What is agoraphobia?

You may have heard of agoraphobia, which is the irrational fear of being in open spaces.

It is, without a doubt, the most well-known definition, but the truth is that it is oversimplified and fails to consider the true dimensions of this disease, which go much further.

Agoraphobia is an anxiety disorder that can significantly affect your quality of life. Fortunately, psychology offers tools to provide solutions for agoraphobia.

What is agoraphobia?

People who suffer from this phobia tend to withdraw not so much out of fear of open spaces, but rather out of fear of fear itself. There are multiple causes of panic or anxiety attacks that can arise from everyday situations such as using public transportation, shopping, traveling, waiting in line at the cinema, being in a crowd, interacting with strangers, or simply leaving the house. Not having complete control over what's happening around us is a stressful situation and can lead to a panic attack. People with agoraphobia live on a cycle where the fear of experiencing these situations directly triggers their fear. Imagining that they can't escape or get help at a given moment can trigger a full-blown panic attack. It's more of an irrational fear of suffering a possible anxiety attack in an "unsafe" place. Therefore, although the most popular idea of ​​agoraphobia is "fear of open spaces," the truth is that an agoraphobic might be terrified at the idea of ​​being trapped in an elevator if it means there's no escape route for them or a way to get help from others. Consequently, the person suffering from agoraphobia takes a step back and retreats into the home, avoiding going out and/or exposing themselves to stressful situations. It's a vicious and escalating cycle.

What symptoms does an agoraphobic fear?

The most common fear of a person with agoraphobia is experiencing the symptoms of a panic attack or anxiety attack. This fear is justified by the fact that the fear of being helpless in the midst of a potentially dangerous situation generates a spike in anxiety that can spiral out of control.

The mind plays tricks

Psychological symptoms are common in these cases. The person with agoraphobia may suddenly be invaded by destructive thoughts, such as that they will be trapped and disoriented in a crowd and no one will be able to save them. This assumption isn't based on concrete facts: the person with agoraphobia isn't in that situation; in fact, they are avoiding any similar scenario at all costs; yet, their fear remains.

Another mind game played by someone suffering from agoraphobia is to compare themselves to other people and put themselves in the worst situation: "If I have an accident on the bus and it catches fire, I'm the only person who won't be able to get out, everyone will run away, no one will stay to help me, and I'll suffer very serious burns." All of this happens in calm situations and this is precisely what is most harmful: the person with agoraphobia is thinking about critical moments that generate strong anxiety, but these critical moments are not really happening, so the person has nothing to fight and their thoughts and feelings accumulate, forming an internal pressure that at times seems impossible to channel.

The stomach turns

This "fear of fear" that invades a person suffering from agoraphobia often has physical expressions that can sometimes seem like symptoms of another illness.

Loss of appetite or anxiety-induced eating are common in these cases. The enormous tension experienced by an agoraphobic at the prospect of being in danger and defenseless can cause digestive problems ranging from a simple "tingling" easily attributed to nerves to stomach pain, nausea, heartburn, and gastroesophageal reflux. The intestinal tract can also suffer from the high stress burden experienced by the agoraphobic: constipation and diarrhea can occur in many cases, sometimes alternating. All of these symptoms can become habitual companions of the patient, and as long as agoraphobia is not treated, the symptoms will persist, affecting daily life.

Breathing becomes difficult

The fear that something might happen and no one would come to help can cause patients with agoraphobia to breathe irregularly, experiencing difficulty maintaining a normal inhalation and exhalation pattern. The sensation of being "out of breath" even at rest becomes recurrent, as with other types of phobias, and in extreme cases this "lack of air" gives rise to another fear: that of dying from suffocation. Many people with agoraphobia, faced with the prospect of leaving their safe spaces, experience such a feeling of suffocation and chest pain that they think they are having a heart attack. This occurs because of the combination of poor breathing, which does not bring in enough air and oxygen, and an overactive heart, with tachycardia and palpitations, in response to the anxiety.

The muscles contract

Agoraphobia is often associated with muscle tension, manifested by stiffness in the neck, shoulders, and back. When the fear persists and this stiffness doesn't subside, it leads to contractures and pain in the neck and lower back that can affect the patient's daily life.

In some cases, the muscle tension is so severe and the pain so intense that the patient experiences headaches, dizziness, fainting, hot flashes, chills, tremors, and a sensation of flashing lights or blurred vision.

The skin complains

Although agoraphobia is a psychological disorder, its physical manifestations even extend to the largest and most visible organ: the skin. For many people, the skin acts as a shock organ for nervous disorders, ranging from the sensation of "cold hands" or tingling to more serious problems. For example, many cases of agoraphobia are associated with excessive sweating, hives, or lesions. Hair also suffers, and sudden graying and alopecia are common. These symptoms, moreover, being so obvious, create vicious cycles in the patient, who becomes even more nervous upon seeing their lesions, which worsens the injuries themselves.

Sexuality suffers

A patient with agoraphobia lives in constant fear of finding themselves in a dangerous situation from which they cannot escape. This means that not only open spaces but also anything that exposes them in any way causes fear.

Sex, of course, is on this list: any feeling of loss of control is something agoraphobics should avoid. Hence, it's common for people with agoraphobia to experience periods of sexual indifference, female frigidity, premature ejaculation, and impotence.

What causes agoraphobia?

The exact causes of agoraphobia are unknown because there is no single trigger. Each person expresses it in a unique way, as each person defines their own risk factors.

There are cultural and social factors that can facilitate its onset, but there are also biological factors that can influence it. Organic factors such as the mechanisms of the endocrine system or the consumption of certain substances are known. These genetic, medical, personal, social, and cultural factors can act alone or in concert.

Diagnosis of agoraphobia

A diagnosis of agoraphobia doesn't always strictly follow the same list of symptoms. Every person is different, and so are the expressions of their fear. Below, we'll list some of the most common guidelines that allow for a diagnosis of agoraphobia.

However, it is essential to avoid assumptions and not assume that you are suffering from something until it is confirmed by a professional, in this case, a psychologist.

Do you recognize these symptoms?

As we mentioned before, the diagnosis is the responsibility of a psychology professional. However, we will mention the symptoms of agoraphobia.

The main symptom is fear, whether it be fear of places with difficult exits, fear of being alone, or fear of losing control.

This fear is so strong that people avoid certain situations that are considered risky and stay at home, even if it affects their quality of life.

The panic attack

The distress of agoraphobia can lead to a panic or anxiety attack. Panic symptoms are often quite common, although they don't necessarily all occur at once. They include:

Tachycardia. Sweating.

Feeling of suffocation and pressure in the chest.

Dizziness, vertigo, nausea.

Stomach discomfort and/or loss of sphincter control.

Panic attacks create a loop that the patient must break with the help of a psychologist.

Once a person has a first panic attack, the fear of a repeat attack generates more fear and brings the patient closer to a repeat of the first attack. This happens continuously unless tools and strategies are established to help the person regain confidence and control.

There is a way out

Agoraphobia is a debilitating disorder that usually begins with occasional attacks, but can become chronic. Thus, you could start by avoiding elevators, and then expand your fear to other narrow spaces like the subway or buses. Over time, this can extend to the subway station itself, and from there to the entire urban space.

This situation turns the agoraphobic's life into a prison: they can't go out to do the most basic tasks and can't work outside the home. Sometimes, they even need to feel constantly accompanied by someone they trust, even at home, with whom they feel safe to be helped in a crisis.

Overcoming agoraphobia is possible, so the search for solutions is more than justified. Cognitive-behavioral therapy can radically improve the quality of life of agoraphobics. New technologies allow you to choose an online psychologist from the comfort of your own home. A safe environment becomes the starting point for online therapy.

Ultimately, knowing how to overcome agoraphobia is possible if you have the right professional, someone who provides you with tools to control your panic and, ultimately, be able to face what lies "beyond the door." Because there is a way out, and it's worth crossing that threshold.