Agoraphobia is generally known as a fear of open or public spaces, or a fear of leaving the house. It is diagnosed when the person experiences anxiety symptoms or panic attacks in multiple situations that fall under the umbrella of agoraphobia triggers. The origins of agoraphobia can be complex. They include trauma, brain chemistry, and co-occurring disorders.
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Agoraphobia symptoms include the same symptoms as anxiety and panic disorders. These include difficulty breathing, chest pain, trembling or shaking, lightheadedness, sweating, and nausea. Agoraphobia also frequently leads to panic attacks. Panic attacks are more severe episodes of anxiety. A panic attack typically peaks within about ten minutes and lasts about an hour.
A number of theories about agoraphobia and panic disorder in general have been put forward. These include faulty patterns of thinking, as well as biochemical and physiological aberrations.
Clark’s theory of catastrophic interpretations points to maladaptive or faulty interpretation of bodily sensations as a cause of panic disorder. Healthy individuals interpret certain physical sensations as normal or not alarming. Those same sensations are interpreted as imminently dangerous by an individual with panic disorder. For example, a racing heart after climbing stairs might be interpreted as a sign of an oncoming heart attack. This theory suggests that these patients can find relief by changing their interpretation of bodily sensations.
Another theory focuses on predisposing and precipitating factors. Those factors could include:
- physical conditions
- coping skills
These factors, combined with an immediate stressor such as the loss of a loved one, illness, or drug use set off a chain reaction of anxiety. After a series of panic attacks, automatic thoughts are engaged that lead to faulty conclusions about dangers. Thus, agoraphobia develops from an association between panic attacks and certain situations, driven by automatic thoughts.
The theory of panic attacks as a result of selective focusing on panicogenic interoception states that panic disorder patients give excessive attention to somatic sensations. They notice, perceive, and react to bodily stimuli, which then triggers a panic attack. Another interpretation of the theory says that instead of paying too much attention, panic disorder patients have more accurate and sensitive perceptions of somatic changes.
Learned alarm reaction
In the learned alarm reaction model, panic attack is a fight or flight reaction without any real danger. When the physiological sensations are paired with the false alarm, the reaction then becomes maladaptive.
Simple and complex
The theory of simple and complex agoraphobia says that anxiety caused by trauma, drugs, or illness would be simple, and agoraphobia caused by personality or psychological factors would be complex. Some other examples of simple phobias are animal phobias, bodily phobias, and sexual phobias.
Complex phobias are usually more disabling. In patients with complex agoraphobia, anticipation creates a vicious cycle of avoidance and fear triggers.
A final theory suggests that the primary symptom of panic attack, hyperventilation, is itself the cause of panic attack with agoraphobia. Contrary to the traditional view, that the panic attack is initiated by fear, this theory proposes that unexpected bodily sensations are the initial trigger for the disorder. One study showed that in a group of agoraphobes, almost all experienced symptoms of a panic attack before any fear developed.
Reviewed by Liji Thomas, MD.
- Cognitive and behavioral theories of panic disorder, http://psychologytoday.psychtests.com/articles/mentalhealth/cogpd.html
- Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299495/
- Beck AT, Emery G, Greenberg RI. Anxiety disorders and phobias. New York: Basic Books; 1985.
- NHS Choices, Phobias, https://www.nhs.uk/Conditions/Phobias/Pages/Introduction.aspx
- Blood, breath, and fears: a hyperventilation theory of panic attacks and agoraphobia, http://www.sciencedirect.com/science/article/pii/027273588590008X