The Hope Project (THP): Understanding Agoraphobia

Updated: Jul 25, 2021

With over 6 billion people on the planet, 21 megacities such as Tokyo-the world's most densely populated metropolitan area (36.5 million people)- and more than half of the world's population living in cities, we are constantly threatened by urban spaces and infrastructure. This mode of living denotes situations where exit may be difficult or impossible. While the majority of the population copes well with these conditions, people with agoraphobia regard them as distressing, dangerous, or panic-inducing, thinking that they would not be able to escape in the event of a panic attack (American Psychiatric Association, 2000).

This article provides insight into etiology, common symptomatic presentation, and options available for the management of agoraphobia.

What is Agoraphobia?

Fear of the agora—the Greek word for public gathering places—was once assumed to be the source of agoraphobia (Marks, 1987). This led to a widespread misperception that agoraphobia is always associated with a dread of going outside or that individuals with agoraphobia are usually housebound. In reality, agoraphobia can be understood as an irrational or disproportionate fear of a variety of situations in which an individual believes getaway or availability of help may be unfeasible, very complicated, or very humiliating if he or she develops panic-like symptoms or some other immobilising loss of control.

Who Is At Risk?

In most people, agoraphobia develops as a complication of panic disorder. In agoraphobia with panic attacks, a combination of biological and psychological factors form the basis.

Biological Factors:

  • Fight/Flight reflex: It has been found that when the fight and flight reflex is triggered wrongly it may lead to a panic attack.

  • Neurotransmitters: An imbalance in neurotransmitter levels in the brain, might alter mood and behaviour. In some cases, this might result in a heightened stress reaction.

  • Spatial Awareness: Some individuals with panic disorder have a reduced sense of balance and spatial awareness. In crowded environments, this can make them feel overwhelmed and disoriented.

Psychological Factors:

  • A painful childhood event, such as a parent's death or being sexually molested.

  • Grief, separation, loss of employment, or experiencing any other stressful events.

  • A previous history of depression, anorexia nervosa, or bulimia, as well as alcohol or drug abuse.

  • Being in an unsatisfactory relationship or one in which the partner has a lot of power over the individual.

Even if a person does not have a history of panic disorder or panic episodes, they can experience symptoms of agoraphobia. A variety of irrational fears (phobias) can cause this sort of agoraphobia, including the fear of:

  • Landing in a situation of violent crime or terrorist attack if they leave home.

  • Risk of contracting a serious illness, if they visit crowded places.

  • Doing something unintentionally that causes them to embarrass or humiliate themselves in front of others.

Women are far more likely than men to have agoraphobia, and the intensity of agoraphobic avoidance increases among females. Approximately 80 to 90 percent of persons with severe agoraphobia are female (Bekker, 1996; White & Barlow, 2002). A sociocultural explanation is the most popular explanation for the significant gender gap in agoraphobia (McLean & Ander- son, 2009). It is more normal in a lot of cultures for women who experience panic to avoid the circumstances they fear and to require the company of a trusted companion when they enter fearful settings. Males who experience a sense of panic are more likely to "rough it out" owing to cultural expectations and their assertive, utilitarian approach to life (Bekker, 1996).

Other studies have found that civilizations and societies with inflexible gender norms on a sociocultural level have a greater prevalence of agoraphobia.

How does it affect people?

Streets and crowded areas such as shopping malls, movie theatres, and stores are among the most typically feared and avoided circumstances in agoraphobia. It can be extremely challenging to wait in line. Individuals with agoraphobia are afraid of having a panic attack or becoming ill if they are in places or situations where escaping would be physically impossible or psychologically unpleasant, or where immediate help would be unavailable if something horrible happened. They are usually terrified of their own physiological sensations, therefore they avoid arousing activities like exercising, viewing scary movies, consuming caffeine, and even engaging in sexual activity.

Individuals with agoraphobia also prefer to avoid places where panic attacks have occurred at first, but this avoidance usually spreads to other circumstances where a panic attack may occur. An individual may be anxious even while venturing outside their homes alone in fairly severe cases. In the most extreme cases, agoraphobia is a completely crippling illness in which an individual is unable to leave the limits of their house—or even certain areas of their home. Other symptoms include rapid heartbeat, hyperventilating, feelings of hot sweat and sickness, chest pain, diarrhea, trembling in the body, dizziness, or ringing in the ear.

Treatment/Management Options

To obtain adequate symptom management, patients might choose between psychotherapy and medications.

According to most studies, cognitive-behavioral therapy (CBT) efficiently treats and alleviates target symptoms, reduces additional anxiety symptoms, and improves the patient's overall quality of life. There are various successful drug management alternatives for patients with more severe cases of agoraphobia or for those who prefer pharmacotherapy rather than psychotherapy. Selective serotonin receptor inhibitors (SSRIs) are commonly used as first-line therapy, with therapeutic doses similar to those used for depression. Alternatives to SSRIs include serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and benzodiazepines. Owing to side effect profile, price, availability, less risk for misuse, and superior tolerance, SSRIs are often preferred to these other drugs.

There is also evidence that suggests that combining CBT with medication may be the most effective way to control symptoms.


Agoraphobia is exceedingly common in the general population, despite the fact that it was only recently distinguished from panic disorder by its diagnostic criteria. When it's present, it can cause severe distress, incapacitating the person; because agoraphobia has a persistent and chronic course, if left untreated, it's critical that it's detected early and treatment started right away.


Unwired India is a neurotech-startup that aims at integrating state-of-the-art research and developments in STEM, for catalyzing the transition of Neuroscience to Neurotechnology. We develop avant-garde non-invasive neurostimulation products used to solve some of the world’s most critical global issues and challenges. Our mission is to take cutting-edge brain research directly into the lives and homes of people, thereby fostering a unique culture of sustainable neuroscience and scientific literacy in India.

  • Founded in 2020, we are the pioneers of Nootropics and non-invasive Neurotechnology devices in the country, and offer so much more than high-quality, delicious Brain Nutrition products for daily cognitive support; a full-service health and fitness startup that has become an important part of the local community, here in New Delhi, India.

  • We develop non-GMO, all-natural nootropic (smart-drug) formulations, Himalayan herb blends, and specialized amino-nutraceutical interventions and supplements for enhanced brain function, cognition, neuroinflammation, and neurodegeneration.


The Hope Project (THP) is a neuro-disorder awareness initiative within the organizational framework of Unwired India. The initiative aims at creating and scaling awareness against the stigma, fear, and apprehensions associated with Neurological disorders.

Aims: To promote and develop awareness across global masses and to emphasize the importance of early detection, in addition to fostering a healthy lifestyle- which is important in the management and treatment of these ailments.


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A friendly reminder: We've done our research, but you should too! Check our sources against your own and always exercise sound judgment. 

Butcher, J. N., Mineka, S., Hooley, J. M. (2013). Abnormal Psychology. Pearson. 

Image Sources: by Skitterphoto


About the Author

Ishika Jain

Content Writer for The Hope Project (Delhi, India)

Ishika Jain is a student of Psychology honors from the University of Delhi, armed with hands-on knowledge in research, public health, and health tech. She has worked in the field of global mental health, community research, and intervention, assisting in science communication and research writing. She has a keen interest in Neuropsychology, with a blend of neuroscience, philosophy, and interpersonal contact.

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