What is agoraphobia, the fear of open spaces?

We often hear about it, but do you know what agoraphobia is? Contrary to popular belief, it can occur in places where people are moving around en masse as well as in large deserted areas and enclosed spaces with little traffic. The anxiety is mainly focused on the fear of not being able to be rescued or of not being able to escape. Agoraphobia is different from ochlophobia, which is only the fear of crowds.

Imagine having to leave home to do your shopping at the supermarket during rush hour. The idea of having to be alone to take public transport, to go to the shopping centre and to be in a queue to do your shopping makes you anxious. You feel your heart speeding up, muscle tension, you start to sweat, etc. These symptoms of anxiety lead you inexorably to avoid these situations unless someone close to you can accompany you and reassure you.

What is the link between panic disorder and fear of open spaces?

There are two clinical possibilities: either agoraphobia is accompanied by panic disorder (in 95% of cases) or agoraphobia is simple, i.e. no history of panic disorder has been identified (5% of cases). Panic disorder is defined by recurrent panic attacks that may occur unexpectedly. In other words, the disorder does not necessarily start when you are directly exposed to the feared object or situation. As Henri Legrand du Saulle (1878) pointed out, the agoraphobic is “afraid of being afraid“, of not being able to flee, of not being able to be rescued, while at the same time involving physical sensations that may become threatening. What is curious about agoraphobia is this relationship to loneliness. You can feel very lonely and at the same time be drowned in a crowd because you are not in contact with anyone. You find yourself with yourself, surrounded by faces that are unknown to you, taking the place of the expected object of comfort. This lack of relationship is an unavoidable element to take into account. You have a strong need for security and at the same time for freedom. You need to plan everything before starting an activity (“if I’m embarrassed or uncomfortable, how can I do it?”). You refuse invitations to sit-down meals, prefer to take the bike rather than the metro, avoid going too far away from your home to get home quickly in case of panic,… If these situations cannot be avoided, you will not fail to take preventive measures. You will always arrange to be near a cinema exit, or to stand just behind the bus driver to warn him in case of discomfort, etc.

The origin of agoraphobia, the fear of open spaces 

The origin of the word agora comes from the Greek word for public square. In 1872, the Berlin neuropsychiatrist Carl Westphal gave a clinical description. He indicated that agoraphobic individuals suffer from anxiety attacks when they are in a large space. Since then, the analysis has evolved and a psychiatric manual (DSM 5: Diagnostic and Statistical Manual of Mental Disorders) defines agoraphobia as follows: “Anxiety related to being in places or situations from which it might be difficult (or embarrassing) to escape or in which there would be no help in the event of a panic attack or panic-like symptoms (fear of dizziness or sudden diarrhoea). In Europe, 3% of the population suffer from panic disorder and 1.7% of adults suffer from agoraphobia. This phobia most often begins in young adults between the ages of 20 and 30. Few studies of children have been done to measure the prevalence of this phobia but it seems to be rare in children.

What are the differences between agoraphobia and social phobia?

Agoraphobia can thus be reminiscent of social phobia because it gives a particular feeling of loneliness among others and an excessive interpretation of body-related disorders. It also differs from demophobia which is more specifically focused on the fear of others (in this case the public place is no longer associated with this fear) and ochlophobia which is the fear of crowds (not of individual people). These differences are subtle and you don’t need to know about them to admit that it bothers you.

What to do in case of a panic attack?

First of all, it is important to be aware that although the occurrence of a panic attack is an extremely distressing episode for the person experiencing it, it is not a real health hazard. Despite perceived bodily sensations that may indicate otherwise, one cannot “die” from a panic attack. However, when it occurs, two attitudes can really help. The first is to control your breathing at the first sign of a panic attack. Cardiac coherence breathing exercises such as square breathing (breathe in through your nose, hold your breath, breathe out, then hold your breath for the same length of time for each step) will help bring the anxiety down. On the other hand, it is essential to divert the attention of people experiencing panic attacks. Focusing on the breath can again be an effective way.