Agoraphobia is an anxiety disorder characterized by an intense fear of situations or locations that may be difficult to escape. People with agoraphobia may avoid public transportation, movie theaters, long lines, airplanes, and other public spaces. Agoraphobia can trigger severe panic attacks that in some cases prevent individuals from leaving their homes.
History and Origins
The term “agoraphobia” is derived from the Greek word “agora.” Agoraphobia literally translates to “fear phobia of the marketplace agora,” but the term marketplace refers more broadly to any populated public space.
German psychiatrist Carl Friedrich Otto Westphal first introduced the term in 1871, when he wrote Agoraphobia: A Neuropathic Phenomenon. He described his observations of individuals who suffered sensations of panic when faced with the proposition of being in public.
One of the earliest notable individuals known to have agoraphobia was Charles Darwin. The Journal of the American Medical Association speculates that Darwin's lifelong isolation that ensued after his Beagle voyage was a result of panic he felt in public spaces. However, the journal also credits the disorder with the eventual publication of On the Origin of Species and Darwin's famous theories around evolution.
Traits and Signs
Agoraphobia is most commonly associated with fears of crowds, lines, enclosed spaces, large open spaces, public transportation, or leaving home. These fears must exist in tandem with the following characteristics for a diagnosis of agoraphobia to be made:
- An anxiety reaction and a disproportionate fear response when confronted with a phobic stimulus (such as public transportation, enclosed spaces, or large open spaces)
- Deliberate avoidance that significantly affects or disrupts ability to function
- Symptoms that persist for at least six months
Some individuals experience physical symptoms of panic in association with agoraphobia. Panic attacks produce physical sensations including rapid heartbeat, trouble breathing, dizziness, tingling, sweating, chills, and nausea.
The Napa State Hospital's Department of Psychiatry studied the behavior of "Mrs. E.L.," a 91-year-old patient who suffered from agoraphobia. Mrs. E.L. lived with her husband and received health care from a home health aide. She spent 17 years confined to her bed due to extreme fears of falling, dying, never being found, and being accidentally buried alive. Her fear was so intense that, in addition to never leaving the house herself, she also forbade her husband from going outside.
Mrs. E.L. was prescribed medication and a course of behavioral and exposure therapy. Soon, she was able to leave her bed and eventually her home. Based on this case study, researchers concluded that even the most severe cases of agoraphobia can be treated and rehabilitated, as long as patients have access to a properly coordinated care plan.
Representations in Popular Culture
Several celebrities have spoken out about their experiences with agoraphobia, including cooking show personality Paula Deen and Beach Boys singer/songwriter Brian Wilson. Author Shirley Jackson's novel We Have Always Lived in the Castle is believed to be largely inspired by her struggle with agoraphobia.
Agoraphobia has been depicted onscreen in films like Copycat, Intruders, Nim's Island, and The Last Days. These movie depictions are not always accurate or comprehensive. For example, in Copycat, a character develops severe agoraphobia after experiencing a violent assault. Agoraphobia can be triggered by a traumatic episode, but not all individuals with agoraphobia report a prior traumatic incident. In addition, not everyone with agoraphobia is afraid of leaving their home. While cultural representations of agoraphobia can help build awareness of the disorder, it's important to note that every individual's experience of agoraphobia is distinct, and not all depictions are entirely accurate.
- Aqeel, Noorulain, et al. “A Strange Case of Agoraphobia: A Case Study.” Insight Medical Publishing Group, Insight Medical Publishing Group, 19 Oct. 2016, primarycare.imedpub.com/a-strange-case-of-agoraphobia-a-case-study.pdf.
- Barloon, T. J. “Charles Darwin and Panic Disorder.” JAMA: The Journal of the American Medical Association, vol. 277, no. 2, Aug. 1997, pp. 138-141., doi:10.1001/jama.277.2.138.
- Mayo Clinic Staff. “Agoraphobia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 Nov. 2017, www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987.
- McNair, James. “Brian Wilson: Here Comes the Sun.” The Independent, Independent Digital News and Media, 2 Sept. 2007, www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html.
- Moskin, Julia. “From Phobia to Fame: A Southern Cook's Memoir.” The New York Times, The New York Times, 28 Feb. 2007, www.nytimes.com/2007/02/28/dining/28deen.html.