For a long time I didn't see it as fear. I like being home. I like the quiet. I live in La Petite-Nation, surrounded by lakes and trees, and who in their right mind wants to drive into a crowded store when they could stay here?
Some of that is true. Some of it was a story covering something else. Somewhere in my 40s and 50s the list of places I could go without dread got shorter, and the COVID years didn't help. I've never been diagnosed with agoraphobia. My diagnoses are Autism Spectrum Disorder (ASD), BPD and ADHD, and those are the only labels I'll claim. But I've read enough about it to know the shape, and to know a lot of people my age are quietly living inside it.
Can you develop agoraphobia later in life? Yes. It most often starts earlier, in young adulthood, but it can show up later. One French study followed nearly 2,000 people over 65 and found that about one in ten of those with agoraphobia said their first episode came after 65 (Ritchie and colleagues, American Journal of Psychiatry). Most of those late cases traced it back to an illness or another frightening event.
What agoraphobia actually is
People hear the word and think of open fields. The NHS describes it as a fear of being in situations where escape might be difficult, or where help wouldn't be available if things go wrong. That can mean shops, public transport, crowds, lineups, bridges, or simply leaving home.
What makes it agoraphobia is less the fear itself and more what you do about it. You avoid. You start doing your groceries online. You only go out with someone. You take the long way round the busy part of town. Each choice makes sense. Together they build a smaller and smaller life.
The NHS says it often grows out of panic disorder: you have a panic attack somewhere, your brain connects the panic to the place, and you start avoiding it. But it can also come from other fears, like illness or crime, with no panic attacks at all.
Why it can start in midlife or later
Nobody gave me a neat explanation for this, and I'd be suspicious of anyone who did. But a few things come up again and again in what I've read and in what I've lived.
Health scares are a big one. In the French study, late-onset agoraphobia was mostly linked to physical illness or a traumatic event, and it usually didn't come with panic attacks. Your body lets you down once, out in public, and the outside world starts to feel unsafe.
Depression is another. The same study found severe depression was a major risk factor. I know from my own life that depression and fear of going out feed each other. When I'm low, the effort to go out looks enormous, so I don't, so I get lower.
And then there are the slow changes nobody notices. Retirement, kids gone, working from home, a partner who does the errands, moving somewhere quiet. For a lot of people, me included, the pandemic was a two-year rehearsal for staying in. Some of us never fully came back out.
Is it agoraphobia, autism, or something else?
This is where I had to be careful. As an adult with ASD, I find crowded places draining for sensory reasons. That's real, and it isn't agoraphobia. The difference, roughly, is what you're afraid of. Sensory overload is about the noise and lights being too much right now. Agoraphobia is about what might happen, about being trapped or helpless if something goes wrong.
They can sit together, and depression can mimic both. I wrote about why I got scared to leave the house, which gets into that tangle. A doctor or psychologist is the person to sort it out properly, and they'll also want to rule out physical causes, especially if this is new at 50 or 60.
How it's treated
Agoraphobia responds to treatment. That part surprised me.
The main talking treatment is cognitive behavioural therapy, usually with gradual exposure: you and the therapist work out a list of situations and you face them step by step, starting with the easier ones. The NHS lists CBT and medication (usually an antidepressant), alone or together. If you can't get out to see a therapist, ask about phone or video sessions to start.
In Québec, public mental-health services are free. Start with your doctor, a CLSC, or call 811 and choose option 2 (Info-Social). Phobies-Zéro runs self-help groups for anxiety and phobias, including virtual ones, which matters a lot when going out is the problem. Relief, the organisation formerly called Revivre, also covers anxiety. If panic attacks are part of it, I wrote about what stops my panic attacks.