Agoraphobia is the fear of leaving one’s home or space of comfort. It also involves the fear of crowded places. Agoraphobia is a debilitating condition. It stands in the way of living a healthy, happy life. Agoraphobia is an anxiety disorder. It involves anxiety and panic when one finds themselves outside of the safety of their own home, especially when one’s surroundings are busy with people. Even at home, the thought or anticipation of leaving and being around people can bring on feelings of panic. As such, people who struggle with agoraphobia feel unable to leave their homes due to the fear of panic attacks and other anxiety-related symptoms that might come up.
Understanding Agoraphobia
Agoraphobia is a manifestation of anxiety. It relates to a common anxiety-related symptom – panic. Those struggling with agoraphobia may feel unable to leave home or another comfortable space because they anticipate a panic attack.
Anxiety is a common symptom of trauma, such as post-traumatic stress disorder (PTSD) or other trauma-related disorders. Panic is a type of anxiety in which the person experiencing panic feels intense fear. Shaking, sweating, and rapid breathing are all physical symptoms of a panic attack. Panic attacks can feel uncontrollable. As such, they are highly undesirable experiences.
Around 1 in 3 people who struggle with panic disorder will develop agoraphobia.[1] Symptoms of agoraphobia are physical, cognitive, and behavioural. The condition ranges from mild to severe. A person with mild agoraphobia may be able to travel short distances or be in potentially frightening situations for a brief period. Those with severe agoraphobia may feel unable to leave their home.
Physical symptoms of agoraphobia include[2]:
- Rapid breathing
- Rapid heartbeat
- Faintness, dizziness
- Trembling, shaking
- Sweating
- Ringing in the ears
- Claustrophobia
- Nausea
- Chest pain
Cognitive symptoms of agoraphobia are fear-based. Those struggling may fear[3]:
- Embarrassment
- Health issues (heart failure)
- Inability to escape
- Loss of control in public
- Being stared at or judged
- Feeling unable to survive or cope without help
- Anxiety, dread
Behavioural symptoms of agoraphobia include[4]:
- Avoiding situation in which a panic attack could happen (crowded places, public transport, queues)
- Locking oneself away at home
- Needing a trusted other for company when going somewhere
- Staying close to home, avoiding long-distance travel
Some of those struggling with agoraphobia may push themselves to leave the house and enter frightening situations but still feel considerable anxiety and fear as a result.
What Is Avoidance?
Those struggling with agoraphobia fear the onset of a panic attack, especially in situations where they would perceive having a panic attack as a source of embarrassment, inappropriate, or in situations from which they cannot easily leave. As a result, those struggling with panic and agoraphobia may avoid certain situations altogether.[5] This is avoidance and is a common trauma symptom.
Avoidance behaviours tend to progress. They can grow in intensity over time, and impair a person’s quality of life. Home, school, work, and relationship responsibilities and commitments may suffer as a result of avoidance. For example, a person struggling with agoraphobia, and subsequent avoidant behaviour, might miss important appointments, social occasions, and even daily responsibilities due to their fear and avoidant behaviour. In agoraphobia, staying at home and feeling unable to leave is extremely disruptive avoidant behaviour.
What Is the Relationship Between Trauma and Agoraphobia?
Traumatic events are those which overwhelm the nervous system and compromise our ability to cope with stress.[6] Stressful life events, such as exposure to combat, witnessing domestic violence, or being a victim of abuse in childhood, lead to chronic stress and overwhelm our ability to cope.[7] Suppose a person has been through a single or multiple traumatic events. In that case, they are likely to develop a trauma-related disorder, such as post-traumatic stress disorder, or anxiety-related disorders such as Generalised Anxiety Disorder (GAD) or Panic Disorder (PD).
When we live with trauma, we are sensitive to triggers that remind us of our trauma. A trigger could be a person, place, or thing that brings up our traumatic memories. Panic attacks can arise as a result of trauma. They can also be traumatic. If a person experienced a traumatic event or had a panic attack in a public, crowded space, being in such a space again might trigger their traumatic memories.
Treatment for Agoraphobia
Psychotherapy and medication are two evidence-based approaches to treatment for agoraphobia.[8] Agoraphobia stems from anxiety and panic, so these conditions must be addressed in treatment. Often, the intense anxiety and panic associated with agoraphobia have their roots in past trauma. As such, treatment providers must identify, acknowledge, and address a client’s traumatic past. Care and treatment should take a trauma-informed approach. Trauma-informed care (TIC) is a recommended treatment approach for those struggling with trauma-related anxiety and panic.[9]
Eye Movement Desensitisation and Reprocessing (EMDR) for Agoraphobia
EMDR is an evidence-based approach to trauma treatment.[10] In EMDR, clients explore their past trauma under the support and guidance of a trained therapist. EMDR uses bilateral stimulation. Through sound or visuals, clients remain present and grounded in the room as they explore their traumatic past. This serves to desensitise clients to the physical and psychological influence of traumatic memories on their current well-being. Clients reprocess their traumatic memories, ultimately reducing the severity of associated symptoms.
Somatic Experiencing (SE) for Agoraphobia
Somatic Experiencing involves the guided exploration of one’s physical sensations as they relate to traumatic memories.[11] By regaining a connection and sense of control over the body, clients can reduce the severity of symptoms and experience of overwhelm associated with their past trauma.
Medication
Certain medications may help clients struggling with agoraphobia ease their debilitating symptoms. These include:
- Selective Serotonin Reuptake Inhibitors (SSRI)
SSRI’s are a popular first choice of pharmacological treatment for panic disorders.[12] SSRI’s are a type of antidepressant. They prevent the quick reuptake of serotonin in the brain. Serotonin is a neurotransmitter involved in feelings of happiness and well-being. By inhibiting its reuptake in the brain, serotonin remains in the synapses for longer, ultimately providing relief from panic-related symptoms.
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
SNRIs are similar to SSRI’s. They influence the level of neurotransmitters in the brain to improve balance in the client’s brain chemistry.
- Benzodiazepines
Benzodiazepines slow down activity in the central nervous system (CNS).[13] As such, they promote relaxation and reduce the physical symptoms of anxiety. Benzodiazepines require clinical consideration. They have a high potential for abuse, so it is vital to follow the treatment providers strict prescription guidelines. Common benzodiazepines are alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan).
Healing from Agoraphobia
Once agoraphobia or other anxiety-related disorders develop, it can be challenging and overwhelming to face a feared situation. Those struggling are likely to engage in avoidant behaviours to cope. Avoidant behaviours are maladaptive. Though they serve to prevent the onset of a panic attack, they can disrupt other important areas of one’s life. In the long-term, avoidant behaviours can exacerbate panic and anxiety.
Fortunately, treatment is available. At Khiron Clinics, we are a team of trauma-trained mental and behavioural health specialists. We offer a range of expert-led treatment programmes and services to help you overcome your trauma-related issues. Please reach out to Khiron today to get the help you need. Treatment can help you manage your condition, reduce the frequency and severity of panic, and help you live a healthier, happier, and more independent life.
[1] Wittmann, A et al. “Anticipating agoraphobic situations: the neural correlates of panic disorder with agoraphobia.” Psychological medicine vol. 44,11 (2014): 2385-96. doi:10.1017/S0033291713003085
[2] “Symptoms – Agoraphobia”. Nhs.Uk, https://www.nhs.uk/mental-health/conditions/agoraphobia/symptoms/. Accessed 29 Apr 2021.
[3] “Symptoms – Agoraphobia”. Nhs.Uk, https://www.nhs.uk/mental-health/conditions/agoraphobia/symptoms/. Accessed 29 Apr 2021.
[4] “Symptoms – Agoraphobia”. Nhs.Uk, https://www.nhs.uk/mental-health/conditions/agoraphobia/symptoms/. Accessed 29 Apr 2021.
[5] White, Kamila S et al. “Avoidance behavior in panic disorder: the moderating influence of perceived control.” Behaviour research and therapy vol. 44,1 (2006): 147-57. doi:10.1016/j.brat.2005.07.009
[6] Sherin, Jonathan E, and Charles B Nemeroff. “Post-traumatic stress disorder: the neurobiological impact of psychological trauma.” Dialogues in clinical neuroscience vol. 13,3 (2011): 263-78. doi:10.31887/DCNS.2011.13.2/jsherin
[7] Sherin, Jonathan E, and Charles B Nemeroff. “Post-traumatic stress disorder: the neurobiological impact of psychological trauma.” Dialogues in clinical neuroscience vol. 13,3 (2011): 263-78. doi:10.31887/DCNS.2011.13.2/jsherin
[8] Imai, Hissei et al. “Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults.” The Cochrane database of systematic reviews vol. 10,10 CD011170. 12 Oct. 2016, doi:10.1002/14651858.CD011170.pub2
[9] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 1, Trauma-Informed Care: A Sociocultural Perspective. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207195/
[10] Shapiro, Francine. “The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences.” The Permanente journal vol. 18,1 (2014): 71-7. doi:10.7812/TPP/13-098
[11] Payne, Peter et al. “Somatic experiencing: using interoception and proprioception as core elements of trauma therapy.” Frontiers in psychology vol. 6 93. 4 Feb. 2015, doi:10.3389/fpsyg.2015.00093
[12] Marchesi, Carlo. “Pharmacological management of panic disorder.” Neuropsychiatric disease and treatment vol. 4,1 (2008): 93-106. doi:10.2147/ndt.s1557
[13] Griffin, Charles E 3rd et al. “Benzodiazepine pharmacology and central nervous system-mediated effects.” The Ochsner journal vol. 13,2 (2013): 214-23.