This fear often leads to persistent avoidance behaviors, in which the person begins to stay away from the places and situations in which they fear panic may occur. For example, a person with agoraphobia may avoid driving a car, leaving the comfort of home, shopping in a mall, traveling by airplane, or simply being in a crowded area. Due to these avoidance behaviors, the life of a person with agoraphobia can become very restrictive and isolated—greatly affecting their personal and professional life. For example, heightened fears and avoidance behaviors can make it difficult for a person with agoraphobia to travel for work or to visit with family and friends. Even small tasks, such as going to the store, can become extremely difficult. Fear and avoidance can become so severe with agoraphobia that the person with the phobia becomes confined to their home. Fortunately, agoraphobic symptoms can be treated.
Symptoms of Agoraphobia
Symptoms of agoraphobia may include:
Being afraid of leaving homeBeing afraid of open spaces, bridges, or shopping centersFear of enclosed spaces or buildingsFear of leaving home or being in social situations aloneFear of losing control in a public placeFear of places where escape might be difficultFear of public transportation
These situations almost always trigger an anxiety response that is out of proportion to the actual danger presented by the situation. Panic attacks often precede the onset of agoraphobia. When forced to endure a feared situation, a person may experience a panic attack that causes symptoms including:
Chest painChillsDiarrheaDizzinessFeelings of chokingFeelings of unrealityNauseaNumbnessRapid heartbeatShortness of breathSweatingTrembling
Types of Agoraphobia
Although many people with agoraphobia will also have panic disorder, it is possible to be diagnosed with agoraphobia without having a history of panic disorder. When this occurs, the person still has a fear of being stuck in a situation where escape would be difficult or humiliating. However, they generally do not fear having full-blown panic attacks. Rather, they may be afraid of having some other type of distressing anxiety symptom or other intense physical issues, such as vomiting or having a severe migraine. For instance, the person may be afraid that they will lose control of their bladder in public or faint without any help being available. Approximately one-third to half of those diagnosed with panic disorder will also develop agoraphobia. The National Institute of Mental Health (NIMH) reports that agoraphobia occurs to approximately 0.9% of adults in the U.S. population in any given year. This condition typically develops in adulthood, though it can emerge earlier in adolescence.
Causes of Agoraphobia
The exact causes of agoraphobia are not known, but there are a number of risk factors that may increase your risk of developing this condition. These include:
A person with agoraphobia may avoid traveling by airplane due to a fear of having a panic attack on a plane and not necessarily due to aerophobia, or the fear of flying. A person with agoraphobia may avoid crowds, fearing the embarrassment of having a panic attack in front of a lot of people. Such a fear is not the same as social anxiety disorder, which is a separate mental health condition that involves anxiety about being negatively evaluated by others.
Having another anxiety disorder, such as generalized anxiety disorder or social anxiety disorder Another phobia A family history of agoraphobia A history of abuse or trauma Brain chemistry Low self-esteem or depression
Learned associations can also play a role in the development of agoraphobia. Experiencing a panic attack in a certain situation or setting can lead to a fear that such a reaction will occur again in the future. In some cases, post-traumatic stress disorder (PTSD) can contribute to the development of agoraphobia. PTSD can occur following a traumatic event and lead to hypervigilance and anxiety symptoms, which can lead to the onset of agoraphobia. Extended periods of isolation may increase the risk of developing agoraphobia. For example, fear caused by the COVID-19 pandemic combined with isolation caused by social distancing and quarantines has increased anxiety for many Americans. Mental health experts believe that the repercussions of these events may have a lasting effect on the well-being of adults and children for years to come.
Diagnosis of Agoraphobia
To receive a diagnosis of agoraphobia, a healthcare provider will assess your symptoms and check for any underlying medical conditions that might be causing those symptoms. You may be asked about your medical history and you will be asked about the nature, duration, and severity of your anxiety symptoms. In order to be diagnosed with agoraphobia, you must:
Have marked fear in at least two different situations, such as open spaces, crowded areas, or public transportationHave the agoraphobic situation almost always provoke an anxiety responseHave fear that is out of proportion to the threatExhibit avoidance behaviors or distress that disrupts your normal routines, work, school, and relationshipsExperience these symptoms for at least six months
The symptoms must also not be better explained by another medical or mental condition.
Treatment for Agoraphobia
If a person does develop agoraphobia with panic disorder, symptoms typically begin to occur within the first year that the person starts having recurring and persistent panic attacks. Agoraphobia can get worse if left untreated. For the best outcomes in managing agoraphobia and panic symptoms, it is important to seek treatment as soon as symptoms arise. Treatment options typically include a combination of both medication and psychotherapy.
Psychotherapy
The therapeutic approach may include some systematic desensitization, in which the person gradually confronts avoided situations with the support and guidance of their therapist. Some research has shown that integrating exposure therapy with psychodynamic treatment has been beneficial in panic disorder with agoraphobia. Many times, the person will fare better in facing their fears if accompanied by a trusted friend.
Medications
Medications may also be prescribed to help manage certain symptoms of agoraphobia. These medications include:
Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and Zoloft (sertraline); selective serotonin-norepinephrine inhibitors (SNRIs) such as Effexor (venlafaxine); and tricyclic antidepressants (TCAs) such as Tofranil (imipramine) and Anafranil (clomipramine) Anti-anxiety medications, such as Klonopin (clonazepam) and Xanax (alprazolam)
Coping With Agoraphobia
In addition to seeking help from a mental health professional, there are also lifestyle changes that can help you to better manage the symptoms of agoraphobia. These include:
Practicing stress management techniques, such as deep breathing, visualization, and progressive muscle relaxation to help reduce anxiety Eating a healthy and nutritious diet Getting regular physical exercise Avoiding drugs and alcohol Limiting caffeine intake
Through the support of family and friends and professional help, a person with agoraphobia can manage their condition. With medication and psychotherapy, a person with agoraphobia can expect to eventually experience fewer panic attacks, fewer avoidance behaviors, and a return to a more independent and active life. For more mental health resources, see our National Helpline Database.
