Agoraphobia: symptoms and treatment

By Cristiano Antonino On Jan 5, 2023

The term agoraphobia comes from the Greek word Agora meaning square; in fact, the earliest uses of the word in psychology and psychiatry were for people who were afraid of going to crowded places

In reality, patients with agoraphobia symptoms fear situations where it is difficult to escape or receive help.

Consequently, they avoid such places in order to control anxiety related to the foreshadowing of a new panic crisis.

What is agoraphobia: what is it?

Agoraphobia is an anxiety disorder characterised by marked fear and anxiety triggered by real or anticipated exposure to a wide range of situations.

Anxiety and/or fear are generated as a result of being alone in places or situations from which it would be difficult or embarrassing to leave.

Or in which help may not be immediately available.

People suffering from agoraphobia experience thoughts related to the fact that something terrible might happen to them.

E.g. ‘I can’t escape/run away/get out’ and/or ‘there is no one who could help me’.

Characteristics and manifestations of agoraphobia

In most cases, agoraphobia is a problem that emerges secondary to the onset of panic attacks or minor anxiety crises.

It sets in when the agoraphobic subject begins to systematically avoid all places, situations and contexts in which there could be obstacles to being helped.

Agoraphobic avoidance and protective behaviour

Among the situations most frequently avoided by those who show symptoms of agoraphobia are

going out alone or staying home alone
driving or travelling by car
attending crowded places such as markets or concerts
taking the bus or aeroplane
being on a bridge or in a lift

When these avoidances begin to impair a person’s daily activities and social-work functioning, then we speak of agoraphobia.

Sometimes, the problem is more difficult to detect because the subject does not avoid certain feared situations but becomes unable to cope with them without the assistance of a trusted person.

In this regard, it is possible that instead of avoidance, the agoraphobic subject uses protective behaviour in order to prepare himself to face a certain feared situation.

Although avoidance and protective behaviour may be useful for the subject in the short term, in the long term they do not allow the problem to be tackled and are powerful maintenance factors for the disorder.

Agoraphobia and panic disorder

Agoraphobia can be diagnosed as panic disorder with agoraphobia or as agoraphobia without a history of panic disorder.

In the latter case, the crises that the patient avoids are characterised by panic-like anxiety symptoms, but without all the features of the actual panic attack.

Symptoms of agoraphobia

Agoraphobia is, in short, characterised by symptoms such as:

Anxiety related to being in places where it would be difficult to leave, escape or seek and receive help, should a panic attack or anxiety crisis occur.
The feared situations are avoided or coped with either with great difficulty or with the support of an accompanying person.
Anxiety and avoidance limit the subject’s socio-occupational functioning and do not stem from other types of fear or phobias. For example, avoidance of lifts for a claustrophobic, avoidance of social situations for the social phobic, avoidance of stimuli reminiscent of a traumatic event in post-traumatic stress disorder.
There may also be symptoms such as increased heart rate, excessive sweating, increased respiratory rate, feeling dizzy, fear of losing control or of dying. This is because those suffering from agoraphobia frequently experience the physical and psychological symptoms typical of a panic attack.
One may experience the presence of brooding, i.e. the continuous thinking and rethinking of negative events that might occur, with the aim of anticipating, preventing and preparing for them.

Treatment of agoraphobia

Cognitive-behavioural therapy

Standard cognitive-behavioural therapy for the treatment of agoraphobia involves initial psycho-education and cognitive interventions in addition to behavioural interventions based on situational exposure.

Within cognitive-behavioural psychotherapy, exposure techniques have proven useful in reducing the behaviours that fuel agoraphobic anxiety.

Recently, strategies have been implemented to increase subjects’ ability to be in touch with anxious activation without fearing its catastrophic consequences. By fostering acceptance and decreasing the need for control of anxiety symptoms.

In certain cases, it is appropriate for the psychotherapist to work in a multidisciplinary perspective with a psychiatrist to also consider pharmacological help in treating the disorder.

Pharmacological therapy

In general, however, psychotherapy is essential for the treatment of agoraphobia.

Psychopharmaceuticals, by containing anxiety symptoms and panic episodes, may be helpful in the short term, but in the long run they generate a strong psychological dependency.

Very often, moreover, the symptoms of agoraphobia recur when they are discontinued.