Copies of Prince Harry's memoir titled "Spare."
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  • In his new memoir, Prince Harry talks about his mental health struggles.
  • In particular, he mentions dealing with agoraphobia.
  • About 1.3% of adults in the U.S. have agoraphobia.

Prince Harry shares in his new memoir that he struggled with agoraphobia, an anxiety disorder that causes intense fear in certain situations, such as among crowds. This fear can be severe enough that people avoid leaving home.

According to NBC News, which translated a Spanish copy of the memoir “Spare” before its Jan. 10 release, Harry writes: “I was an agoraphobe. Which was nearly impossible given my public role.”

He also recalls that he “nearly fainted” during one speech that “couldn’t be avoided or canceled.”

What is agoraphobia?

Agoraphobia is defined as an “excessive, irrational fear of being in open or unfamiliar places, resulting in the avoidance of public situations from which escape may be difficult,” according to the American Psychological Association.

This can mean a fear of open or enclosed spaces, crowds, public transportation or other places outside a person’s home.

For some people, the further away they get from home, the less safe they feel emotionally, and the more they have a sense of impending doom, said Gregory Jantz, PhD, a clinical psychologist and founder of The Center • A Place of HOPE in Edmonds, Wash.

Some people with agoraphobia may also have a panic disorder, a type of anxiety disorder that involves panic attacks.

A panic attack is a sudden feeling of extreme fear, with symptoms such as rapid heart rate, trouble breathing, lightheadedness or dizziness, sudden flushing or chills, or excessive sweating.

How does agoraphobia affect people?

People with agoraphobia who have had a panic attack may avoid certain places or situations in an attempt to prevent another panic attack.

“As their anxiousness builds, they feel a dread of a potential panic attack,” said Jantz. “So they’re basically afraid of this fear.”

If the agoraphobia is severe enough, a person may be unable to leave their home, visit family and friends, go to school or work, and do other daily activities.

Jantz said one of the misperceptions about this condition is that a person’s fear is “all in the mind,” which can lead people to feel embarrassed or ashamed.

However, “even if the fear has nothing to do with reality, that doesn’t mean the anxiety is not real,” he said. “Your body is reacting and there are physiological things happening.”

How many people are affected?

An estimated 1.3% of U.S. adults experience agoraphobia at some point during their lives, according to the National Institute of Mental Health (NIMH).

Of adults with agoraphobia in the past year, seven in 10 had moderate to severe impairment, the institute reports.

Agoraphobia is less common than other anxiety disorders, such as social anxiety disorder, which affects 12.1% of U.S. adults at some time in their lives, according to the NIMH.

Researchers are still trying to understand why certain people develop agoraphobia, but they believe it involves a combination of genetics and experiences.

Certain factors increase the risk of agoraphobia, including:

  • Having a panic disorder or phobias (excessive fear reactions)
  • Experiencing stressful life events such as abuse, a natural disaster or the death of a parent
  • Having a nervous or anxious personality
  • Having a close relative with agoraphobia

Has agoraphobia increased during the pandemic?

Jantz suspects that there may have been an increase in agoraphobia post-COVID. 

“We did lockdowns, etc., and individuals who were already struggling with anxiety or depression may be a little more prone to developing agoraphobia,” he said.

According to the World Health Organization, the first year of the COVID-19 pandemic triggered a 25% increase in anxiety and depression worldwide.

However, it’s unclear if there has been an increase in agoraphobia, because avoiding public spaces may be a natural response to the risks associated with the coronavirus.

What is the treatment?

Jantz said before deciding on any treatments, it’s important to determine if anything else may be causing anxiety such as increased alcohol use, a medical condition or a medication.

These other factors need to be addressed alongside the anxiety and agoraphobia.

Treatment for agoraphobia often involves talk therapy — cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT).

These therapies help people learn what may trigger a panic attack or panic-like symptoms, and provide ways for them to cope with the increased anxiety that occurs in certain situations.

For people with agoraphobia who have trouble leaving their home, some therapists may offer therapy sessions over video or phone.

A physician may also prescribe an antidepressant or anti-anxiety medication.

Jantz said when people with agoraphobia are being treated, he recommends that a clinician be with them when they try new things, such as entering a public space.

“That way, they know, ‘I can get through this,’” he said. “If they have someone with them who is supporting them, their symptoms will often decrease after five or 10 minutes. But if they are on their own, their symptoms may worsen.”

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