|Agoraphobia (from Greek word, "gathering place") is an anxiety disorder characterized by anxiety in situations where the sufferer perceives certain environments as dangerous or uncomfortable, often due to the environment's vast openness or crowdedness. These situations include, but are not limited to, wide-open spaces, as well as uncontrollable social situations such as the possibility of being met in shopping malls, airports, and on bridges. Agoraphobia is defined as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven.|
It’s interesting to note that Agoraphobia was a term coined by the German neurologist Westphal in 1871. In his original description, Westphal described four patients who had attacks of anxiety in public places. Interestingly, they were all men and he described how several of them used alcohol to reduce their fears. The term 'agoraphobia' derives from the Greek, the word 'agora' meaning the market place. This term, Westphal felt was appropriate because it described how people felt vulnerable in public places and in particular where there was no obvious exit. At the same time, another neurologist, Benedikt, coined another term (Platzschwindel) which translated from the German, means dizziness in public places. Over the years, this syndrome has been called many things, one of the most convoluted terms being the "phobic anxiety depersonalisation syndrome!"
The Agoraphobic Cluster
The problem with many agoraphobics is that they have a number of fears that are separate but related to everyday activities. This is extremely common and one that you may recognise in yourself. This is commonly known as the ‘agoraphobic cluster.’ The fears associated with an ‘agoraphobic cluster’ often have to be tackled separately to really overcome them.
The great thing about overcoming one fear is that they often help you overcome another fear. Also once you have learnt to overcome one fear your confidence increases and you know what you need to do to overcome the next fear. This may take more time but probably not more work.
What really causes Agoraphobia?
Agoraphobia effects people in different ways, but the overriding common feeling is feeling ‘trapped’ in a situation where they cannot easily escape to the safety of home, the car, outside, etc. The ‘agoraphobia cluster’ comes in to the equation because the person may have panic attacks in different situations, but they relate to the same thoughts which are to do with the feeling of being trapped.
The common fears include -
- Enclosed environments such as lifts, boats, shops, cinema, trains, etc.
- Places where leaving is embarrassing - the dentists, queues, meetings, hairdressers, etc.
- Crowded places - pubs, large shops, festivals, restaurants, etc.
Agoraphobics are often affected by other phobias which are linked to the above.
- Environmental phobias, thunder, lightening, wind, anything that can make the person feel threatened and frightened to leave home.
- Bodily phobias – blushing, heart attacks, strokes, vomiting, etc
- Social phobias – eating in public or drinking in pubs. Standing in crowds because their legs feel wobbly, making a fool of themselves in front of people, etc.
- Specific or simple phobias usually creatures such as dogs, birds, insects, reptiles, etc.
"Avoiding danger is no safer in the long run than outright exposure. The fearful are caught as often as the bold." Helen Keller
There were several times I come close to having full blown agoraphobia. Thankfully I always persevered and made myself go outside even when I felt it was the last thing I wanted to do. From research we know agoraphobia usually develops between 18 & 35 years old and affects approx 1.5 to 3.5 % of the population.
Full blown agoraphobia probably affects .5 to 1 % of the population so there could be well over half a million people who are stuck in their own homes. In a less severe form it’s estimated about 1 in 8 (i.e. about 5-7 million people) may have some agoraphobic symptoms.
Panic Disorder with Agoraphobia
Over recent years the American classification system has reclassified agoraphobia as a more general panic disorder condition. It states panic attacks at being at its core. This is open to dispute but from my own experience panic attacks and agoraphobia are linked. By fearing you’re going to have a panic attack if you step out of the comfort of your own home, you develop a phobia to protect yourself from the fear of the symptoms or sensations.
If we go back to the beginning it’s worth remembering that 1 in 3 people will have at least one panic attack in their life. That’s around 20 million people in the UK, but only a small proportion will develop panic disorder.
Agoraphobia seems to develop in early adult life. It peaks around 18 to 30 years of age. It’s very rare to develop this condition after the age of 30, although people who come forward with this condition in their 40’s and 50’s usually have experienced initial symptoms of agoraphobia for many years. If agoraphobia does develop later on in life and no phobic history can be found of the sufferer fearing public events or social interaction, then its usually part of some other illness like depression.
What is Agoraphobia
People use to think agoraphobia meant fear of ‘open spaces’ but we now know this is incorrect. Agoraphobics fear being trapped or far from the safety of somewhere (i.e. home or car). This maybe an out of town shopping centre, theme park or motorway. Sometimes the word ‘agoraphobic cluster’ is used to diagnose the sufferer’s condition where there is a variety of reasons or phobias which stop them leaving a place of safety.
Its also worth mentioning that a person can have a phobia of wide open spaces called space phobia. There are several theories stating this is an evolutionary fear when it was not safe for us to go out into open spaces, where we could have been attacked by predators. I don’t really buy into this line of thinking as its our thoughts in these places that define how we feel, rather than some inbuilt warning system.
How common is a Phobia?
It’s worth checking out Mind.org.uk (the mental health charity) as it has lots of information on phobias. It estimates that in the UK there are around 10 million people with a phobia.
It is estimated that agoraphobia without panic disorder affects around 4% of women and 2% of men during any 12-month period.
There has been lots of famous people who have suffered from this condition as well, so please don’t feel your alone. Heart throb Donny Osmond has also experienced agoraphobia and panic attacks.
Billy Bob Thornton suffered from agoraphobia and has said that he was sometimes afraid to go out. The eccentric billionaire Howard Hughes may also have had some form of agoraphobia.
Woody Allen suffers from both agoraphobia and claustrophobia and spent many years going through psychoanalysis. Speaking of psychoanalysis, it's ironic that "the father of psychoanalysis", Sigmund Freud, suffered agoraphobia.
Kim Basinger one of the most famous Hollywood actresses said, “I used to go home and play piano and scream at night to let out my frustrations and this led to my agoraphobia.” Basinger was featured in a 2001 HBO documentary called Panic: A Film About Coping, in which she describes her struggle with agoraphobia. “Fear has been something I’ve lived with my entire life, the fear of being in public places.”
How does agoraphobia develop?
Agoraphobia usually develops after a series of ‘life stressors’ which cause anxiety levels to increase and self confidence to diminish. Agoraphobia does not seem to be triggered by a single trauma or bad experience.
Some people express that the symptoms can come and go according to the problems in the person’s life. But if the problem persists over many months or even years then eventually it spreads and becomes more severe. The symptoms that people suffer can vary greatly depending on how much of a grip it has on them, but generally they are the same as panic disorder. Often people can tolerate them for quite some time before it really starts impacting on their lives. They eventually find things like holidays and work becoming increasingly difficult. For other people once the symptoms start they worsen rapidly.
What are the symptoms of agoraphobia?
They are just the same as panic attacks and can be found on my website http://www.positivepanicattacks.com/whatarethesymptomsofapanicattack.html. In avoiding their fears agoraphobic people stay at home, but their anxieties continue to worsen and so they may develop other disorders like depression or OCD.
Often agoraphobic sufferers have similar fears to social phobic people in that they fear doing something embarrassing when they leave home or going crazy in front of other people.
Also agoraphobia can lead to other symptoms like depression, obsessive thoughts, lack of interest in sex, lack of confidence, health issues related to lack of exercise - weight gain, lack of sunlight, etc. By far women are more affected then men. anxiety or panic a As described earlier many people think of agoraphobia as a fear of leaving a safe place, but there is much more to it than that. You may have the condition in its various degrees but not even know it. Such as -
- Worrying when you leave the safety of home
- Fear in crowded or public places
- Feeling trapped when you’re in a place which your unable to leave or escape
- Fear of getting stuck in lifts
- Fear of being unable to escape on Public Transport – bus, train or plane
- Standing in a queue
- Having a need to go out with a ‘safe person’ then becoming totally reliant on that person for help.
- Fear of going over bridges
- Sitting in a dentist’s chair or hairdressers chair
- Feeling you will lose control in situation and freak out and embarrass yourself
If your suffering from 3 or more of these symptoms then you could be agoraphobic.
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