Agoraphobia is a condition in which the patient experiences anxiety in situations that are unfamiliar, from which they cannot escape, or in which they perceive they have little control. This anxiety leads to avoidance of those situations.
It is an example of irrational fear of situations. It is characterized by an irrational fear of being in places away from the familiar setting of home. It is a fear of places or situation that cannot escape from. The word itself refers to ‘ fear of open spaces ‘. People with agoraphobia fear being situations altogether and stay inside their homes.
Agoraphobic patients are anxious when they are away from home, in crowds, in situations they cannot leave easily, in social situations, and in open spaces (this last fear explains the name—‘agoraphobia’ contains the Greek word for ‘marketplace’).
Patients experience anticipatory anxiety and avoid situations that cause anxiety. Anxious thoughts are common, with themes of fainting and loss of control. The anxiety symptoms are any of together with panic attacks, depression, and depersonalization.
As the condition progresses, patients avoid more and more of these situations until in severe cases they may be almost confined to their homes.
The anxiety experienced in these situations is reduced by the reassuring presence of a trusted companion, or a reassuring object such as a few anxiolytic tablets, which are carried but never taken.
Suddenly, the person develops an unexplained panic attack, and either hurries home or seeks immediate medical help.
This first episode subsides before long, but there is another when the same or similar situation is encountered again, and another hurried escape is made. This sequence recurs over and over again and the person begins to avoid the situations.
It is unusual to discover any immediate cause for the first panic attack, although some patients describe a background of problems at the time (e.g. worry about a sick child).
The development of agoraphobic symptoms late in life is often linked to physical frailty, and the fear that an accident or major medical illness will occur.
As the condition progresses, patients become increasingly dependent on the partner or other relatives for help with activities, such as shopping, that provoke anxiety. These demands on the partner sometimes lead to arguments, and serious marital problems are common.
Prevalence The 1-year prevalence of agoraphobia without panic disorder is about 18 per 1000, whilst the lifetime risk is 1–2 per cent.
Approximately twice as many women as men are affected. As described above, the age of onset follows a bimodal distribution.
Co-morbidity The most common co-morbid condition is panic attacks, but agoraphobia is also associated with other anxiety disorders, depression, and alcohol misuse disorders.
Approximately 50 per cent of patients with agoraphobia will fit the diagnostic criteria for social phobia as well.