What You Might Be Getting Wrong About Agoraphobia

Agoraphobia may be one of the most common phobias out there (it even played a part in the last season of American Horror Story), but there's still a lot that we get wrong about it. While many people assume that it only has to do with fear of open spaces, it's a bit more complex than that.

Dianne Chambless, PhD, a psychology professor at the University of Pennsylvania, says that the term comes from the Greek word "agora," meaning an open air marketplace — so, yes, the phobia can involve open spaces, but as Dr. Chambless puts it, there are other things, like large crowds, that can make an open market anxiety-inducing for some people.

In that sense, she says agoraphobia is typically defined as being afraid of situations where you might have a panic attack and not be able to leave, or to get to someone who, for you, represents safety. In other words, it isn't only about being averse to open spaces in general.

"It might, for some people, include fear of open spaces, but it also very often includes a fear of being away from home, with some people only afraid of being away from home if they’re out of town, and other people being afraid of being away from home if they’re just down the block," she says, adding that this can also lead to fears of bridges, public transportation, and driving — or things that take people away from home.

In fact, part of what makes agoraphobia complicated is that many people who have it also have a fear of being closed into confined spaces — a key characteristic of a condition known as claustrophobia.

According to Laszlo Papp, MD, associate professor of clinical psychiatry at Columbia University Irving Medical Center, someone who has agoraphobia can also have claustrophobia (meaning, claustrophobia can definitely exist under the blanket of agoraphobia). But Dr. Chambless says that agoraphobia, just by nature of encompassing so many issues, has the potential to be more serious than claustrophobia.

"Severe claustrophobia can have a very negative impact on a person’s life," she says. "But with agoraphobia, at its most severe, people can even become housebound."

Of course, not everyone has the same symptoms or even fears. So how can you tell if you might be suffering from agoraphobia?

A surefire sign, Dr. Papp says, is if you develop a pattern of panic attack-like symptoms in certain situations, whether it happens in an open space or just outside your doorstep.

"Your heart starts palpitating, you're short of breath, you start feeling faint and dizzy," he says.

What's more, with agoraphobia, those panic symptoms may cause you to fear the onset of the anxiety itself, and go out of your way to avoid the situations in which they happen. Dr. Chambless says that the patients she sees in treatment for agoraphobia usually also have a panic disorder, which is why treatment for the phobia also often addresses panic attacks and anxiety.

"We help people to understand that what’s happening is very unpleasant but is not life-threatening, or threatening to their mental stability," she says.

Treatment is also two-fold — doctors work on gradually exposing the person to the bodily sensations that are reminiscent of panic, as well as the actual situations that cause them panic. Since people with panic disorder can be afraid of any physical sensation that reminds them of panic attacks, like a rising heart rate, they may stop doing things like exercising or having sex that would get their heart rate up.

"[To treat that,] we help them get comfortable with those sensations again so that they’re not so frightening when they occur," Dr. Chambless says. "And then we work on the avoidance of things, like being away from home using public transportation, driving, whatever those particular patterns of fear would be."

The bottom line is, if you think you might be suffering from agoraphobia — or any phobia, for that matter — it's worth asking for help, even if you don't completely understand where it's coming from just yet.