Agoraphobia (Fear Of Crowds)

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Agoraphobia is a debilitating anxiety disorder in which you experience a debilitating fear of public places, being in large crowds, and avoid places or situations that may cause you to feel panicked, scared, trapped and helpless. It is also more commonly known as the fear of crowds.

This fear can be associated with an actual or an imagined situation, i.e a real or a perceived threat such as going to the general store or using public transport, standing in a queue, being in open or enclosed spaces with large crowds, etc. Often, people with agoraphobia feel the need to rely upon a companion to accompany them for even the most regular outings and in most cases, they avoid going out. This avoidance based behaviour is one of the most distinctive symptoms of agoraphobia. 

Like with other phobias, people with agoraphobia do realize that their fears are irrational, but they feel as though they can’t do anything about it. This interferes with their day to day functioning and regular tasks.

Agoraphobia Symptoms

Following are the signs and symptoms of agoraphobia. If you feel that you experience a few or all of the symptoms enlisted below, then you must consider visiting a mental health professional. 

Agoraphobia causes the patient to feel:

1. Fear of leaving their home for extended periods of time
2. Fear of losing control in a public or open space, among large crowds
3. Fear of being in places where it is difficult to escape, like an elevator, a vehicle, etc. 
4. Fear of being alone in a social situation or gathering
5. Feeling detached from others
6. Feeling anxious or agitated most of the times 

Agoraphobia, like other phobias, can also result in panic attacks. Panic attacks involve the experience of a series of symptoms that occur in phobias as well on exposure to triggers. Following are some of the symptoms of panic attacks: 

• Shortness of breath and hyperventilation
• Shaking, trembling
• A feeling of choking
• Palpitations or increasing heart beat
• Nausea
• Diarrhea 
• Chest pain and discomfort
• Hot and cold flashes
• Numbness
• Tingling sensations in the limbs
• A feeling of dizziness and light-headedness 
• Sweating
• Abdominal pain 
• Depersonalization: Feeling detached from oneself
• Derealization: feelings of unreality
• A fear of going crazy, dying or losing control

Agoraphobia Causes and Risk Factors

Generally, agoraphobia develops when panic disorder gets aggravated, i.e., it is a complication of panic disorder. Hence, the symptoms of panic disorder and agoraphobia overlap. Agoraphobia can develop when the affected persons associate open places and large crowds with panic attacks, and this tends to happen when they’ve had panic attacks in such situations.

Now, the exact cause of agoraphobia isn’t known yet. However, some risk factors increase the likelihood of a person developing agoraphobia. These are as follows: 

• A history of physical, emotional, or sexual abuse
• Substance abuse
• Family history of agoraphobia
• Depression
• Having other phobias, such as social phobia or claustrophobia
• Having another anxiety disorder, such as generalized anxiety disorder, obsessive compulsive disorder, or post traumatic stress disorder. 

Diagnosis of Agoraphobia

A diagnosis of agoraphobia is generally made if the following is confirmed with the help of a few psychological tests and other means (at the same time it should also be confirmed that some medical causes are ruled out with the help of physical examination): 

• You feel anxious about being in a place or a situation which involves large crowds or escape is difficult to the extent that it harms your daily functioning. At the same time you experience anticipation anxiety about having a panic attack or feeling panic in the above situations.
• You tend to display avoidance-based behaviour and avoid the aforementioned situations by not going out, or rely on a companion each time you go out, or endure in these situations while experiencing extreme levels of anxiety.
• There is no underlying condition that explains such symptoms (which, again, must be ruled out with the help of physical examination as previously stated). 

Agoraphobia Treatment

The treatment of agoraphobia involves therapeutic techniques, medication, or a combination of both. 

Therapies can be of different types depending on the signs and symptoms and their severity of the client. Some of the therapeutic interventions used for treating phobias include eye movement desensitization reprocessing therapy (EMDR) which is based on some concepts of cognitive behavioural therapy (CBT) which is also used for treating phobias, systematic desensitization, and exposure therapy among others.

A part of the therapeutic treatment plan may require the patient to see a psychiatrist, for which, a referral may be arranged. The psychiatrist can decide whether or not medication is required for the treatment depending upon the severity and the range of symptoms. Medication mostly includes antidepressants, and anti-anxiety medication to reduce the emotional and physical reactions of fear. 

A few examples of the kinds of medication used for agoraphobia treatment are:

• selective serotonin reuptake inhibitors: paxil (paroxetine), and prozac (fluoxetine)
• Selective serotonin and norepinephrine reuptake inhibitors: effexor (venlafaxine), and cymbalta (duloxetine)
• Tricyclic antidepressants: elavil (amitriptyline) and pamelor (nortriptyline)
• Anti Anxiety medications: Xanax (alprazolam) and Klonopin (clonazepam)

FAQ

Q. Is agoraphobia a social phobia?

No, agoraphobia is not a social phobia because the symptoms can occur in situations which do not involve any social interaction. It is distinct from social phobia in the sense that it involves a fear of entrapment which can occur even in isolation. But there is an overlap of symptoms as people often feel social anxiety in agoraphobia.

Q. When was agoraphobia first discovered?

Agoraphobia was first added to the DSM’s third edition in 1980. It has been included in each version since.