Agoraphobia

The word agoraphobia was first used by Westphal in 1871 to describe the intense experience of anxiety when walking across open spaces. Since this time, the term agoraphobia has expanded to describe fear and avoidance of a number of situations in which people are afraid that they might not be able to cope with panic attacks or other symptoms (e.g., vomiting or incontinence) that they view as incapacitating or embarrassing. Examples of these fears include, “I might lose control if I have a panic attack in a public place”; “I might really embarrass myself if I vomited in front of other people”; or “I could not get to the emergency room fast enough if I had a heart attack or a stroke.” The types of situations that people avoid can vary widely, but some commonly avoided situations include public transportation (buses, cars, trains, planes, boats), open spaces (like parking lots and bridges), enclosed spaces (like malls or movie theaters), being in a crowded place or in a long line, or leaving one’s house alone. To cope with fears such as not being able to escape or get help fast enough in these situations, many people begin to use unnecessary protective actions, such as carrying anxiety-reducing medications on their person at all times, or only leaving the house with a trusted companion. Though these unnecessary protective actions serve the purpose of reducing anxiety in the short term, they have the unfortunate effect of increasing anxiety in the long term.

To be diagnosed with agoraphobia, these symptoms must be present for 6 or more months, and cause marked distress or interference with daily life activities. About 5% of the population will have agoraphobia at some point in their lifetime. Though agoraphobia is seen in men and women of all ages, it is relatively more common in women and usually begins before age 35.