Rasika Karkare 
What is Agoraphobia?
Agoraphobia is a form of anxiety disorder. Agoraphobia typically involves an intense fear of places or situations where escape might be difficult or embarrassing, or where help may not be readily available in the event of a panic attack or other anxiety symptoms. In simpler terms, people suffering from agoraphobia find it difficult to leave an environment that feels safe, as it helps them avoid feelings of anxiety or panic. In extreme cases, people may not even leave their homes due to anxiety.
Dealing with agoraphobia can be very distressing, as people suffering from it typically experience symptoms of panic attacks such as rapid heartbeats, nausea, and shortness of breath whenever they are in a stressful situation. Due to fear and anxiety, someone with agoraphobia is likely to avoid new and unfamiliar situations like:
- A highly crowded area
- A large open or closed space
- Public transport
They avoid these spaces because they fear that they might not get any help in case they experience a panic attack.
How Does Agoraphobia Start?
Agoraphobia can begin in childhood, but it usually starts in late teenage or early adulthood before the age of 35. Sometimes Agoraphobia can begin even in older adulthood. Typically, agoraphobia can begin if a person experiences a panic attack in a specific situation or environment. They may start avoiding that situation for fear that they might get another panic attack when they are in that situation again. Over time, this can escalate into a generalized fear of being in public.
Causes of Agoraphobia
The exact cause of agoraphobia is unknown as of now. However, because agoraphobia is a complicated disorder, there are a variety of causes for it, including:
Panic Disorder
Panic disorder is a condition where people regularly experience sudden attacks of panic or fear. Panic disorder is closely linked with agoraphobia, as many but not all people with panic disorder can develop agoraphobia.
Genetics and Personality Factors
Genetics plays an important role in the development of agoraphobia. The heritability of agoraphobia is reportedly 61 per cent, which makes it the phobia most strongly connected to a genetic predisposition among all phobias. Having a nervous personality has also been linked with agoraphobia.
Fight or Flight Response
The body's "fight or flight" response, which is intended for stressful situations, may inadvertently be triggered in case someone has a panic disorder with agoraphobia. This results in the release of hormones such as adrenaline, which quickens breathing and raises the heart rate during a panic attack. It's like your body preparing for danger even when there isn't one.
Other Anxiety Disorders
Having another anxiety disorder, such as Obsessive Compulsive Disorder (OCD) or Generalized Anxiety Disorder (GAD) may also increase the risk of developing agoraphobia.
Psychological Factors
Certain psychological factors can also increase the risk of agoraphobia. They are:
- Experiencing a traumatic event in childhood, like the death of a loved one or being sexually abused
- Experiencing a stressful event like loss of job or divorce
- A history of depression or eating disorders
- A history of substance abuse
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.
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.
How To Get Over Agoraphobia Naturally?
Agoraphobia may initially start with fear or avoidance of some anxiety-provoking places, but it can worsen over time. In extreme cases, some people might avoid leaving the house entirely due to fear. While anti-anxiety medications can certainly be helpful, there are also natural strategies that people can incorporate into their daily lives to overcome agoraphobia. Some of them are:
Aromatherapy
Aromatherapy is an alternative therapy approach that involves using essential oils or fragrances to reduce the symptoms of anxiety. Following are the scents commonly used in aromatherapy to promote relaxation and decrease negative emotions.
- Lavender oil is known for its soothing properties. The fragrance of lavender is thought to enhance mood and lessen nervous feelings. This fragrance is suitable for calming effects at any time of the day. Using it before bedtime can be particularly helpful in encouraging peaceful sleep.
- Lemon: The fragrance of lemon oil is thought to improve mood, increase concentration, and reduce feelings of fear, which are hallmarks of agoraphobia.
- Bergamot: Inhaling the fragrance of bergamot oil can bring about a sense of refreshment and energy. This essential oil is thought to assist in managing symptoms of anxiety by reducing feelings of fear and bringing about deep relaxation.
Practicing Visualisation
Visualization involves using imagination or mental imagery to achieve a relaxed mind. For agoraphobia, visualisation can be used in multiple ways. Some of them are:
- Visualizing a calm and comforting space that makes you feel safe while you are undergoing a stressful situation.
- Thinking of a recent positive or happy memory to trigger positive feelings in situations that trigger agoraphobia.
- Visualize successfully navigating through situations that trigger agoraphobia. Imagine yourself calmly moving through crowds or walking in open spaces. Combine positive affirmations with these visualizations to reinforce a sense of control and capability.
Gradual Exposure
Gradually exposing yourself to difficult situations can help overcome agoraphobia. Create a list of difficult situations and rank them from least difficult to most difficult, creating a fear hierarchy. Start with small steps, such as taking short walks close to home or spending time in less crowded areas. As comfort increases, gradually expose yourself to more challenging situations. Celebrate each achievement, no matter how small, and be patient with the process.
Self-Care
Self-care is an essential part of overcoming agoraphobia. Take care of yourself by incorporating regular exercise, a balanced diet, and 7-8 hours of sleep in your daily schedule. All these things have been proven to reduce stress and anxiety over time. Also, start practising deep breathing techniques so that you can use them during stressful situations.
Social Support
A strong support system is crucial for overcoming agoraphobia. Share your experiences with trusted friends or family members who can provide encouragement and understanding. You can also consider joining support groups or online communities where individuals with similar struggles can share insights and advice.
While all the above-mentioned techniques can contribute to recovery from agoraphobia, ultimately recovery depends on the severity of symptoms as well. If the symptoms are particularly severe, it might be a good idea to use these techniques alongside psychotherapy or medications. Trying to overcome severe agoraphobia with natural remedies comes with the risk of making it worse in the long run.
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
Dealing with agoraphobia can often be overwhelming, as it can restrict a person from living their life fully. However, it is important to know that agoraphobia can be treated and overcome with effective treatments. Agoraphobia can often be treated with a combination of psychotherapy, medications, exposure therapy, social support, and lifestyle changes. 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. If you see anyone in your life going through agoraphobia, it is advisable to seek help at the earliest.
References
A Daily Plan for Overcoming Agoraphobia. (2016, May 17). Psych Central. https://psychcentral.com/lib/a-daily-plan-for-overcoming-agoraphobia
Agoraphobia. (n.d.). Cleveland Clinic. Retrieved December 1, 2023, from https://my.clevelandclinic.org/health/diseases/15769-agoraphobia
Agoraphobia—Symptoms and causes. (n.d.). Mayo Clinic. Retrieved December 1, 2023, from https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987
B.C.B, R. M., Psy D. (2023, March 28). 6 Effective Ways to Treat Panic Disorder Naturally. Evolutions Behavioral Health Services. https://www.evolutionsbh.com/articles/6-effective-ways-to-treat-panic-disorder-naturally/
Bharani, N., & Lantz, M. S. (2007). New-onset agoraphobia in late life. Clinical Geriatrics, 15(1), 17–20.
Causes—Agoraphobia. (2021, February 12). Nhs.Uk. https://www.nhs.uk/mental-health/conditions/agoraphobia/causes/
Joel Yager, M. D. (2013). Agoraphobia—Not Just in Young Patients. NEJM Journal Watch, 2013. https://doi.org/10.1056/nejm-jw.NA31310
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
Sharif, A. (2023, December 12). What Are the Causes of Late Onset Agoraphobia? https://www.icliniq.com/articles/geriatric-health/late-onset-agoraphobia
Using Essential Oils to Ease Anxiety When You Have Panic Disorder. (n.d.). Verywell Mind. Retrieved January 15, 2024, from https://www.verywellmind.com/aromatherapy-for-panic-disorder-2584281
Visualization Techniques Can Help Manage Your Symptoms. (n.d.). Verywell Mind. Retrieved January 15, 2024, from https://www.verywellmind.com/visualization-for-relaxation-2584112