The term agoraphobia derives from the Greek word ‘agora’ which translates as ‘open place’ or ‘market place’ so ‘agoraphobia’, in literal terms (as opposed to clinical terms) means fear of ‘open places’ or ‘fear of the market place.’
Agoraphobia is listed by DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – sometimes referred to as the ‘psychiatrist’s bible’) as an anxiety disorder and, in order to be diagnosed as suffering from it, an individual must experience a ‘marked fear’ of two or more of the following situations :
- using public transport
- being in large, open spaces such as car parks
- being in enclosed spaces such as shops
- standing in a queue or being in a crowd
- being outside of one’s home by oneself
As a result of this fear, the individual who is suffering from agoraphobia either avoids such situations or endures them whilst experiencing significant distress; the distress or avoidance are caused by a fear that if something goes wrong escape would be difficult or help may not be forthcoming if panic symptoms or other incapacitating or embarrassing symptoms occur.
POSSIBLE CAUSES OF AGORAPHOBIA LINKED TO CHILDHOOD
Research has found that certain types of childhood trauma increase an individual’s risk of developing agoraphobia such as the death of a parent or being sexually abused.
REJECTION AND LACK OF PARENTAL WARMTH :
Research conducted by Arrindell et al. compared in-patient agoraphobics with ‘normal’ controls. All the participants were given questionnaires about how they were parented and it was found that :
- agoraphobics reported being brought up by parents who were less emotionally warm than the controls’ parents
- agoraphobics were more likely to report being rejected by their mothers compared to the controls.
These findings were given added weight because of the fact they replicated previous research findings involving agoraphobic out-patients (as opposed to in-patients that were used in the research described above).
SEPARATION ANXIETY :
Gittelman and Klein, in a paper reviewing research into whether or not there exists a link between agoraphobia and separation anxiety found that there is evidence of such a link in females but not in males; they concluded from this that it is possible that agoraphobia has different causes in females than it does in males.
Furthermore, a review of research literature carried out by Gwinnett Center for Counseling and Family Therapy found that there was a link between adult agoraphobia and separation-anxiety issues as a child.
OTHER POSSIBLE CAUSES OF AGORAPHOBIA
- An imbalance of neurotransmitters in the brain leading to an exaggerated stress response.
- The brain’s ‘fear circuitry’ is ‘wrongly wired’
- Impaired spatial awareness.
- Fight/flight response incorrectly triggered.
Arrindell, W., Kwee, M., Methorst, G., Van der Ende, J., Pol, E., & Moritz, B. (1989). Perceived Parental Rearing Styles of Agoraphobic and Socially Phobic In-patients. British Journal of Psychiatry, 155(4), 526-535. doi:10.1192/bjp.155.4.526
Ellis EM. Adult agoraphobia and childhood separation anxiety: using children’s literature to understand the link. Am J Psychother. 1990 Jul;44(3):433-44. doi: 10.1176/appi.psychotherapy.19188.8.131.523. PMID: 2221215.
Klein, Rachel & Klein, Donald. (1984). Relationship Between Separation Anxiety and Panic and Agoraphobic Disorders. Psychopathology. 17 Suppl 1. 56-65. 10.1159/000284078.
David Hosier BSc Hons; MSc; PGDE(FAHE).