Agoraphobia
Agoraphobia
Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda, S. Psi.
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
Welcome
Dear Reader,
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
Definition
Agoraphobia vs Transient Avoidance
In cases of extreme stress, avoidant behaviours fall within the range of expected behaviours. Furthermore, individuals suffering from health conditions or those with limited mobility may choose to avoid certain situations due to a fear of incapacitation and public humiliation.
Individuals with agoraphobia differ from those simply avoiding situations in a number of ways. These include the range and duration of their symptoms. Further, the symptoms of agoraphobia greatly interfere with day-to-day functioning. Importantly, impairment exceeds what is expected relative to their situational and sociocultural context.
What is Agoraphobia?
Agoraphobia is a mental health condition in which individuals experience marked and excessive fear in response to situations that may be difficult to escape, or where they may not be able to readily access help. This includes an array of situations encompassing driving on the highway, using public transportation, being in crowded areas such as malls, being outside of the house alone, and standing in line at the public supermarket.
Individuals with this condition experience a persistent, marked, fear about facing many of these everyday situations. One of the hallmarks of agoraphobia is the tendency to envision worst-case scenarios brought about by particular surroundings. Moreover, an individual may fear they will experience a panic attack, or other detrimental physiological symptoms, brought about by the perceived stress of their situational environment. Consequently, those with this condition may go to great lengths to avoid many of these circumstances, with many only entering them if they are accompanied by a supportive companion. Otherwise, the situations may be endured with much fear and escalating anxiety.
These symptoms are usually experienced symptoms for at least several months. Generally persistent and chronic in nature, the condition has been construed as causing detriment to multiple life domains, including social, relational, occupational, academic and otherwise. Normal functioning can is generally only maintained through concious exertion and additional effort.
Importantly, the symptoms of agoraphobia disorder are not better explained by the existence of another mental health condition.
Symptoms
For a comprehensive list of agoraphobia symptomatology, we recommend you visit the ICD-11 webpage.
Comorbidities
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside agoraphobia include but are not limited to:
- Other anxiety disorders (amongst others, the condition is closely associated with panic disorder)
- Mood disorders such as depression
- Substance use
Development and Course
Below, we present research findings as reported within the ICD-11. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- Agoraphobia typically appears during late adolescence; however, amongst some individuals, it appears before the age of 35. The condition may appear later in life (for instance, mid to late 20s) amongst those with a pre-existing Panic Disorder.
- Agoraphobia follows a persistent and chronic course. It is associated with an increased risk of developing depressive disorders and substance use in the long term.
- Individuals who endure comorbidities and more severe symptoms of agoraphobia (including avoidance of social activities and remaining homebound). Further, these individuals are at higher risk of relapse and may endure a worse long-term prognosis.
Variability
There are variations in the way this condition presents. Below, we present findings reported within the ICD-11.
Age-Related Differences
- Agoraphobia generally consistently presents across conditions. Nevertheless, differences in the reasoning for avoidance has been observed. For instance, children and adolescents may fear being outside of their house alone due to an apprehension of getting lost. On the other hand, adults may be afraid of being in open, public spaces or experiencing a panic attack. Older individuals may fear falling in public.
- Both children and adults demonstrate excessive avoidance of certain situations or particular locations. Those who do travel to locations they deem uncomfortable typically require the presence of a companion or loved one.
Gender and Sex-Related Differences
- The condition typically presents earlier in females compared to males.
- Women are twice as likely to endure agoraphobia during their lifetime.
- Men who endure agoraphobia often simultaneously endure conditions that may be attributable to their substance use.
Etiological Risk Factors
The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops.
Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis and outcome are not definitively based upon the presence of one, or even several, of the variables.
Temperamental or personality factors
- Irritability
- Anxious tendencies
- Depressive tendencies
Heritable predisposition
- Although hereditary rates vary across studies, agoraphobia is more prevalent amongst individuals who have close relatives with the condition.
Neurobiological factors
- Studies have implicated a “fear network”, suggesting panic disorder is the product of several brain regions (specifically, frontal limbic regions)
- Neurotransmitter imbalances
Environmental factors
- Insecure parental attachment style
- Adverse childhood experiences
- Stressful life experiences
Consequences
Studies have suggested that many individuals with agoraphobia have a compromised quality of life compared to community samples. Whilst not everyone experiencing this condition will experience these disruptions, studies have highlighted various associated consequences. Individuals with agoraphobia have been observed to be at heightened risk for:
- Social isolation
- Homeboundedness
- Avoidance of social situations, and consequent decline in social support
- Diminished well-being
- Compromised health
- Frequent dependency upon medical services
- Lower occupational attainment
- Financial dependency
- Marital strife
- Divorce
- Suicide ideations
- Suicide attempts
- Suicide
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Readings
Disclaimer
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/
Code for Agoraphobia: 6B02
Bienvenu, O., Onyike, C., Stein, M., Chen, L., Samuels, J., Nestadt, G., & Eaton, W. (2006). Agoraphobia in adults: Incidence and longitudinal relationship with panic. British Journal of Psychiatry, 188(5), 432-438. doi:10.1192/bjp.bp.105.010827
Mosing, M. A., Gordon, S. D., Medland, S. E., Statham, D. J., Nelson, E. C., Heath, A. C., Martin, N. G., & Wray, N. R. (2009). Genetic and environmental influences on the co-morbidity between depression, panic disorder, agoraphobia, and social phobia: a twin study. Depression and Anxiety, 26(11), 1004–1011. https://doi.org/10.1002/da.20611