AgoraphobiaThe straight translation from ancient Greek is “fear of the marketplace” but agoraphobia has come to mean the fear of any uncontrolled situation whether it’s an open public space, busy thoroughfare or a confined method of transport such as a car or bus.

The effect of agoraphobia is crippling to the person who experiences it because it effectively curtails their ability to go outside if they feel they are going somewhere where they feel they can’t escape immediately.

This avoidance can be countered by going outside with a trusted friend or relative, but leads to an extreme change of lifestyle where they have serious limitations on their choice of career, social life and general activities such as exercise and shopping.

As with many phobias and anxiety-related disorders, the basis of an agoraphobic’s fear is the presumption that putting themselves into the feared situation would bring on the symptoms associated with panic – for example palpitations, dizziness and loss of control. Hence, the occurrence of agoraphobia is far more common in people who have experienced panic attacks a great deal – especially those who suffer with panic disorder.

The diagnosis of agoraphobia is even divided into agoraphobia without history of panic disorder (which actually accounted for the least common specific phobia – 0.6{7e66f01e68c52d858b59d425bd8f3886b02d30322136bee7d8e459b39be00af4} – in the 2006 New Zealand Mental Health Survey) and agoraphobia with panic disorder (about one in three people who have panic disorder also suffer with agoraphobia).

It’s easy to see why panic disorder can lead to agoraphobia.

Once someone has experienced the terror and fears of death usually associated with panic attacks, then any recurrence or mention of similar physical symptoms such as feeling sweaty or having chills, shaking and sweating, tingling or numbness in the hands and fingers, feeling faint, weak and dizzy, choking sensations and nausea, muscle spasms, heart palpitations, chest pains and breathing difficulties, will trigger those same fears.

That leads them to become continually on guard for those physical symptoms and to avoid anywhere where they have previously experienced the symptoms. In some cases that leads them to create fixed routes and routines and can tie in with obsessive-compulsive disorder as they look to control their environment, but in extreme cases their safety zone diminishes to their own home and they become an effective prisoner behind their front door, leading to further complications with depression.

This in turn leads to difficulties in treating agoraphobia because the simple act of seeking therapy may place the individual in a situation they would usually seek to avoid.

Cognitive behavioural therapy and mindfulness techniques are an effective route to helping someone learn why they are experiencing agoraphobia – especially if it is linked to panic disorder – because they allow individuals to understand and control some of the triggers to their panic attacks and become more realistic about their feared situations.

Treatment will also progress to gradual exposure therapy so an individual can learn to experience both some of the symptoms associated with panic and some of the places which trigger those reactions in a controlled situation.