Can Agoraphobia Develop Later In Life?

Agoraphobia is a sub-type of anxiety disorder and is typically associated with the fear of open spaces; however, it is much more complex. Traditionally, it is believed that agoraphobia develops in childhood, adolescence or early adulthood before the age of 35, but there are other research findings to suggest that agoraphobia can manifest in older adults as well.    In fact, late-onset agoraphobia can be quite challenging to deal with, especially due to ageing. In this article, we’ll look at late-onset agoraphobia in depth.  

Understanding Agoraphobia

  Agoraphobia is an anxiety disorder characterized by an intense fear of being in places or situations where a person might find it difficult to escape or seek help if they get a panic attack. People with agoraphobia also fear losing control or being embarrassed in public. They find it difficult to leave spaces that they consider safe. Thus, they are likely to avoid crowded places like public transport, shopping malls or any large open spaces or even enclosed places.   Agoraphobia is usually triggered by a panic attack, after which the person will try to avoid any situation or place where they previously had a panic attack. In extreme cases, people may find it difficult to leave their houses without support.   

Late Onset Agoraphobia

  While it is typically associated with adolescents and young adults, agoraphobia can develop in later stages of life as well. In such cases, it is known as late-onset agoraphobia, which can manifest in adults above the age of 65. Although it is less common, various factors put older adults at risk for agoraphobia. They are:  

• Poor Visuospatial Memory

Older adults may experience a decline in visuospatial memory, the brain’s ability to identify and remember spatial relationships between objects. Poor visuospatial memory can lead to disorientation or fear of becoming lost, particularly in unfamiliar settings, increasing anxiety and contributing to agoraphobic tendencies.  

• Severe Depression

A study suggests that a prior diagnosis of depression is a major risk factor for the late onset of agoraphobia. Depression, especially common in older adults, can heighten anxiety and lead to fears of public or social spaces.  

• Trait Anxiety

Trait anxiety is a personality characteristic that predisposes people to experience heightened anxiety. It can intensify with age, putting older people, who are naturally prone to having anxious thoughts, at an increased risk for agoraphobia as they may feel less secure or confident in going into unfamiliar environments.  

• Traumatic Events

Experiencing traumatic events such as the loss of a spouse, serious illness or a significant life transition can trigger symptoms of late-onset agoraphobia.  

• Family History Of Mental Illness

Genetics can play a role in the development of agoraphobia. Older adults with a family history of anxiety or other mental health disorders may be more susceptible to developing agoraphobia, even if they have not shown symptoms earlier in life.  

• Chronic Physical Health Issues or Disability

Research suggests that chronic physical health issues and disability can lead to the development of agoraphobia in older adults.  

Treatment of Late-Onset Agoraphobia

  Late-onset agoraphobia can be treated in the following ways:  

• Cognitive Behaviour Therapy (CBT) which involves challenging negative thoughts and replacing them with helpful ones, is one of the most effective and evidence-based treatments for agoraphobia.
• Exposure Therapy which involves gradually exposing the person to feared stimuli in controlled conditions, is also effective in treating agoraphobia
• Social support through support groups, group therapy, and friends and family can play a key role in recovery.
• Sometimes medications and lifestyle changes might be necessary to facilitate recovery.

 

Conclusion

In summary, while agoraphobia is associated with adolescents and young adults, late-onset agoraphobia, a subtype of agoraphobia, can develop in adulthood. As per research, severe depression, loss of a loved one, predisposition to anxiety and physical illness are all risk factors for late-onset agoraphobia, which can manifest after the age of 65. However, late-onset agoraphobia can be treated with therapy, medications, lifestyle changes and social support.  

References:

 

1. Agoraphobia—Symptoms and causes—Mayo Clinic. (n.d.). Retrieved October 25, 2024, from https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987
2. Bharani, N., & Lantz, M. S. (2007). New-onset agoraphobia in late life. Clinical Geriatrics, 15(1), 17–20.
3. Joel Yager, M. D. (2013). Agoraphobia—Not Just in Young Patients. NEJM Journal Watch, 2013. https://doi.org/10.1056/nejm-jw.NA31310
4. Ritchie, K., Norton, J., Mann, A., Carrière, I., & Ancelin, M.-L. (2013). Late-onset agoraphobia: General population incidence and evidence for a clinical subtype. The American Journal of Psychiatry, 170(7), 790–798. https://doi.org/10.1176/appi.ajp.2013.12091235
5. Sharif, A. (2023, December 12). What Are the Causes of Late Onset Agoraphobia? https://www.icliniq.com/articles/geriatric-health/late-onset-agoraphobia