Agoraphobia (fear of crowds)

What is agoraphobia?

Agoraphobia is an anxiety disorder where you have a fear of places and situations that can cause panic or helplessness. These are often places where it can be difficult to quickly escape or get help, such as open squares, shopping malls, public transport and other large open spaces.

People with agoraphobia may experience severe anxiety or panic attacks in these environments and may avoid them altogether. This can lead to problems of isolation or avoidance of activities that would otherwise be beneficial. It is possible to treat agoraphobia and feel much better.

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What does agoraphobia mean?

The word agoraphobia comes from Greek, where ‘agora’ means square or open space, and ‘phobia’ means fear. So agoraphobia means ‘fear of open spaces’. The term has been broadened in healthcare to include fear of open spaces in general and situations where escape may be difficult or embarrassing.

Panic disorder with agoraphobia

It is also common to have panic disorder if you have agoraphobia. This can mean that the fear becomes so intense that the body reacts with a panic attack. This is not dangerous but can be very uncomfortable. Physical symptoms may include rapid heartbeat, difficulty breathing and sweating.

People with agoraphobia may experience panic attacks in situations such as being in large crowds, standing in a queue, travelling by bus or train, and even being outside their own home. As a result, people with severe agoraphobia may become so afraid that they avoid things they would actually like to do, which reduces their quality of life.

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How common are phobias?

About 2% of the UK population have agoraphobia and find squares, bridges and other open spaces frightening. Phobias in general affect about 10 million people in the UK so they are a fairly common anxiety disorder. Other phobias include a fear of heights and social phobia, to lesser known ones such as ‘hole phobia’ (trypophobia). Treatment for phobia is available.

What causes agoraphobia?

Agoraphobia can be caused by a combination of several factors. There is a hereditary component; if you have a relative with the syndrome, there is a risk that you will be affected. Biological factors can also contribute, as well as psychological factors such as certain personality traits where people are more anxious. Traumatic events can also cause phobias. You might have had a panic attack in a specific situation and from then the anxiety became associated with that. The anxiety has then generalised, a typical development in anxiety disorders in general. These can all be treated in therapy. You might have one or more of these causes so it is important to identify what is causing difficulty in a person’s life and adapt treatment accordingly.

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Symptoms of agoraphobia

The symptoms of agoraphobia can vary in severity from person to person, with some having mild symptoms and others severe ones. An assessment always takes into account and investigates the client’s level so that treatment can be adapted accordingly. There are several symptoms that can indicate the presence of this syndrome:

1. Intense fear or anxiety: The most prominent feature of agoraphobia is a strong fear of places or situations where escape may be difficult or where help is not available.
2. Avoidance behaviour: People with agoraphobia tend to avoid situations that cause anxiety. These include crowded places, public places, travelling far from home, or being alone outside your home.
3. Panic attacks: Many people with agoraphobia experience panic attacks, which can include heart palpitations, sweating, trembling, shortness of breath, feeling of suffocation, chest pain, nausea, dizziness, fear of losing control, or fear of dying.
4. Physical symptoms: In addition to the emotional symptoms, agoraphobia can also cause physical symptoms such as upset stomach, diarrhea, headaches and muscle tension.
5. Dependence on others: People with agoraphobia may become dependent on a specific friend or family member to accompany them when they have to go out.
6. Sense of powerlessness: A sense of powerlessness over their fear and the situation is common among those suffering from agoraphobia.
7. Emotional distance: Feelings of being separated from others or not really being present can occur.

If one suspects they have agoraphobia, it is important to seek professional help, as there are effective treatments available.

Treatment for agoraphobia

Agoraphobia is a treatable anxiety disorder and if you have symptoms you should not be afraid to seek help. Treatment is tailored to each person and the severity of the problem. There are certain parts that the treatment usually contains and it is among other things:

Cognitive behavioural therapy (CBT): This is one of the most effective treatment methods for agoraphobia. CBT focuses on identifying and challenging negative thought patterns, managing emotions related to triggering situations, and changing behaviours that contribute to anxiety. Behaviours often involve avoiding different places and situations where fear is stronger. The therapy helps to gradually expose patients to these in a controlled and systematic process, reducing anxiety over time. There is a relearning process that stops associating the places with fear.

Medication: Some people with agoraphobia may benefit from medication, such as antidepressants (especially SSRIs) or anti-anxiety medication for more severe problems. These can help control anxiety symptoms, making it easier to participate in therapy and daily activities.

All treatment is individualised; what works for one person may not work for another. A combination of therapy, medication and support may be the most effective way to deal with agoraphobia. It is also important to seek help from a qualified health professional to design a treatment plan that is most appropriate for you.

How therapy can improve your life

Seeking professional help can significantly improve your quality of life as it gives you effective tools to manage your phobias and change the pattern you have developed that causes anxiety. Seeking help for psychological problems can be embarrassing, but talking to a psychologist can be incredibly liberating and helpful if you are living with a phobia that hinders your daily life.

Taking that first step to getting help

Life is too short to let phobias limit you. Therapy is a step in the right direction to help you live a full and rich life. If you or someone you know is living with phobias, professional therapy can make a real difference. Our therapists and psychologists offer a confidential and safe environment to explore and treat your phobias.