What Is Agoraphobia

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Agoraphobia is an anxiety disorder involving intense fear of situations where escape might be difficult or help might not be available if something goes wrong, such as having a panic attack or feeling faint. People with agoraphobia often avoid public transit, crowds, open spaces, enclosed spaces like shops or theatres, and being away from home alone. It is not simply fear of open spaces or of going outside, though in severe cases people may become housebound. Agoraphobia is treatable, and many people regain their freedom with therapy.

What Agoraphobia Looks Like

Agoraphobia usually involves fear in two or more of these situations:

• Using public transit, such as buses, SkyTrain, ferries, or planes.
• Being in open spaces, such as parking lots or bridges.
• Being in enclosed spaces, such as shops, cinemas, or elevators.
• Standing in line or being in a crowd.
• Being outside the home alone.

People may only go out with a trusted companion, stick to familiar routes, sit near exits, or carry items that make them feel safe. At work, agoraphobia can limit commuting or travel. At home, it can shrink life to a small radius. Relationships can be strained when a partner becomes the only safe companion.

Why It Happens

Agoraphobia often develops after panic attacks. After an unexpected attack in a particular place, people begin to fear having another where escape would be difficult or embarrassing, and start avoiding those places. Avoidance brings relief, which reinforces the fear, and the list of avoided places tends to grow. Contributing factors include genetics, an anxious temperament, stressful life events, and sensitivity to physical sensations such as a racing heart or dizziness. Agoraphobia can also develop without a history of panic attacks, centred on fears of fainting, losing bladder control, or other symptoms.

What It Is Not

• Not just fear of open spaces. The core fear is being unable to escape or get help, which can apply to many kinds of places.
• Not social anxiety. Social anxiety centres on fear of judgment. Agoraphobia centres on fear of panic or incapacitating symptoms in places hard to leave.
• Not a specific phobia. Specific phobias focus on one object or situation. Agoraphobia spans several situations linked by the same fear.
• Not PTSD-related avoidance. Avoiding reminders of trauma is a different pattern, though the two can coexist.
• Not a choice. Avoidance feels necessary, not optional, for people with agoraphobia, which is why avoiding nervous situations becomes self-reinforcing.

How It Is Assessed and Treated

A psychologist or physician assesses agoraphobia by asking about feared situations, panic attacks, avoidance, and the effect on daily life, and by ruling out medical causes of symptoms. Cognitive behavioural therapy is the main treatment. It helps people understand panic, reduce safety behaviours, and gradually face avoided situations through exposure. Interoceptive exposure, deliberately bringing on harmless physical sensations, can reduce fear of the body's signals. Medication prescribed by a physician may also help some people. Virtual therapy can be a useful starting point for those who find leaving home very difficult.

Getting Support at Pacific Maple Psych Centre

If fear of panic or of being trapped is limiting where you can go, therapy can help you expand your world again at a pace that feels manageable. Virtual sessions are available if coming in person feels too hard at first.