By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Agoraphobia is about fear.
Agoraphobia is often translated as “fear of the marketplace.” This disorder involves being overwhelmed when you encounter people outside your home or “nest.” People with this problem become fearful when they have to venture out. It is not required that the person actually leaves their house and experience the situation, just thinking about the possibility and then having symptoms can qualify as Agoraphobia. For some people, these symptoms and their efforts to avoid feeling these feeling can result in their becoming home-bound.
This disorder has been associated with panic attacks and panic disorder. We used to diagnose this as Panic Disorder with or without Agoraphobia. The new trend, as dictated by the DSM-5, is to separate Panic Disorder from Agoraphobia as some people can have either one without the other, some people have both in which case they get both diagnoses put on their chart.
Current estimates are that between five and six million Americans have Agoraphobia. Somewhere between one-third and half of these also have panic attacks. Many do not receive treatment because they are too fearful to leave their homes and go for treatment. Agoraphobia is a major cause of disability with over one-third of those with Agoraphobia being home-bound and unable to work. There are treatments for Agoraphobia if you are able to access them.
Some people report that when they experience settings that would qualify them for the diagnosis of Agoraphobia they have “Anxiety Attacks.” Having a brief increase in Anxiety as in an “Anxiety Attack” can be a part of other illnesses such as any Anxiety disorder, trauma and stressor-related disorders, depression and so on.
To be Agoraphobia, by definition, you need to experience these fear-based symptoms in two or more specific situations. This helps separate the Agoraphobia condition from a narrower specific fear or phobia. These fears also need to be excessive or unrealistic. Fear of leaving the house does not count if you live in a war zone or a high crime neighborhood.
The 5 specific fears of Agoraphobia you asked?
- Being on public transportation.
- Open spaces.
- Closed or confined spaces.
- Standing in a line or being in a crowd.
- Being outside your home alone.
To get the diagnosis of Agoraphobia it is not enough that you just be scared or nervous in these situations. People with Agoraphobia avoids these and possibly related experiences. This interfering with the rest of your life is one of the hallmarks of a mental health issue that should get diagnosed and treated.
People with Agoraphobia also worry excessively that they may not be able to escape or won’t be able to get help in these situations. It is these two key characteristic, not being able to escape and the belief that something terrible will happen that make Agoraphobia so debilitating.
For this diagnosis to “fit” this intense fear can’t be just a one time or occasional occurrence. It has to happen most or all the time you encounter these situations. People with Agoraphobia often insist on having a companion to reassure them when they leave the house and they can only endure these situations by ensuring intense fear.
Symptoms for Agoraphobia are a little wider than the psychical ones seen in Panic Disorder. Other possible symptoms would include the risk of having an embarrassing or incapacitating incident such as loss of control over bodily functions or falling, passing out or getting lost. In the elderly, it is hard to separate real concerns from excessive ones that would count towards Agoraphobia.
As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the fear but you may not get the diagnoses if this is a preference, not a problem. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem this fear needs to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get the Agoraphobia diagnosis.
For more on these topics see Anxiety Disorders,
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.