Agoraphobia or fear of open spaces and public places

Being in a public place, a crowd or an open space is usually not threatening. For agoraphobics, it can turn into a nightmare.

What is agoraphobia?

Agoraphobia is the phobia (irrational fear) of public places, open spaces, and crowds. A person who suffers from it, called an agoraphobic, feels anxiety or panic in situations that are not dangerous or frightening in themselves and tries to avoid them for fear of being unable to escape or find help if something goes wrong. This medical condition is part of a group of anxiety disorders.

The situations leading to agoraphobia are varied. Here are some of the common ones:

  • being alone outside of the home (which is perceived by an agoraphobic as a safe place)
  • finding oneself in a crowd or waiting in line
  • finding oneself in a wide open space
  • using an elevator
  • crossing a bridge, and
  • being in a vehicle or taking public transit

Agoraphobics who cannot avoid a phobic stimulus (that triggers a phobic reaction) must confront these situations at the cost of great distress or adopt particular avoidance behaviours (e.g., leaving in a hurry). The affected person can deal with the situation with varying degrees of ease if they are accompanied by a trusted individual. 


What causes the onset of agoraphobia?

Agoraphobia generally occurs at the end of adolescence or at the start of adulthood. It appears suddenly or progressively and tends to become chronic. Its causes are unknown. Its onset often occurs following a traumatic event or a panic attack that occurred in a public place. It is frequently accompanied by another anxiety disorder (often panic disorder). Women are more affected by it than men. In Canada, there are thousands of cases of agoraphobia.


What are the symptoms of agoraphobia?

The main symptoms of agoraphobia are anxiety and panic. Panic attacks result in various manifestations including:

  • respiratory difficulties
  • sweating
  • hot flushes
  • nausea
  • headaches
  • dizziness
  • trembling
  • spasms
  • racing heart
  • desire to escape
  • loss of contact with reality, and
  • feeling that you are not yourself

The person in a state of panic caused by agoraphobia can feel as though they are about to die. In reality, a panic attack is not life-threatening, unless it worsens a potentially fatal condition (such as a heart condition or respiratory illness).

The fact remains that the distress felt during episodic anxiety and panic is very real to agoraphobics and leads them to adopt avoidance behaviours related to phobic stimuli. In the mid to long-term, this behaviour can become a source of family tension, social isolation, reclusion, unemployment, and psychological problems such as depression.


How is agoraphobia treated?

Treatment of agoraphobia includes cognitive behavioural psychotherapy. This therapy helps a person to gain perspective on the object of their fear and to control their phobia and its manifestations using various desensitization techniques (information, role-playing, and exposure). The success rate for this type of therapy is high.

If needed, the treating physician can prescribe medication, such as antidepressants or an anxiolytic (antianxiety medication) as an add-on treatment. The use of other drug treatments may be considered.

Furthermore, relaxation techniques such as abdominal breathing, mindfulness meditation and visualization can be taught to agoraphobics to help them control their anxiety and panic attacks.

Untreated agoraphobia can run a variable course; in some rare cases, it can disappear on its own.


What are the other resources for better management of agoraphobia?

People with agoraphobia and their loved ones can turn to various online resources to learn more about agoraphobia and its treatment or to find a support group or healthcare professional who can help. Here are a few of them:

Moreover, several books on agoraphobia have been published. A simple search using the keyword "agoraphobia" in your library's database or on the website of your favourite bookstore will allow you to find a great number of book titles.

Speak to your pharmacist for additional information about anxiety disorders and how they are treated.


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Agoraphobia or fear of open spaces and public places

For many people, the upcoming festival season is synonymous with joie de vivre and outdoor events that attract throngs of lively crowds. For those who suffer from agoraphobia, this period is not one of enjoyment and seems to take on nightmarish proportions.
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