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Although the name is very little heard among the public, the population-based study, which included more than 136 thousand participants from twenty-seven countries, determined the lifetime and 12-month prevalence of agoraphobia as 1.5% and 1%, respectively. I wanted to introduce more common agoraphobia, which affects the functionality of the patients very negatively, in more detail.



The term agoraphobia, defined by the Austrian psychiatrist Carl FO Westphal (1833-1890) in 1871, is the combination of the word agora, which means the market or market used in Greek, and the words phobos. While Westphal described this term after the intense anxiety experienced by three men in the open space, he also found that these individuals had physical symptoms such as palpitations, redness and chills. Today agoraphobia is one of the phobic conditions that cause disability and treatment.


Clinical View


The primary view of agoraphobia is anxiety. This anxiety is related to a particular situation and avoidance behavior can also be observed. Avoidance behavior can have many different causes. In the majority of cases, individuals exhibit avoidance behavior due to fear of encountering panic symptoms and facing a shameful result or feelings of helplessness. They may have fears that they will lose control or die. Concerns about losing control, such as losing bowel or urine control, vomiting, fainting, going crazy, or becoming dysfunctional are typical. In some cases, phenomena cannot fully define their fears, and it can be described as terrified and ruptured.


Individuals with agoraphobia describe a safe area in which they feel safe. This safe area can also be homes or a certain area in their neighborhood. Especially when they want to travel alone, individuals diagnosed with agoraphobia can completely prevent leaving this area or they have a serious anxiety. Individuals diagnosed with agoraphobia can do some safe behavior to reduce their anxiety. Safe behaviors are actions taken to prevent individuals from fear or to cope with the expected threat. For example, traveling with someone they know and trust, carrying a mobile phone, carrying anxiety medication, carrying a water bottle, sitting near the exit, using anti-diarrheal medicines or anti-nausea medications. These behaviors may play a role in the survival of the disease.



Common Agoraphobic Conditions


  1. Waiting in line

  2. Crowded places

  3. Being alone at home

  4. Shopping markets

  5. Drive a car

  6. Restaurant

  7. Movie-theater

  8. Wide open spaces

  9. Hairdresser

  10. Doctor-dental examinations

  11. Don't be away from home

  12. Public transport

  13. Fly



Clinical Features


Agoraphobia is seen three times more in women. Agoraphobia may start suddenly immediately after panic-like symptoms, or it may start gradually over time. The average age of onset is twenty, and the vast majority of cases begin before age 55. Its incidence in young people is two times higher than in middle-aged adults.


Risk factors


Known risk factors for the development of agoraphobia are shown below.


  1. Young age,

  2. Female gender,

  3. Presence of panic disorder diagnosis,

  4. It is the presence of a diagnosis of other phobic disorders.


Disease Going


The course of the disease is usually chronic and spontaneous recovery is not expected in cases without treatment. During the 10-year follow-up period, agoraphobia has been identified as one of the most resistant disorders and it has been found that complete recovery is very unlikely. Agoraphobia changes the lifestyle of the person. Patients are looking for a safe zone. If agoraphobia is severe, it can make the person dependent on the home or some people.





A. Significant fear or anxiety regarding two (or more) of the five conditions below

  1. Using public transport (eg cars, buses, trains, ships, planes).

  2. Being in open places (eg parking lots, shopping malls, bridges).

  3. Being in closed places (eg shops, theaters, cinemas).

  4. Waiting in line or being in a crowded place.

  5. Being out of the house alone.

B. The person is afraid or avoids such situations because he thinks that escaping may be difficult or that he may not be able to get help if there are other symptoms that are panic-like or inadequate or embarrassing (eg fear of falling in the elderly; fear of missing gold).

C. The source of agoraphobia almost always causes fear or anxiety.

D. The sources of agoraphobia are effectively avoided, a companion is required, or suffered with intense fear or anxiety.

E. Fear or anxiety is disproportionate to the real danger posed by agoraphobia and in the social-cultural context.

F. Fear, anxiety, or avoidance is a constant condition, lasting six months or more.

G. Fear, anxiety, or avoidance causes a clinically apparent distress or reduced functionality in social, work-related areas, or other important areas of functionality.

H. If there is another condition that concerns health (eg inflammatory bowel disease, Parkinson's disease), fear, anxiety or avoidance is clearly excessive.

Fear, anxiety, or avoidance cannot be better explained by the symptoms of another mental disorder. For example, its symptoms are not limited to specific phobia, situational species; it does not cover only social situations (as in social anxiety disorder) and only with attachments (such as in obsessive-compulsive disorder), perceived imperfections related to external appearance (as in body perception disorder), abusive events with reminders (as in post-abuse tension) or separation. it is not associated with fear (as with separation anxiety disorder).


Note: The diagnosis of agoraphobia is made regardless of whether there is panic disorder. If the person's clinical appearance meets the diagnostic criteria for both panic disorder and agoraphobia, both diagnoses should be made together.


Differential Diagnosis


As with restless bowel syndrome or Crohn's disease, in general medical conditions, serious anxiety can be observed and situational avoidance can be observed. Before diagnosing agoraphobia, general medical conditions should be questioned and the source and reason of avoidance behavior should be questioned.


  1. Social Anxiety Disorder

  2. Specific Phobia

  3. Post Traumatic Stress Disorder

  4. Obsessive compulsive disorder

  5. Separation Anxiety Disorder

  6. Major Depressive Disorder

  7. General Medical Conditions




Generally, the history of patients diagnosed with agoraphobia under polyclinic conditions should be questioned about the presence of panic attacks or the presence of other psychiatric diseases accompanying panic disorder. There are several typical features. There are two proven treatment types. Depending on the clinical condition of the patients, either of them can be preferred or applied together.


1. Medication treatment


The drug therapy recommended in the treatment of agoraphobia is similar to the treatment of panic disorder. Generally, the first option is SSRI group (sertraline, paroxetine, escitalopram, fluoxetine, fluvoxamine, citalopram). The response rate to treatment is high from the first month of treatment. How long the drug treatment will last and when it should be stopped should be made by making a joint decision under the control of the doctor. One of the most common mistakes in daily practice is that the patient feels good and stops both control and medication on his own. Like all psychiatric disorders, agoraphobia is a recurring disorder.


2. Cognitive Behavioral Therapy (CBT)


Exposure-based Cognitive Behavioral Therapy is the gold standard for agoraphobia and has been shown to improve at least 50% in agoraphobic avoidance in 60-70% of agoraphobic patients. So what does exposure-based cognitive behavioral therapy mean?

Exposure therapy typically begins with a hierarchical configuration of the avoided condition (not going to the shopping mall alone, driving a car, not getting into the elevator). Patients are encouraged to start with the easiest situation and are kept there until their anxiety ends. In some cases, the therapist initially accompanies the patient, but it is expected that patients do this on their own. The most difficult point during therapy is to motivate patients to do exposure exercises without using avoidance strategies. The patient should not overlook any avoidance or anxiety-relieving behaviors before the therapist starts doing exposure exercises. Ideally, the exposure therapy should be selected at the beginning of the therapist's control of the avoided condition and where avoidance and avoidance strategies are difficult (eg leaving the patient alone at the mall). After the patient has successfully mastered this situation, situations where the therapist can control less can be selected (such as long-distance driving alone).


As a result, if you think you have similar problems after this article you read, consult your nearest psychiatrist. When agoraphobia treatment is possible and regularly treated, it is a satisfying disease both as a result of treatment in both the patient and the doctor. As with all psychiatric disorders, the important thing in the treatment and course of agoraphobia is that the patient-physician compliance is well established, the treatment (whether pharmacotherapy, psychotherapy or combined treatment) is determined by the doctor and the patient's joint decision and discontinued when appropriate.


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