Agoraphobia – Symptom Attacks, Triggers, Panic, & Avoidance Behaviors

Agoraphobia might not be what you think it is. Contrary to popular opinion, agoraphobia is the fear of having physical symptom attacks in situations where escape might be difficult or embarrassing.

Let’s dispel a common misconception about agoraphobia. Agoraphobia is not a fear of the outdoors. Many people mistakenly believe this myth, due to the word’s Latin roots.  Because agoraphobia can be broken down into the roots agora (“marketplace”) and phobia (“fear of”), many people assume that agoraphobia is a “fear of the marketplace” or a fear of being in wide open spaces.

What is agoraphobia?

However, this literal interpretation is different than what psychologists mean when they use the term agoraphobia. Clinical psychologists, therapists, and psychiatrists conceptualize agoraphobia as a fear of experiencing physical symptom attacks in certain types of situations (Zuercher-White & Pollard, 2003). Symptom attacks include full-blown panic attacks, limited symptom panic attacks (sweating, dizziness, disorientation, difficulty breathing. heart pounding, nausea), diarrhea, other gastrointestinal (GI) issues, vomiting, headaches, and feelings of dissociation, depersonalization, or derealization.

Agoraphobia-related Situations

The fear of having a physical symptom attack is often strongest in certain types of situations (Zuercher-White & Pollard, 2003), including those in which:

• Your symptoms might be embarrassing or are likely to be noticed by others.
• Escape is difficult or impossible.
• Help is not readily available.
• Restrooms are inaccessible (or not private).
• You have little personal control over the environment.

Agoraphobia-related Avoidance Behaviors

Fear of symptom attacks then contributes to avoidance behaviors and significant changes in one’s daily routine (Zuercher-White & Pollard, 2003). These changes might include:

• Shopping at odd times (e.g., going to the store after midnight to avoid crowds or getting stuck in a checkout lane).
• Avoiding concerts, fairs, and other loud, chaotic gatherings.
• Avoiding lines at stores and theme parks.
• Avoiding driving (especially on highways and freeways that are prone to traffic/accidents and/or have limited exit ramps). (Note: Sometimes individuals think they have a “fear of driving” but the underlying condition is actually panic or agoraphobia.)
• Avoiding small social gatherings where others might notice one’s physical symptoms.
• Avoiding spontaneous, unplanned activities that might seem unpredictable and uncontrollable.
• Avoiding interactions with authority figures or people whose impressions are important (e.g., bosses, superiors).
• Avoiding certain foods to prevent GI problems (e.g., not eating spicy foods, Mexican foods, dairy).
• Avoiding caffeine (coffee, soda) or alcohol because of potential physical symptoms.
• Avoiding airplanes/flights, trains, roller coasters, subways, buses, boats, taxi cabs, and most forms of public transportation.
• Avoiding eating unfamiliar foods or in unfamiliar restaurants.
• Over-planning activities (i.e., planning escape routes, planning excuses to make if one has to leave an activity early)
• Only leaving the house for very short intervals (e.g., to avoid having a symptom attack in public, to avoid using public restrooms or eating outside the home).
• Only leaving the house in the company of a trusted friend or family member.
• Avoiding isolated places.
• Avoiding getting lost or driving in unfamiliar places.
• Avoiding busy or crowded places (e.g., malls, airports, etc.).
• Avoiding standardized examinations (e.g., timed exams, exams without bathroom breaks, prolonged exams, exams that are access-controlled).
• Avoiding travel or staying in hotels.

Agoraphobia often co-occurs with panic disorder, but it can also accompany OCD, social anxiety, generalized anxiety disorder, phobias, and other anxiety-related conditions. It may also occur in isolation, seemingly without any other obvious cause. Agoraphobia is readily treated through cognitive behavioral therapy (CBT) that includes elements of cognitive restructuring and behavioral exposure. Effective treatment for agoraphobia often parallels exposure and response prevention (ERP) therapy for OCD.

UPDATE: Read more about our recently launched group therapy program for panic and agoraphobia.

Thoughts?  Questions?  Physical symptoms or avoidance behaviors not mentioned above? Please share below…

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