Ted (not his real name) spent most of every day sitting in his bedroom worrying about what might happen if he went to the store. He needed food and some other things, but what if he went there and there was a crowd? He might faint, or lose control and start screaming, or not be able to get out when he wanted to. Ted decided to just stay in his bedroom and not take the chance.

Does the scenario above sound familiar to you? It does to thousands of people every day who have agoraphobia symptoms. These people fear going out of the place they feel safe because something terrible might happen. They might have a panic attack or lose their minds or cause all kinds of humiliation and embarrassment.

What Is Agoraphobia?

Literally, agoraphobia means “fear of the marketplace.” In clinical practice and everyday life, it is the fear of leaving a safe place to go anywhere else. As in the example above, the fear underlying this condition is unreasonable, but paralyzing. The fear often grows from only one or a few times something has happened in a public place that either frightened or humiliated the person.

This fear then grows greatly as the person goes into “what if” thinking. What if I go back to that place and the same thing happens again. What if someone there remembers what I did or what happened to me?

Over time, this fear of possibly a single place generalizes into fear of almost everywhere outside of one place where the person feels safe. Some people literally never leave one room in their houses because that’s the only place they feel completely safe.

Their fears may be about:

  • Feeling trapped
  • Being helpless
  • Having a panic attack
  • Being embarrassed or humiliated
  • Feeling scared

Am I the Only One With Agoraphobia Symptoms?

Short answer: No. The National Institute of Mental Health estimates about 2.4 million people in the U.S. suffer from agoraphobia symptoms. And of this number, about 960,000 suffer from severe symptoms that may keep them isolated and, in many cases, alone.

An unfortunate fact about agoraphobia and its diagnosis is that most people are adults before being diagnosed with this condition. That means they may have had agoraphobia for many years before getting treatment and their symptoms are deeply embedded.

This makes treatment for this condition very difficult. Sometimes it is a lifelong condition that requires continuing treatment. Fortunately, there is good treatment available. Many people require medication to keep the anxiety which is at the basis of the condition under control.

Many people realize their fears are not likely to come true, but they’re unable to get past them. These fears can become very disabling. As with many psychological problems, more women are diagnosed with agoraphobia than men. Whether this means more women have the disorder or just that men don’t seek treatment, isn’t known. 

What Are the Main Agoraphobia Symptoms?

As mentioned above, fear is the basic symptom of agoraphobia. Fear that is connected to specific situations, places, or behaviors. In order to be diagnosed with agoraphobia, these symptoms must be present for at least six months.

People who suffer from agoraphobia typically

  • Fear leaving home, or their safe place in their home, for any length of time
  • Fear being in a social situation without someone being there by their side
  • Fear getting out of control in public
    • This fear may be of “going crazy”
    • It may be of fainting or vomiting in public
    • It may be of flailing out against others when they can’t escape
  • Fear being in places they can’t get out of easily, like public transportation
  • Feel different from other people, detached, as if they don’t belong
  • Feel agitated, at least on the inside, and anxious

Agoraphobia often is accompanied by panic attacks. These attacks have very significant physical symptoms that come with them. Sometimes, these physical symptoms are similar to what people think is a heart attack. This makes them doubly frightening. Some of these physical symptoms that can occur with panic attacks include:

  • Chest pain in the middle of the chest
  • Difficulty getting enough breath
  • Sweating
  • A racing heart
  • Feeling dizzy
  • Shaking or trembling
  • Feeling hot and cold one after another
  • Feeling sick to your stomach
  • Tingling or numbness in hands and fingers.

With these kinds of physical symptoms, many people end up in the emergency department of their local hospital fearing they’re having a heart attack. You can imagine how frightening this can become.

When agoraphobia symptoms are accompanied by panic attacks, the fear of getting away from the person’s safe place is magnified. What if going to the store down the street brings on another panic attack? And what if this time it isn’t a panic attack, but a real heart attack? And what if no one believes it’s really a heart attack and no one helps me? I could die!

You can get a sense of the fear that can grow from just one time having a panic attack when you already fear going away from home.

What Causes Agoraphobia and Its Symptoms?

At this time, there is no definitive answer to what causes agoraphobia. There are about as many causes as there are people who have the condition, but some factors may be common and may increase the risk of developing agoraphobia. Some of these conditions are:

  • Depression
  • Having other phobias, such as, claustrophobia or social phobia
  • Having another type of anxiety disorder
  • A history of abuse, either sexual or physical
  • A personal history of using drugs
  • A family history of others having agoraphobia

This last common factor has seen a lot of research attention recently. Research has shown possibly as any as two-thirds of cases of agoraphobia and panic have a family connection. A person with a family history of agoraphobia has three to four times the chance of developing the condition as someone without this family history.

One theory of the development of agoraphobia comes from this research. It says basically that people with a family history of the condition may be genetically predisposed to developing it. Then, when a stressor of some kind occurs in their lives, this genetic predisposition is triggered, bringing on the condition. The stressor could be an instance of being severely embarrassed in public by something the person did or something that happened to them.

Can My Agoraphobia Symptoms Be Something Else?

That is possible. Recent clinical and research evidence suggests a couple of possibilities.

One is that some symptoms of panic that comes so often with agoraphobia could be due to a mitral valve prolapse. This is a small valve in your heart that doesn’t work as it should. Commonly known as one of the kinds of heart murmur, this isn’t a serious condition and only has to be monitored by your healthcare professional. But you can feel it. And feeling it means you pay attention to it. Doing this can bring on thoughts of something terrible being wrong with your heart, resulting in increased anxiety that could trigger panic feelings.

Another possible alternative explanation for your symptoms of agoraphobia has to do with vestibular, or balance, problems. Once again, clinical practice has shown people with balance problems tend to avoid the same kind of situations that people with agoraphobia avoid. The situations and environments that cause people with balance issues to feel disoriented are the same as those with agoraphobia who feel this kind of disorientation.

Some research has shown people with balance problems that are not quite to the level of being considered a health problem may be more susceptible to both panic and agoraphobia symptoms. This appears to be related to space and motion discomfort primarily. The fear of crowded places that brings agoraphobia symptoms also brings fear to those with vestibular issues because they depend on visual cues to keep their balance. In crowds there is simply too much motion.

Conclusion

Agoraphobia is one of those emotional conditions that is hard to understand. How could a person willingly choose to isolate him or herself from all that lies outside the walls of their home?

One thing to keep in mind is that the choice these people make is due to wanting to keep themselves safe. Safe from what could happen. It’s the “what ifs” that plague them.

And things people believe could happen grow in their likelihood as they think about them.

As these things grow, people become more frightened of them. They believe staying in their safe place is the only way to avoid what might happen. They seem to be afraid of being afraid.

These decisions lead them to be truly disabled. Agoraphobia is a lifelong condition most of the time. Treatment is ongoing. There are good treatment approaches available, both psychotherapy and medication.

With the possibility of physical conditions playing a part in agoraphobia symptoms, it is necessary to consult with your healthcare professional in order to decide the best care.

References

What are agoraphobia symptoms?  http://www.medicinenet.com/agoraphobia/page3.htm#what_are_agoraphobia_symptoms

What Is Agoraphobia?  http://www.healthline.com/health/agoraphobia#overview1

The genetics of panic disorder and agoraphobia https://www.ncbi.nlm.nih.gov/pubmed/2864687

Agoraphobia  http://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/dxc-20311920

Agoraphobia Symptoms  https://psychcentral.com/disorders/agoraphobia-symptoms/

Panic, agoraphobia, and vestibular dysfunction http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.153.4.503

Vestibular Disorders Leading to Agoraphobia? Maybe  http://hearinghealthmatters.org/dizzinessdepot/2013/vestibular-disorders-leading-agoraphobia-maybe/