focus is on Agoraphobia – an anxiety disorder quite similar to Claustrophobia. In that, the cause is generally due to panic, or a fear of fear.

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This is a condition, where you begin to fear situations where escape might be difficult, or that help might not be available in the case of a panic attack. And, if the condition becomes more severe, this looks like having trouble leaving your home due to the fear that doing so may cause you to panic.

It’s estimated that more than a third of people with agoraphobia have trouble leaving their home and are unable to study or work as a result. Hence, why Agoraphobia’s translation from Greek is “fear of the marketplace”, the general out-and-about are where you buy what you need and work to earn money, which becomes so tricky with Agoraphobia.

Let's delve into the intricacies of this often debilitating condition

Agoraphobia is most noticeable by its effect on your activities, from fear of crowded places or of open spaces causing you to avoid fields or concerts, to other situations perceived as inescapable, where you might avoid lecture theatres or work meetings. Approximately 1.3% of the global population grapples with agoraphobia, with about 1% struggling with it in any particular year. Women are more likely to develop this in adolescence, but men are about as likely to have it in adulthood as women. Interestingly, it often surfaces between late adolescence and the early twenties, with 2.5% of adolescents struggling with agoraphobia.

Just like claustrophobia, agoraphobia can trigger severe anxiety and panic attacks. Some common situations triggering this anxiety may surprise you.

We’ve got:

• Shopping malls
• Crowded streets or public transportation
• Large open spaces like parks or squares
• Theatres or cinemas
• Standing in lines or being in a crowd
• Crossing bridges or being in tunnels
• And being far from home or in unfamiliar places

The physical and psychological symptoms of agoraphobia mirror those of a panic attack. Physically, you might notice:

• Shortness of breath or hyperventilation
• Increased heart rate
• Trembling or shaking
• Sweating
• Nausea or abdominal distress
• Feeling lightheaded or dizzy
• Chest pain or discomfort
• And a sense of choking or suffocation

And Psychologically, you may find yourself:

• Experiencing intense fear or dread
• Feeling like you're losing control or going crazy
• Worrying that your anxiety is very visible and will be judged by those around you
• Fearing that you might die or get seriously ill
• And actively avoiding situations that trigger these feelings

So, what causes Agoraphobia?

Why do we develop this fear?

Agoraphobia typically runs off-of the fear that we will panic if we go in a particular situation, which can become as expansive as “anything outside of our house”. This often starts with experiencing a panic attack and becoming understandably distressed by this intense and, previously unknown, surge of symptoms.

It then becomes linked to the situation we were in, with the midbrain going, “Right, we felt the presence of extreme danger on the bus, so, if we don’t want to die, we shall avoid buses henceforth!”

Interestingly, the reason we fear having panic or high anxiety with agoraphobia is most commonly to do with a social fear. That other people will be able to tell we’re anxious and judge us as weak, or that we won’t be able to act right in that meeting, or we’ll run out and embarrass ourselves in front of everyone.

We then start to avoid these situations, so as to not embarrass ourselves, or be in danger. Though many people are only aware of the brain’s shortcut thought, that, “panic attacks are bad, and you don’t want another one of those.”

And, voila, once you have significant avoidance due to this fear (for at least 6 months), you have Agoraphobia.

That initial panic attack often follows a period of stress, or a stressful event, (like the death of grandparent) and are very heritable (meaning, you’ll likely find one of your parents or grandparents struggled with a bit of this). They pass onto you the idea that emotions can be dangerous, and you only need a match, in the form of your first panic attack, to kick the bonfire of this anxiety condition off.

It’s common for people to cope with agoraphobia by relying heavily on other family members, a spouse, or close friend to do their shopping and household errands, and when they do need to go out, arranging to go with one of these comfort people. And, of course, to use alcohol and sedative medication as a way to bring down the distress and panic (so as to feel safe from it).

Treatment for Agoraphobia

Treatment is generally highly successful and often involves cognitive and behavioral therapy, including exposure, similar to claustrophobia. Starting with small, manageable steps to gradually confront feared situations (which can start out as just imagining them), while learning coping strategies to manage anxiety effectively and break the cycle of panic attacks.

This generally takes at least 8-12 weeks, with some people needing more time to learn and implement their new skills.

It has a low relapse rate (so, you’re generally free from it from there) and is effective at reducing or eliminating anticipatory anxiety and avoidance of the very activities you want to be able to do, and the panic attacks that are a hallmark feature of this disorder.

Treatment can be complicated by people having trouble leaving home to come to therapy sessions, which is why I’ve got a 90-day program to work you through this that’s completely online, where you don’t have to leave your home to do it. You can check out a case study on that here.

Understanding agoraphobia helps break down the barriers to seeking support and initiating steps toward treating this anxiety disorder. Remember, progress might be gradual, but each step forward is a victory worth celebrating.

So there you go! Like with Claustrophobia, the real cause of Agoraphobia is the fear that going out into the particular situation, like going to work, will trigger a panic attack, and believing that we won’t be able to cope with that level of anxiety.