Agoraphobia: Fear of Open or Crowded Places

Any tourist or local of New York City who has visited the iconic Times Square can tell you about the overwhelming lights, crowds, and noise of the space. Billboards with blazing lights at every turn, people bumping into you (pre-Covid), and noise from the bustle of cars and street performers. A subway station with a never-ending maze of tunnels stands below, full of tourists and commuters traveling every which way. To the average person, Times Square feels inundating and overwhelming. There certainly isn’t an easy exit plan out of Times Square and, I would venture, most wouldn’t care to go there every day.

Imagine if everywhere felt like Times Square. Nowhere would feel safe and you’d likely prefer to stay home. This is how those with agoraphobia feel all the time—fearful of entering many types of spaces, especially if there’s no easy exit. For someone with this type of phobia, being in open spaces, crowds, or outside alone is terrifying and anxiety-provoking.

Read on to learn more about agoraphobia including the signs, causes, and ways to cope with this type of phobia.

Agoraphobia is a type of anxiety disorder defined by an intense fear of places that can lead to feeling trapped, helpless, scared, or embarrassed. Types of places that bring on this fear, such as crowds or public transport, are avoided to minimize social anxiety. Panic attacks are commonly experienced with agoraphobia. Someone with this type of specific phobia may also have panic disorder, but it depends on the person.

Agoraphobia definition and diagnosis

The term agoraphobia comes from the root “agora,” an assembly of people, and “phobia” or fear. Put together, agoraphobia means the fear of spaces with an assembly of people, which usually includes places with lines of people, crowds, and with no easy exit. This manifests as an anxiety disorder, a type of mental health condition diagnosed based on certain specified criteria.

Psychologists define agoraphobia in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5) as an anxiety disorder with intense fear of two or more of the following situations:

• Using public transportation
• Open spaces, such as markets or parking lots
• Enclosed spaces, such as stores and theaters
• Standing in line or being in a crowd
• Being outside of the home alone

Being in these situations causes significant distress to people with this type of social anxiety, so much so that it can inhibit normal daily life. The deeper fear is that of feeling trapped, helpless, panicked, scared, or embarrassed, which then manifests in the fear of the above situations. People with this type of specific phobia worry about being able to leave a situation and fear embarrassment as well. The fears associated with agoraphobia often make it difficult for someone struggling to leave their home as they prioritize avoiding anxiety-inducing places.

Agoraphobia usually emerges in young adulthood, with 17-years-old as the average age of onset. Approximately 1.3 percent of US adults will experience agoraphobia in their lifetime. There are similar rates of agoraphobia in women and men, and yearly prevalence for women sits at .9 percent and .8 percent for men.

Like all anxiety disorders, the symptoms associated with agoraphobia are intense and often debilitating. Feeling anxious or having a panic attack are key symptoms of agoraphobia, which may present in varying ways depending on the person. This could include dizziness, chest pain, hot flashes, among other symptoms. Here are some of the most prevalent symptoms of agoraphobia:

• Intense fear in situations involving public transport, crowds, open spaces, enclosed spaces, or leaving home.
• Moderate to extreme anxiety or panic attacks, symptoms of which can include:
• Sense of danger that is disproportionate to the situation
• Avoidance of situations that may trigger fear and distress
• Feeling a loss of control
• Feeling out of touch with reality

Someone dealing with these symptoms for six months or more may be diagnosed with agoraphobia by a doctor or psychologist if it’s causing them significant distress and inhibiting daily functioning. This can often look like avoiding any and all triggering places, which limits the ability to live normally. Panic disorder is another diagnosis that will be considered if panic attacks are prevalent as well. Always consult a medical or licensed mental health professional for an official diagnosis.

Agoraphobia has multiple causes that contribute to its onset. These factors include family history, genetic predisposition, comorbidity, and environmental stress.

Family history is one of the most significant risk factors for agoraphobia. If a blood relative has agoraphobia, you are much more likely to have this form of extreme anxiety  as well. Research has shown you are as much as 61% more likely to have agoraphobia if someone in your family does too. Just because someone in your family struggles with agoraphobia, however, doesn’t mean you absolutely will also, it simply increases the likelihood.

Along with family history, genetic predisposition to anxious tendencies are other risk factors of agoraphobia. If you struggle with another anxiety disorder or panic disorder you are at a higher risk for agoraphobia. Comorbidity is common with agoraphobia as it often presents with other mental health conditions. This could be another anxiety disorder or a different type of mental health condition such as depression, personality disorders, or substance abuse.

Environmental stress is also a significant factor in causing agoraphobia. History of abuse or traumatic life events, such as the death of a loved one or being attacked, can lead to fearing places that are overwhelming and lack an easy exit. This trauma, especially when combined with a predisposition towards anxiety, can lead to the onset of agoraphobia in people of all ages, but especially those in adolescence and young adulthood.

Clearly many factors contribute to agoraphobia, so if you’re experiencing symptoms of agoraphobia and relate to some or all these experiences, please seek out the help and advice of a mental health professional.