Agoraphobia is the fear of places from which it would be difficult or embarrassing to escape or be rescued. This phobia is based on the fear of not being able to find help and safety in the place if something happens and not in the place itself.

Crowded, enclosed, or deserted places can represent a real torture for some of us. In this case, we talk of agoraphobia, a psychic disorder that makes the 3% of the population who suffer from it panic just at the idea of being confronted with a situation they deem uncontrollable.

What is agoraphobia?

Agoraphobia is defined as “a phobia of open and public places”. It is characterized by a fear of places where it is difficult to escape or be rescued. This implies that the fear is not only about places with crowds, but also about enclosed spaces with little attendance or vast deserted places.

It is therefore wrong to reduce agoraphobia to a unique fear of crowds, which a phobia on its own right called ochlophobia. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) also introduces the notion of anxiety to the definition of agoraphobia. It is then described as “anxiety related to being in places or situations from which it might be difficult or embarrassing to escape or in which no help could be found in the event of a panic attack or panic-like symptoms.”

Namely! “Agora” comes from Greek which means “public square”.

Symptoms

People with agoraphobia often suffer from recurrent and unpredictable panic attacks. The crisis results in various symptoms:

• Palpitations;
• Feeling of warmth;
• Dizziness;
• Intense fear;

Therefore, the person suffering from agoraphobia will develop an avoidance behavior towards situations or places at risk, because they fear reliving the panic attack. These spaces include:

• Large spaces such as shopping malls or public squares;
• Enclosed spaces, e.g. public transport (bus, metro, planes, train), tunnels, elevators or cinemas;
• Public places such as restaurants, queues or gatherings;
• Places at height, for example bridges, landings or escalators.

Patients may also fear loneliness, and be afraid to leave their homes or loved ones.

Not all agoraphobes have the same fears. A patient may, on the other hand, be afraid of several situations or several places, without specificity. Ultimately, agoraphobia can have a strong impact on the patient’s social life.

Diagnosis

The diagnosis is clinical, and is based on the presence of the three components of the phobia:

• Anticipatory anxiety: the patient anticipates the fear. The latter can be varied: fear of dying, fear of discomfort or an accident, fear of losing self-control, fear of going crazy;
• The anxiety reaction itself: anxious behavior is variable in duration and intensity. The attack may, for example, manifest itself in 2 or 3 symptoms such as tachycardia, dizziness and a feeling of suffocation;
• Avoidance to calm anxiety. Patients thus adapt their behavior, by being getting someone to with them or by choosing hours of low attendance, for example, to visit such places.

Treatment

A psychotherapist can help the patient manage a panic attack, including learning breathing techniques or diverting attention. The objectives of agoraphobia management are therefore based on reducing the frequency and intensity of panic attacks. Drug treatment (antidepressant or anxiolytic) may be offered for a short time to help manage the panic disorder.

Cognitive-behavioral therapies are widely used to treat agoraphobia and achieve very good results. They are based on the progressive exposure of the patient to the physical sensations that he or she fears in order to develop relaxation methods. Often, 10 to 25 sessions are enough.

The gradual exposure of the patient can be carried out through virtual reality. This is called therapy through gradual exposure in virtual reality.