Breaking down the term agoraphobia gives us its literal definition. Agora originates in the Greek language and refers to an open space, most typically a marketplace. A phobia is an intensely irrational fear. This meaning suggests that agoraphobia is an intense and abnormal fear of open or public places. But, this definition falls short in explaining the true meaning of this condition.
For the agoraphobic, the fear is not necessarily associated with open spaces. The central feature of agoraphobia is intense fear (panic response) of being in certain situations in which escape is difficult or potentially embarrassing, or where help is not readily available. This may include many places that would not meet the definition of open spaces, including many confined spaces. Such situations may include leaving home alone, being home alone, traveling by car, train or bus, being in an elevator, being in a crowd, being in a large store or mall, being on a bridge or standing in a line.
The fear associated with agoraphobia results in behavioral changes in order to avoid feared situations. An individual with agoraphobia may survey settings for escape routes and avoid situations where an exit is not easily available. This leads to avoidant behavior that may include only driving on certain roads, always sitting near the door in meeting or school settings, avoiding crowded places, or avoiding any place where it may be difficult to get to an exit. In extreme cases, the fear may become so consuming that the individual will not leave the house alone or becomes homebound altogether.
How Is Agoraphobia Related to Panic Disorder?
In a small minority of cases, agoraphobia may occur without panic disorder. However, it is typically triggered by the onset of panic attacks associated with panic disorder. Approximately one-third of people with panic disorder will develop agoraphobia. This complication can cause extreme disability and interference in one’s life. The risk of agoraphobia is increased if appropriate diagnosis and treatment is not begun during the early stage of panic disorder.
What Causes Agoraphobia?
As in the case of panic disorder, the exact cause of agoraphobia is not known. However, there are several theories that suggest the condition develops based on a complex interaction of biological, genetic, environmental and/or social factors and experiences.
How Does Agoraphobia Develop With Panic Disorder?
Not all people with panic disorder develop agoraphobia. However, for those that do, there are common thought and behavioral processes that take place. The National Institute of Mental Health published this account of how agoraphobia typically develops:
“One day, without any warning or reason, I felt terrified. I was so afraid, I thought I was going to die. My heart was pounding and my head was spinning. I would get these feelings every couple of weeks. I thought I was losing my mind. The more attacks I had, the more afraid I got. I was always living in fear. I didn't know when I might have another attack. I became so afraid that I didn't want to leave my house or other safe places.”
The symptoms of agoraphobia can be frightening and potentially disabling. But, the majority of sufferers find significant relief with treatment. The sooner treatment begins after the onset of panic disorder, the more quickly symptom reduction or elimination will be realized. However, even those with long-term symptoms will generally experience improvement with treatment, and most will regain the freedom to resume many of the activities they once enjoyed.