Locked in: Understanding Agoraphoboia
What is agoraphobia?
The term agoraphobia translates from the Greek as a fear (phobos) of the marketplace (agora). It is used to describe both a psychiatric condition in its own right and a psychiatric symptom in which people fear crowded spaces and/or going outside. It therefore may occur in isolation or as part of another anxiety disorder, such as a panic disorder or generalized anxiety disorder.
In panic disorder, discreet panic attacks occur, whereas with generalised anxiety disorder, anxiety symptoms may occur throughout the day.
Agoraphobia is thought to affect approximately one in every 200 people.
What does agoraphobia look like?
The symptoms people with agoraphobia may experience include both physical and psychological symptoms of anxiety. The physical symptoms of anxiety include: sweats; palpitations (the sensation of a pronounced heartbeat); difficulty breathing; and chest discomfort.
Psychological symptoms of anxiety include a sense of constant worry and a tendency to catastrophize i.e. to think the very worst of a given situation. These symptoms typically lead to avoidance behaviour i.e. people avoid situations that they anticipate will lead to distress. This helps to explain why people with agoraphobia often stay in a place they regard to be safe, such as their home.
Agoraphobia can cause people to become very disconnected from their friends, family and colleagues. As a result, it can cause the affected person a great deal of shame and embarrassment.
Is agoraphobia more of a problem in light of Covid-19?
There has been more interest in agoraphobia over the past year as significant numbers of people around the world have had to isolate at home because of enforced lockdowns and some have found it very difficult to integrate into wider society as populations have opened up after restrictions have eased. Although self-reported rates of anxiety did go up in the early months of the pandemic, it is unclear whether the prevalence of agoraphobia has increased.
Anecdotally, there have been a significant number of people who have presented to health care professionals with agoraphobia, having not done prior to 2020. This includes those who had never experienced major anxiety symptoms or any previous mental health problems and those with pre-existing mental health problems who had not previously had agoraphobia. Some people who coped reasonably well with lockdown itself have found the easing of restrictions to be particularly unnerving, leading to the onset of these symptoms.
How can agoraphobia be treated?
Like other anxiety disorders, agoraphobia is primarily treated by psychological therapy and may also respond to treatment with medication.
The main form of psychological therapy is cognitive behavioural therapy (CBT). This seeks to explore how thoughts, feelings and behaviour are interlinked, uncover the underlying assumptions that people make in anxiety-provoking situations and identify the core beliefs the person with agoraphobia has about themselves, the world around them and the future. The therapy thus aims to challenge the existing responses and to reduce the distress caused.
Medications used to treat agoraphobic symptoms include antidepressants, particularly those that act on the serotonin pathway. Serotonin is a neurotransmitter (chemical messenger) that is strongly implicated in the onset of most anxiety disorders: the exact reason for this remains unclear. There are other drugs that may be used as second or third line options for patients with agoraphobia.
Treatment for agoraphobia may be started by a GP or may require input from a mental health professional such as a Clinical Psychologist or a Psychiatrist. Anyone who is concerned about whether they themselves or a loved one may have agoraphobia should seek support from their GP in the first instance.
Dr Chi-Chi Obuaya is a Consultant Psychiatrist working in the NHS and in independent practice, as well as a Mind & Soul Foundation Director