What Is Agoraphobia?

<p>Oliver Rossi / Getty Images</p>

Oliver Rossi / Getty Images

Medically reviewed by Kira Graves, PhD

Agoraphobia is an anxiety disorder that causes extreme fear and anxiety of places where leaving or escaping may be challenging. People with agoraphobia often avoid situations where they might feel trapped or panicked, such as events with large crowds, public transportation, or leaving the house alone.

In severe cases, people with agoraphobia can become housebound due to their anxiety of leaving the home. This can greatly impact quality of life and cause them to become dependent on others.

About 1-3% of adolescents and adults experience agoraphobia. The disorder may be more prevalent in older adults; research suggests agoraphobia occurs in nearly 11% of adults over 65 years old.

A mental health professional can help diagnose agoraphobia and treat the symptoms.

Types of Agoraphobia

Agoraphobia is closely linked to panic disorder as the two conditions often occur together. However, you can experience agoraphobia without the presence of panic disorder. To make this distinction, agoraphobia is separated into two types.

Panic Disorder With Agoraphobia

People with panic disorder experience recurrent and unexpected panic attacks, which are overwhelming feelings of fear often accompanied by physical symptoms like trembling and a rapid heart rate.

Following a panic attack, the person will have ongoing anxiety of future attacks and change their behavior to avoid another attack. With agoraphobia, this person will avoid places or situations that could lead to panic and trigger an attack.

People who have panic disorder with agoraphobia tend to have more severe panic symptoms than those with panic disorder alone. They may also start to experience symptoms at a younger age, and have more more mental health symptoms like depression.

Agoraphobia Without a History of Panic Disorder

A person may experience agoraphobia without having a panic attack or presenting other characteristics of panic disorder. In many cases, this person's anxiety stems from a fear of experiencing feelings of panic. They will avoid situations where escape might be difficult in order to avoid feeling panicked, embarrassed, or incapacitated in some other way.

Agoraphobia Symptoms

The main symptom of agoraphobia is a fear of situations you may not be able to easily leave. A person with agoraphobia may also worry they might embarrass themselves in these situations, or that help might not be available if something goes wrong.

Due to their fears, people with agoraphobia will actively avoid situations that cause them anxiety. They may also feel dependent on friends or family members to accompany them in public places or to perform tasks that require leaving the house.

When put into a feared situation, the person with agoraphobia will almost always experience intense fear or anxiety that is not reflective of the actual danger of the situation. This anxiety can sometimes result in physical symptoms, including:

  • Trembling

  • Sweating

  • Racing heart

  • Shortness of breath

  • Chest pain

  • Dizziness

  • Nausea or stomach pains

People with agoraphobia typically exhibit behaviors of fear, anxiety, and avoidance for six months or more. These behaviors cause distress for the person and can impact quality of life.

What Causes Agoraphobia?

There is not one direct cause of agoraphobia. A person's life experiences, personality, and social environment may all play a role. Other mental health conditions can sometimes lead to the development of agoraphobia.

A person might develop agoraphobia after having a panic attack. This happens when the person becomes fearful of having another attack and starts to fear or avoid situations that could potentially cause them to panic.

There also is some evidence that experiencing a traumatic event or having post traumatic stress disorder (PTSD) can cause agoraphobia.

Some research also shows being isolated for extended periods of time—like the social distancing that occurred during the COVID-19 pandemic—can lead to or worsen cases of agoraphobia.

Risk Factors

Researchers have identified certain common factors relating to temperament, environment, and genetics in people with agoraphobia. A person may be more likely to develop the disorder if they:

  • Have a personality that is highly dependent, obsessive-compulsive, or neurotic

  • Have an anxiety or panic disorder

  • Grew up with distant or overprotective parents

  • Experienced night terrors as a child

  • Suffered grief or loss early in life

  • Had a traumatic childhood

  • Have a family history of anxiety disorders or agoraphobia

How Is Agoraphobia Diagnosed?

A mental health professional can diagnose agoraphobia. They will evaluate your medical history, assess your symptoms, and check for any underlying medical conditions that might be contributing to your symptoms.

Be prepared to discuss the nature, duration, and severity of your anxiety symptoms as well as provide a list of medications and supplements you are taking.

When diagnosing someone with agoraphobia, a mental health professional will typically look to see if you have a tendency to avoid at least two of the following situations:

  • Being in open spaces

  • Being in enclosed spaces like stores or movie theaters

  • Using public transportation like buses, trains, or planes

  • Standing in line or being in a crowd

  • Going outside of the home alone

They will want to know how your fears and anxieties impact your day-to-day life and if these symptoms are persistent. Normally, someone is not diagnosed with agoraphobia unless their symptoms have lasted more than six months and cannot be explained by something else.

Treatments for Agoraphobia

If you are diagnosed with agoraphobia, your mental health provider will likely develop a treatment plan that includes some form of psychotherapy. They may also prescribe medication to reduce anxiety. Potential treatments for agoraphobia include:

  • Cognitive behavioral therapy (CBT): CBT is a type of talk therapy designed to work through your thoughts and help you change negative thinking patterns. This approach to therapy focuses on the thoughts or behaviors that are triggering an agoraphobic response and helps you look at these situations from a different perspective.

  • Exposure therapy: Sometimes called systematic desensitization, exposure therapy involves gradually confronting situations you typically avoid with the help and support of your therapist. There is some evidence that incorporating virtual reality—which simulates an actual situation without requiring you to be in the location—may also be an effective type of exposure therapy.

  • Medication: Several different types of medication may be used for agoraphobia. These include anti-anxiety medications, such as serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors, and benzodiazepines. Antidepressants, or selective serotonin reuptake inhibitors (SSRIs), can also be beneficial.

When comparing CBT with medications, researchers found both treatments were effective. However, CBT resulted in a more significant decrease in avoidance, fear, and anxiety.

How to Prevent Agoraphobia

While there is no way to prevent agoraphobia, you can spot the signs and symptoms early on and start treatment to prevent the disorder from getting worse. Your anxiety will increase the more you avoid situations, so it's important to actively address your fears before they escalate.

Similarly, treating panic disorder and other anxiety disorders early on can help reduce your risk of developing agoraphobia.

If you are diagnosed with agoraphobia, it's important to seek treatment from a mental health professional right away. Keeping your appointments and following your provider’s advice can prevent your agoraphobia from becoming worse.

Related Conditions

Many people with agoraphobia also experience other anxiety disorders. Research has shown a high overlap between agoraphobia and social anxiety disorder (SAD), generalized anxiety disorder (GAD), and other specific phobias.

Other comorbid conditions include depression, personality disorders, and substance use disorder.

Living With Agoraphobia

Having agoraphobia can feel challenging—and even debilitating—at times. If left untreated, the disorder can impact your ability to socialize with others, hold down a job, and manage the details of your daily life like grocery shopping or going to healthcare appointments.

Consequently, you may start to feel increasingly isolated, helpless, or dependent on others.

However, with consistent and effective treatment, you can learn to overcome your fears and anxiety and live a full life. Along with prescribing talk therapy and medication, your healthcare provider can recommend coping mechanisms for living with your fears.

For instance, deep breathing practices can help you relax and focus on something other than your fear. Likewise, wearing noise cancelling headphones can block out unwanted noises and help you feel grounded in crowds or large, open areas.

You may also find it helpful to join a support group, many of which are available to attend virtually. Talking to people who can understand your fears and may have similar experiences can help you feel less alone.

It's important to be patient with yourself as you address and manage your fears. Agoraphobia can be a persistent disorder, but it is possible to overcome your anxiety.

Frequently Asked Questions

Does agoraphobia run in families?

You may be more likely to develop agoraphobia if you have a family member with agoraphobia or another anxiety disorder. Research shows there may be a genetic component in anxiety disorders like agoraphobia. Environmental factors like having overprotective or distant parents can also raise the risk for developing agoraphobia.

Does agoraphobia qualify for disability?

In some cases, agoraphobia may qualify for disability benefits, particularly if you are unable to work. To find out if you are eligible, it can be helpful to talk with a Social Security Disability Insurance (SSDI) attorney for advice or someone in the Social Security Administration. If you are currently employed, you may qualify for short-term or long-term disability under your employer's insurance plan.

What happens if agoraphobia is left untreated?

Agoraphobia symptoms can become worse if left untreated. In some cases, people with agoraphobia can become housebound and dependent on others to fulfill daily needs like grocery shopping. This can lead to feelings of isolation, loneliness, and depression.

Does agoraphobia get worse over time?

Without treatment, the symptoms associated with agoraphobia can escalate. This can result in increased isolation, a refusal to leave the home, and worsening fears and anxieties. If you suspect that you have agoraphobia, it is important to talk with a mental health professional as soon as possible to keep your condition from getting worse.

For more Health news, make sure to sign up for our newsletter!

Read the original article on Health.