By: Khonotso Fredah Matlala

Agoraphobia and Epilepsy

WHAT IS AGORAPHOBIA?

Agoraphobia is a mental health disorder characterized by anxiety or fear arising from thoughts that escape might be difficult or that help may not be available in certain situations (Balaram & Marwaha, 2024). Common triggers include being in crowded places, using public transportation, standing in line, or even leaving home alone (Balaram & Marwaha, 2024). In severe cases, a person may feel safest only within their home and avoid going outside altogether. These discomforts stem from the deep concern of possibly experiencing panic-like symptoms, being trapped, embarrassed or unable to get support during a distressing event, such as a panic attack or medical emergency (Balaram & Marwaha, 2024).

Agoraphobia is typically a result of panic disorder. However, these two disorders can develop independently (Barnhill & Zimmerman, 2023).

DIAGNOSTIC CRITERIA OF AGORAPHOBIA

Symptoms of agoraphobia tend to differ in severity wherein they can increase or decrease in severity depending on the context (Barnhill & Zimmerman, 2023).

For an individual to be diagnosed with agoraphobia, he or she must have a marked, persistent fear or anxiety about two or more of the following situations for last least 6 months.

This includes:

• Using public transportation
• Being in open spaces (such as parks, beaches, parking)
• Being in an enclosed place (such as an elevator, movie theatre, or small rooms)
• Standing in line or being in a crowd
• Being alone outside the home

Fear or anxiety about these situations must be accompanied by thoughts that escaping from the situation may be difficult or help might not be available in the event of developing paniclike symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

The following must also be present:

• The agoraphobic situations almost always provoke fear or anxiety
• The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

PREVALENCE, CAUSES & RISK FACTORS

            Agoraphobia is prevalent in approximately 2% of the world’s population and it is more common in women than in men (APA, 2022). It typically develops in adolescence and young adulthood. However, it can also develop in older adults.

            As with most anxiety disorders, agoraphobia is also caused by a combination of biological factors such as family history of anxiety disorders, imbalances in neurotransmitters that are involved in fear responses and temperament as studies show that individuals with naturally anxious or sensitive personality are more likely to develop agoraphobia. That is individuals with high neuroticism and low extraversion are more prone to anxiety disorders (Dong et al., 2022).

            Other causes and risk factors of agoraphobia include psychological and environmental influences. Traumatic life events, such as experiencing abuse, neglect, or a significant loss, can increase vulnerability to developing the disorder (Phobia Solution, n.d.). Chronic stress and maladaptive coping strategies, such as avoidance behaviours, may also contribute to the onset and maintenance of agoraphobia (Craske & Stein, 2016). Additionally, social factors, including overprotective parenting, social isolation, or stressful life transitions, have been linked to higher risk (Craske & Stein, 2016; Phobia Solution, n.d.). These factors often interact with biological predispositions, amplifying the likelihood of developing agoraphobia.

AGORAPHOBIA AND EPILEPSY

Recent studies have shown that individuals with epilepsy are at an increased risk of developing anxiety disorders, including agoraphobia. Anxiety disorders are common comorbidities in epilepsy, with a prevalence rate being higher compared to the general population. For example, a study found that generalized anxiety disorder (GAD) had an estimated prevalence of 18.2% among PWE, followed by agoraphobia, social phobia, panic disorder, and obsessive-compulsive disorder (Clary et al., 2023).

The relationship between epilepsy and anxiety disorders, including agoraphobia, is complex and bidirectional. Anxiety symptoms can occur before, during, or after seizures, and may be influenced by factors such as seizure frequency, medication side effects, and psychosocial stressors . Additionally, the fear of having a seizure in public places can lead to avoidance behaviours characteristic of agoraphobia, further limiting social interactions and mobility (Hingray et al., 2019).

Furthermore, the presence of anxiety disorders, including agoraphobia, in PWE is associated with poorer quality of life, increased seizure frequency, and reduced treatment adherence . Therefore, recognizing and addressing anxiety symptoms, including agoraphobia, in individuals with epilepsy is crucial for comprehensive patient care (Clary et al., 2023; Hingray et al., 2019).

CONCLUSION

Agoraphobia is a debilitating anxiety disorder that can significantly impair an individual’s quality of life. Its development is influenced by a combination of biological, psychological, and environmental factors, with certain personality traits increasing vulnerability. When co-occurring with epilepsy, agoraphobia can further compound challenges by intensifying avoidance behaviours, limiting social engagement, and reducing treatment adherence. The bidirectional relationship between epilepsy and anxiety highlights the need for integrated clinical approaches that address both neurological and psychological aspects. Early recognition, targeted interventions, and patient education are crucial to improving functional outcomes and overall well-being in affected individuals.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

Balaram, K., & Marwaha, R. (2024, November 11). Agoraphobia. In StatPearls. StatPearls Publishing. Retrieved July 19, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK554387/

Barnhill, J. W., & Zimmerman, M. (2023, August). Agoraphobia. In MSD Manual Professional Edition. https://www.msdmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/agoraphobia

Clary, L., Hill, C. E., Strzelczyk, A., Samson, A., & Kanner, A. M. (2023). Anxiety disorders in epilepsy: A systematic review of clinical characteristics and treatment. Epilepsy & Behavior, 145, 109234. https://doi.org/10.1016/j.yebeh.2023.109234

Craske, M. G., & Stein, M. B. (2016). Anxiety (2nd ed.). Oxford University Press.

Phobia Solution. (n.d.). Causes and risk factors of agoraphobia. Phobia Solution. https://phobiasolution.com/agoraphobia-guide/causes-and-risk-factors-of-agoraphobia

Dong, J., Xiao, T., Xu, Q., Liang, F., Gu, S., Wang, F., & Huang, J. H. (2022). Anxious personality traits: Perspectives from basic emotions and neurotransmitters. Brain Sciences, 12(9), Article 1141. https://doi.org/10.3390/brainsci12091141

Hingray, C., McGonigal, A., Kotwas, I., & Micoulaud-Franchi, J. A. (2019). The relationship between epilepsy and anxiety disorders. Current Psychiatry Reports, 21(6), 44. https://doi.org/10.1007/s11920-019-1029-9