AGORAPHOBIA – THE FEAR OF THE OUTSIDE WORLD?

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Agoraphobia is the fear of leaving environments where an individual feels familiar with and safe. Individuals suffering from the condition, referred to as agoraphobics, generally tend to stay away from open spaces, crowds, and any area that does not seem to have an obvious exit.

BRIEF HISTORY:
The condition was first described by a German psychiatrist, Karl Westphal, in 1871. Through the observation of the behaviours of three of his patients in empty streets, bridges, and crowds, Westphal noted the occurrence of situational panic attacks. Upon further inspection, all three patients exhibited symptoms of:
● Anticipatory anxiety – high levels of anxiety experienced in anticipation of a future event or situation;
● Fear of sudden incapacitation – abrupt loss of consciousness, control, or performance.
Initially, agoraphobia was not classified as a formal psychiatric diagnosis, but was instead seen as a form of panic disorder – a condition characterised by recurring and sudden panic attacks.
However, the diagnostic criteria of both panic disorder and agoraphobia has undergone significant changes over time, and, in the present day, a distinction can be made between the two. This means that an individual can now receive a diagnosis of ‘agoraphobia’, ‘panic disorder’, or a combination of both conditions.

DIAGNOSTIC CRITERIA:
In order to receive a diagnosis for agoraphobia, the occurrence of symptoms is required in at least two of the five following situations:
● Being in open spaces (e.g. a parking lot);
● Using public transportation;
● Being in enclosed spaces (e.g. theatres, clothing stores);
● Standing in a line or being in a crowd;
● Being outdoors alone.
Typically, when experiencing anxiety and fear, resulting from being in one of the five situations, the individual will most likely have thoughts that something awful is going to happen. They begin fearing their inability to escape the situation that they are in, and that help might be unavailable when symptoms of anxiety and incapacitation arise.
To be clear, an individual can only be diagnosed with agoraphobia if fear or anxiety is experienced every time they come into contact with the feared situation. This means that an individual who only occasionally becomes anxious in an agoraphobic situation will not receive a
diagnosis of the disorder.

DIAGNOSTIC METHOD & TREATMENT:
The primary tool used for diagnosing agoraphobia is conducting an interview. As soon as the diagnosis is received, the treatment will follow. Interestingly enough, the treatment process for agoraphobia and panic disorder is relatively similar. The first step is focused on determining the
severity of the disorder–meaning the level of impairment that agoraphobia causes in the patient’s life. For patients with mild or moderate symptoms, choosing between psychotherapy
and pharmacotherapy is the most suitable option. Studies have shown that cognitive-behavioural therapy (CBT) has been effective in alleviating symptoms, and overall positively contributes to the patient’s health and wellbeing. CBT is a form of talking therapy which aims to help the patient manage their problems by changing the way they think and behave. For patients with more severe symptoms, medication is recommended. Generally, patients take serotonin receptor inhibitors (SSRIs), as it is the most affordable and readily available option, as well as due to the fact that its side effects tend to improve over time.

PREVALENCE:
According to the DSM-IV, agoraphobia is present in approximately 1.7% of the general population, and the majority of these cases include individuals below the age of 35. Typically, the most vulnerable period of onset is late adolescence and early adulthood, with the average
age being 17 years. However, the condition can be developed at any age, and it most often occurs in people with an above-average intelligence.
Developing agoraphobia without panic attacks is quite uncommon, with the percentage making up only 0.17% of all the people with the disorder.
Studies have also noted that females are twice as susceptible to developing agoraphobia as males.

AGORAPHOBIA & SOCIAL ANXIETY DISORDER:
A common misconception people have is that social anxiety and agoraphobia are the same thing. While the two disorders do share some similarities, it is worth noting that there are key differences.
According to the American Psychological Association (2018), social anxiety is the “fear of social situations in which embarrassment may occur (e.g. making conversation, meeting strangers, dating) or there is a risk of being negatively evaluated by others (e.g. seen as stupid, weak, or anxious). With agoraphobia, the primary fear is related to not being able to escape and/or the embarrassment of a panic attack. Even though both disorders can cause the individual to avoid
certain situations, the reason for avoidance is different.
To conclude, agoraphobia is a disorder that affects millions of people around the globe – some more severely than others. The presence of agoraphobic symptoms may cause significant distress in an individual’s life, which makes it absolutely crucial for a diagnosis to be made early
on and intervention initiated promptly.

By: Sara Janković
sara.j.jankovic@gmail.com

Bibliography:
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Meyerbröker, K., & Powers, M. B. (2015). Panic Disorder and Agoraphobia Across the Lifespan.
International Encyclopedia of the Social Sciences (Second Edition), 474-481. Retrieved from
https://doi.org/10.1016/B978-0-08-097086-8.21014-3
Balaram, K., & Marwaha, R. (2023). Agoraphobia. National Library of Medicine: National Center for Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554387/
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APA Dictionary of Psychology: [Social Anxiety] https://dictionary.apa.org/social-anxiety
PsychCentral: [What’s the Difference Between Agoraphobia and Social Anxiety?]
https://psychcentral.com/anxiety/agoraphobia-vs-social-anxiety