Agoraphobia sometimes occurs by itself, but most often accompanies panic disorder; therefore, the definition of agoraphobia highlights the anxiety and fear of having panic attacks. Agoraphobia can be described as anxiety in or avoidance of situations and places that might be difficult to escape or where help might be inaccessible in case of a panic attack or panic-like symptoms1. Although agoraphobia can occur without panic disorder, it still involves anxiety and avoidance of certain situations due to some symptoms of panic, without the experience of a full-blown panic attack1. In individuals who suffer from Panic Disorder with Agoraphobia, agoraphobia can worsen panic disorder by increasing impairment and disability, by worsening treatment outcome, and by a higher chance of returning of symptoms2.
The diagnosis of Agoraphobia without History of Panic Disorder is given when there are no associated panic attacks and the anxiety and avoidance are not in the context of other anxiety disorders, such as specific phobia, social phobia, obsessive-compulsive disorder, or separation anxiety1. Individuals experience different forms of agoraphobia and degrees of impairment or interference, thus the level of agoraphobia can vary from mild to severe. Women are more likely to experience more severe degrees of agoraphobia than men. The level of agoraphobia is likely determined by the context in which the first panic attack occurred, as well as the degree to which the first panic attack is related to the place or situation where it happened3. Agoraphobia may worsen if the fear response generalizes to more bodily sensations and situations.
Here are some examples of avoided situations in agoraphobia:
- Driving or other modes of transportation like airplanes or buses
- Waiting in line
- Enclosed spaces such as elevators or tunnels
- Open spaces such as parks
- Movie theatres or arenas
- Being alone at home or outside the home
What causes agoraphobia?
Agoraphobia may function as a coping mechanism to avoid panic attacks or other anxiety symptoms. It is believed that after the first experience of a panic attack or uncomfortable anxiety symptoms, some individuals may become very sensitive to physical changes that resemble this experience4. The physical sensations associated with panic attacks include increased heart rate, sweating, dizziness, nausea, shortness of breath, shaking, and a feeling of choking among others1 (Please see the Panic Attack page for a more detailed description of the symptoms). These types of physical sensations can occur throughout the day, for a number of reasons unrelated to anxiety or panic. These internal physical sensations, no matter how harmless or natural, may signal danger and produce anxiety and fear in individuals who have experienced panic or similar discomfort in the past. As a result, these individuals begin to avoid certain situations where they might experience the sensations they associate with anxiety and fear.
Avoiding these certain situations and places may result in a reduction of anxiety symptoms, which then reinforces the avoidant behavior5. By avoiding feared situations,however, individuals with agoraphobia do not get the chance to learn that they can manage or that they will not always have an anxiety response or a panic attack when they put themselves in those situations. Treatment for agoraphobia includes a behavioral exercise of going to feared places and being in situations that produce anxiety symptoms, in order to learn that the anxiety and physical sensations can be tolerated, that the anxiety does not cause harm, and that it eventually subsides6.
1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4thed., text revision). Washington, DC: Author.
2. Nazarian, M., & Craske, M. G. (2008). Panic and Agoraphobia. In Handbook of Psychological Assessment, Case Conceptualization, and Treatment, Vol 1: Adults, Hersen & Rosqvist (Eds.). John Wiley & Sons, Inc.: New Jersey.
3. Craske, M. G., & Barlow, D. H. (1988). A review of the relationship between panic and avoidance. Clinical Psychology Review, 8, 667-685.
4. Barlow, D. H. (1988). Anxiety and its Disorders: The nature and treatment of anxiety and panic. New York: Guilford Press.
5. Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nded.). New York: Guilford Press.
6. Craske, M. G. (1999). Anxiety disorders: Psychological approaches to theory and treatment. Boulder, CO: Westview Press.