Contrary to popular belief, agoraphobia is not the fear of open places. To understand what it truly means to be agoraphobic, one must look at what anxiety disorder drives it and how it manifests in a sufferer.
Agoraphobia is actually the fear of being trapped in a place where there is no immediate escape or where escape might generate a degree of embarrassment. The constant flux of crowds in our modern society can create many places where there would seem to be no easy way out. A person who experiences agoraphobia avoids such situations (e.g., travel is restricted) or else they endure with significant distress or with anxiety about having a panic attack or panic-like symptoms. The burden of the agoraphobic becomes a life of isolation and fear and frequently, in order to be in situations where the phobia is heightened, they require a companion for emotional support.
Agoraphobia is generally not diagnosed if a panic disorder has previously been diagnosed, as the symptoms and treatment are similar. According to the Anxiety Disorders Association of America (ADAA) 6 million Americans suffer with panic disorder. This disorder affects women twice as much as men and is usually linked to depression in some degree.
Typical agoraphobia symptoms include:
- Inability to leave the house for long periods (housebound)
- Fear of being in crowded places, such as a shopping mall or sports stadium
- Fear of losing control in a public place
- Fear of being in places where it may be hard to get out of, such as an elevator or train
- Fear of being alone
- Sense of helplessness
- Overdependence on others
- A sense that your body is unreal
Panic disorder is the effect of people who experience erratic and unexplained panic attacks. These attacks can last for several minutes and are triggered by various events. For many being in crowded or noisy places can trigger a panic attack. The ADAA estimates that one in three people who suffer with panic disorder will develop agoraphobia.
Panic attacks come with symptoms that are quite disturbing. Many of them mimic heart attacks, with chest pain, difficulty breathing, and heart palpitations. There usually is an impending sense of doom and a heightened confusion resulting in the feelings of depersonalization. It is no wonder why anyone would want to avoid the possibility of a panic attack altogether.
Agoraphobia can develop when people are triggered by social situations or specific locations. If the fear of a panic attack is strong enough this can create a permanent and irrepressible desire to create a safe zone. For the agoraphobic this safe zone will get smaller as new panic attacks occur, creating the need to further close off from the outside.
Some agorophobes express symptoms initially by cordoning off "safe" routes to specific locations, a specific path to the mailbox, or down to the corner market. They will not deviate from this route for fear of triggering another panic attack. The prospect of shutting out the outside world is a dangerous temptation for the agoraphobic.
Those who live with agoraphobia are vigilant in their guard against being vulnerable. This can mean only disaster for the sufferer as their interaction with society shrinks from their neighborhood, to their house, and ultimately to a single room. Many agoraphobics become bed-ridden as they completely lose touch with reality.
