Agoraphobia is a psychological disorder. The word agoraphobia is made up of two words: agora and phobia. Phobia refers to extreme fear, while agora means open space—in ancient Greece, the agora was the marketplace. So, agoraphobia literally means fear of the marketplace.
The diagnostic criteria for Agoraphobia
The marketplace is not the only thing that people with agoraphobia might fear. The diagnostic manual DSM-5, published by the American Psychiatric Association, notes that agoraphobia is diagnosed when an individual shows significant fears regarding two of the five situations listed below:
1. Large open spaces
2. Enclosed places
3. Standing in a line or in a crowd
4. Public transportation
5. Being alone outside the home
To understand what these settings have in common, we must understand the root fears of people with agoraphobia. These individuals fear developing panic attacks (sudden episodes of intense fear) or other embarrassing or debilitating symptoms like vomiting. As a result of these fears, they avoid certain kinds of environments, such as the five listed above. Specifically, they avoid environments from which escape might be difficult or environments in which help may not be available should one develop debilitating symptoms.
People with agoraphobia may avoid many types of environments (e.g., parking lots, bridges, malls, elevators, movie theaters). For many, leaving home, for any reason, can cause significant fear. When they do venture outside, they often engage in safety behaviors (e.g., requesting the presence of a friend or relative).
The DSM-5 notes that roughly 1.7% of American adults and adolescents are diagnosed with agoraphobia. Agoraphobia is more prevalent in women than in men. The onset of agoraphobia is usually in late adolescence and young adulthood, though a second peak in the late 30s and early 40s has also been described.
Risk factors and treatment options
The development of agoraphobia may be due to the interaction of genetic, environmental, and psychological factors. Milosevic and McCabe, in their article in the Encyclopedia of Clinical Psychology, suggest heritability estimates for agoraphobia ranging from 30% to 60%. This condition has also been linked, the authors note, with certain personality traits and psychological factors—neuroticism, anxiety sensitivity (fear of anxiety symptoms), limited self-efficacy, low perceived control, social evaluation anxiety (e.g., fear of making a spectacle of oneself during a panic attack), and dependent and avoidant personality traits.
The risk for agoraphobia is also increased in individuals raised by overprotective but emotionally cold caregivers, and in those with a history of stressful occurrences during childhood (e.g., physical abuse, loss of a parent).
Empirically supported interventions for agoraphobia include antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), and psychotherapy such as cognitive-behavioral therapy. These treatments often target panic attacks as well, which are fairly common in those with this condition.
Michael Telch and co-authors, writing in The Wiley Handbook of Cognitive Behavioral Therapy, suggest that in vivo exposure (facing the feared situation or object in real life) is a centerpiece in the cognitive-behavioral treatment of agoraphobia. Exposure therapy requires that the individual approach and eventually enter the avoided situation without the use of safety behaviors.
The goal of therapy is to help people with this condition realize, and learn through practice, that their worst fears will not come true. And that even if something unpleasant or worrisome were to happen, they will have skills and internal resources to handle it well.