Agoraphobia

What agoraphobia actually is

The name misleads. "Agoraphobia" comes from the Greek agorá, the marketplace, which is why it's usually translated as a fear of open spaces. That isn't it.

Agoraphobia is the fear of being somewhere it would be hard to leave, or hard to be helped, if you felt unwell.

That explains why the list of feared situations looks incoherent from outside: the metro and the motorway, the cinema and the supermarket queue, a flight and a bridge, a crowded shopping centre and an empty country road. What they share isn't the space. It's the difficulty of getting out quickly.

How agoraphobia and panic attacks connect

In most cases agoraphobia doesn't come first. It comes after.

Following one or more panic attacks, a different question starts: not "am I unwell?" but "what if I were unwell here?". The assessment moves from the event to the place, and places start being chosen by how manageable an attack would be inside them.

From that point the criterion is no longer danger. It's the exit.

Avoidance: why the list keeps growing

It starts with the places where it happened. Then places that resemble them. Then situations with the same structure — little control over the exit, many people, distance from home.

Each avoidance works in the moment: the anxiety drops, and the relief teaches that avoiding was the right call. That's why the list doesn't stay still. It grows by resemblance, one item at a time, without any decision ever being made to make a life smaller.

Alongside avoidance come the safety behaviours: only going out accompanied, sitting near the exit, carrying medication, checking where the nearest hospital is, always taking the same route.

These bring relief too, and they maintain the fear too: each one confirms that without the precaution something would have happened.

When agoraphobia narrows a life

There's a point where the difficulty stops being about places and starts being about everything else.

Jobs turned down because they involve travel. Invitations declined with plausible excuses. Trips postponed. A personal geography that shortens until it covers home, a few streets and a few safe places.

People who reach that point rarely recognise it happening, because each individual withdrawal seemed reasonable at the time.

Working on agoraphobia in Milan, Monza and Cernusco — in English

I'm an Italian psychologist and psychotherapist, registered with the Order of Psychologists of Lombardy, working in English and Italian. I see people in two practices in Milan, in Monza and in Cernusco sul Naviglio, and online.

For anyone who finds travelling difficult, online is often what makes starting possible — and that's especially true of this difficulty. It matters more if you've moved country: the places that feel safe are usually the ones you've known longest, and after a move there aren't many.

The work runs in two directions. The first is the mechanism: understanding what sets off the alarm, which interpretations feed it, and what role the safety behaviours play.

The second is recovering the field. Gradually, by agreement, and never starting from the hardest situation. It isn't about proving anything: it's about rebuilding access where it narrowed.

When it makes sense to ask for help

— Am I choosing where to go based on how easy it would be to leave?

— Is the list of things I avoid longer than it was six months ago?

— Do I leave the house carrying something I didn't used to need?

— Are there places I only go to accompanied?