Agoraphobia: what is it, causes, symptoms and treatment

In the 90s appeared one of the first films in which a case agoraphobia. The psychologist who stars in this fiction is eager to simply leave his apartment for a few seconds to go to the newspaper.

Of course, and as striking as the scene may seem, it’s always a resource to introduce one of the main characters. It is not used to understand what this anxiety disorder is, but it confronts us with an extreme case of agoraphobia so that we can see how it can limit a person’s quality of life and understand that person’s behavior. . At the same time, it highlights the fact that anxiety attacks caused by this disorder can become very shocking and be present in many spheres of human life.

But while agoraphobia is so shocking and its consequences can be so palpable, it can’t be said that it’s easy to understand what it is. Read what comes next it can help form a somewhat more detailed picture of this type of phobia, And by the way, know its main symptoms, causes and ways to treat agoraphobia.

Agoraphobia, fear of the great outdoors?

Agoraphobia is generally assumed to be an irrational fear of open spaces, such as wide avenues, parks, or natural environments. The very etymology of the word suggests a relationship between phobia and squares (agora, word from the Greek), and it is easy to mistake for agoraphobia some cases of people who just don’t like to leave home or have problems. linked to social isolation.

however, it is not entirely true that agoraphobia equates to fear in open or public spaces. It is a way of experiencing fear and anguish that has a somewhat more abstract origin than just visualizing such environments.

Perceiving open or crowded spaces plays a role in triggering panic attacks in people with agoraphobia, but fear is not produced by these spaces per se, but for the consequences of being exposed there. This nuance is essential and is often overlooked.

So … what is agoraphobia? definition

A first superficial approach to the concept of agoraphobia is to define it as an anxiety disorder which is expressed by noting that it is not in a safe environment in which it is possible to receive help in the face of a crisis. In other words, its symptoms are based on strong anxiety produced by situations in which the sufferer feels unprotected and vulnerable to anxiety attacks that are beyond their control. The root of the problem is like fear of fear. And that means that once you get into the fear dynamic of agoraphobia symptoms, it promotes its onset. It’s a disorder often based on self-fulfilling prophecies, or tail-biting fish related to fear and anxiety.

The distressing fear that a person with this anxiety disorder feels is mainly based on anticipation of panic attacks. Therefore, where there is agoraphobia, there is also a fear-based loop. A vicious circle of recurring thoughts that are difficult to get out of.

In a way, agoraphobia feeds on itself by anticipating both the unpleasant sensations associated with these crises and the dangers of losing control over one’s own actions. Consequently, the way in which this feeling of anxiety is expressed also reproduces the structure of a loop: one fears not the open space, but the possibility of suffering a panic attack or an anxiety attack due to ‘being there, and at the same time having the consequences of being in that place when it happens.

In short, agoraphobia is the fear of losing control on the physiological activation itself and on the results to which it can lead, in addition to the fear of the subjective feelings of discomfort that this would produce in real time. This is why anxiety attacks can occur not only in the great outdoors, but also in an elevator or any place other than the house itself. Agoraphobia is usually expressed in any place that is perceived to be particularly insecure, that is, where we have less control over things.

The myth of agoraphobia as a sealed compartment

From what was said above, we can come to a conclusion: The symptoms of agoraphobia are not always the same and their triggers can take many different forms.. The situations and places that can produce distress or anxiety are neither stereotypical nor the same in everyone diagnosed with this disorder, as one would expect if agoraphobia were expressed in a manner similar to the way it is expressed in popular culture. The fear of vampires on crucifixes. In fact, sometimes anxiety attacks occur even when the person is in a “safe” place, due to internal causes unrelated to the perception of the environment.

Because of this variability, it’s common for people with agoraphobia to be diagnosed with other disorders as well, such as panic disorder or post-traumatic stress disorder, as many of their symptoms may overlap. As we see, there are common confusions about the symptoms and signs of this psychological disorder.

Diagnosis and symptoms

Widely, some of the characteristics of people with agoraphobia son:

  • Being exposed to open placesVery crowded or unfamiliar produces a strong sense of anxiety.
  • This feeling of anguish it is intense enough that the person adopts the strategy of living away from these types of places, although it has a negative impact on their quality of life.
  • These outbreaks of anxiety and distress cannot be explained for other disorders already diagnosed.
  • The possibility of attract the attention of strangers or make fun of due to an anxiety attack, it also plays an important role.

It is very important to emphasize that this information is only indicative and that only a specialist can diagnose on a case-by-case basis when there is a case of agoraphobia and when not.

When diagnosing this type of disorder, it is essential to consider whether the person perceives what is happening to them as something that limits their quality of life and is therefore disabling. That is, the existence of agoraphobia depends or not only on the symptoms, but also on the context in which they occur, both in the subjective (does the patient think that it is is problematic?) And in the objective (do symptoms appear when anxiety is unwarranted?).

That is why it is necessary to consider the extent to which anyone without a problem with anxiety can exhibit more or less one of these general characteristics associated with agoraphobia.

the causes

It’s one thing to describe a disorder, and another to talk about its causes.. In this regard, it is common to believe that phobias in general, including agoraphobia, appear simply due to a stressful lifestyle, or that they are the expression of some kind of trauma or conflict. internal which is expressed symbolically by the fear of open spaces.

Currently, however, such explanations are not very useful (and in the case of the second cannot even be demonstrated by the epistemological foundations of this approach), among other things because they overlook possible organic causes. In other words, those who have to do with the biological functions that determine our thoughts and moods.

If it is true that it is not known what exactly causes agoraphobiaThis type of disorder has been linked to abnormally low levels of serotonin in parts of the brain. These low levels of serotonin can be the cause of a genetic mutation, but they can also be due to chemical decompensation caused by certain experiments or the consumption of certain substances, or be the product of all of these at the same time.

Regardless of whether this finding ends up being correct or not in explaining the mechanisms behind this disorder, what is clear is that there is no single cause of agoraphobia, but several, as in practically any psychological phenomenon, pathological or not.

Agoraphobia appears and is expressed through biological and genetic factors, but also cultural and based on the learning that everyone has achieved and which constitute their memories. Psychologically, the human being is bio-psycho-social in nature, and so are mental disorders.


Once diagnosed, agoraphobia it can be treated with both psychological intervention and medication. Below we will look at what these two types of agoraphobia treatment are, but it is important to stress that only a mental health professional is allowed to perform effective therapy.

1. Drug addiction treatment

In pharmacological treatment, they are usually used both antidepressants (SSRI) com anxiolytics (Clonazepam and diazepam). However, these drugs should only be taken under strict medical supervision and with a prescription only, and are not used to cure the disorder, but to support their symptoms.

It is also important to note that, as is always the case with medications, they can produce significant side effects and unwanted effects, such as the onset of serotonin syndrome. This is because, as with all medicines in general, those used to combat the symptoms of phobias not only work on the parts of the brain involved in keeping the level of anxiety high, but also have an impact on the whole body in general, which may result. in a mismatch according to the genetic and biological predispositions of the individual.

Therefore, there is always some risk involved in using these substances for agoraphobia or any other psychological disorder, and it is the job of mental health professionals to determine if the danger is low enough to use a certain dose. ., And how it should be used.

2. Psychological therapy

Regarding the psychotherapeutic approach, interventions based on cognitive behavioral therapy stand out. It is a type of therapy whose benefits have been scientifically proven.

The advantages of this option are that its benefits tend to last longer than the effects of drugs after the last doses, it is a brief intervention without side effects by not acting directly on the regulation of hormones and neurotransmitters.

Among its drawbacks compared to pharmacological treatment are the relative slowness with which progress appears and the need for the agoraphobic person to be willing to collaborate and achieve the goals proposed in therapy. This is important, because in order to progress with such interventions it involves struggling and dealing with unpleasant situations generate greater resistance to what is feared, with professional guidance and in a controlled environment.

From a cognitive-behavioral point of view, we will work both on the person’s beliefs about their disorder and on their daily habits and actions, so that the changes made in two dimensions, the mind and the behavior, are mutually reinforcing. In addition, it is also common to use relaxation techniques to train the ability to manage anxiety.

In many cases it will be recommended to use both pharmacological and psychological intervention, To alleviate the immediate effects of this anxiety disorder and at the same time train the patient to be able to expose himself more and more to feared situations and to manage the feeling of nervousness. However, this will only happen if it is considered strictly necessary and the drugs should only be consumed under medical indication.

Bibliographical references:

  • Adamec, C. (2010). The Encyclopedia of Phobias, Fears and Anxiety, Third Edition. Editorial infobase. p. 328.
  • American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing.
  • Vats, A. (2006). Treat panic and agoraphobia. Madrid: Pyramid.
  • Hersen, M. and Last, C. (1985/1993). Behavioral Therapy Case Manual. Bilbao: Desclée de Brouwer.
  • Lydiard, RB; Ballenger, JC (1987). Antidepressants in panic disorders and agoraphobia. Journal of Affective Disorders. 13 (2): 153-168.
  • Jacobson, K. (2004). Agoraphobia and hypochondria as housing disorders. International studies of philosophy. 36 (2): 31-44.
  • Luciano, MC (1996). Manual of clinical psychology. Childhood and adolescence. Valencia: Promolibro.

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