Agoraphobia
Agoraphobia is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to his or her home, experiencing difficulty traveling from this “safe place.”
Definition
The word “agoraphobia” is an English adaptation of the Greek words agora and phobos, and literally translates to “a fear of the marketplace.” Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include crowds, wide open spaces, or travelling (even short distances). This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public.
Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack.
Prevalence
The one-year prevalence of agoraphobia in the United States is about 5 percent. According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with panic disorder progress to develop agoraphobia.
Gender differences
Agoraphobia occurs about twice as commonly among women as it does in men. The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviours. Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia.
Causes and contributing factors
The causes of agoraphobia are currently unknown. It is linked however to the presence of other anxiety disorders, a stressful environment or substance abuse. More women than men are affected. Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation. Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces. Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data.
Alternate theories
Attachment theory
Some scholars have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Recent empirical research has also linked attachment and spatial theories of agoraphobia.
Spatial theory
In the social sciences there is a perceived clinical bias in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.
Feminist theory
Feminist scholars have applied feminist theory in an attempt to construct agoraphobia and other anxiety disorders as gendered issues. One such theory explains agoraphobia as a fear of the hysterical woman, meaning a fear of being perceived by others as overly feminine and out of control.
Diagnosis
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur. In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used.
