[13] People with agoraphobia may experience temporary separation anxiety disorder when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone.
These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends.
[16] Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed.
During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response.
[17] Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath.
[20] In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with subjects without agoraphobia.
[25] Some scholars[26][27] have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.
Some evolutionary models propose that agoraphobia—like other specific phobias—may be rooted in adaptive mechanisms that helped early humans avoid threats in open or unfamiliar environments.
From this viewpoint, fear and avoidance behaviors could have been selectively favored if they aided survival—for instance, by prompting individuals to steer clear of potentially dangerous surroundings or minimize exposure to predators and pathogens.
According to preparedness models, human defensive systems are especially sensitive to cues linked to ancestral threats and can rapidly form strong, lasting fear associations with them.
In modern life, such defenses might become mismatched to relatively low-risk environments, producing disproportionate anxiety responses.
Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment.
[33][34] Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.
[39] In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.
[41] Systematic desensitization can provide lasting relief to the majority of patients with panic disorder and agoraphobia.
The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.
[46] This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.
[46] Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.
[49] Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments.
In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).
[50] Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors.
Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.