People with agoraphobia avoid specific public places or situations because they anticipate having anxiety or a panic attack and being unable to escape or get help. In severe cases, these fears cause people to refuse to leave their homes for prolonged periods of time. Agoraphobia is an anxiety disorder that will affect an estimated 1.3% of Americans at some point in their lives.1
What Is Agoraphobia?
Agoraphobia involves an intense fear of being in specific public places. These fears usually involve concern about being unable to escape or get help in the event that they become anxious. Agoraphobia belongs to a cluster of anxiety disorders called specific phobias, and is related to other phobias like scopophobia (fear of being stared at), anthropophobia (fear of people) and sometimes megalophobia (fear of large objects). A phobia is defined as intense anxiety only in response to very specific places, things, or situations.
While there aren’t any distinct subtypes of agoraphobia, there is variation in the specific places that are feared and avoided. Some people with agoraphobia fear crowded or closed spaces while others fear open and empty spaces, and some fear almost any public place. Many times, the specific places and situations people fear are based on their past experiences. It is common that a person with agoraphobia has had panic attacks in the specific places they are afraid to go.2
How Common Is Agoraphobia?
Agoraphobia is relatively common. According to the research:1,3,4
- 1.7% of American adolescents and adults will develop agoraphobia each year
- The average age of onset is 17 with most disorders starting between late adolescence and early adulthood
- Older adults ages 65 and up are much less likely to develop agoraphobia
- 87% of people diagnosed with agoraphobia also have another mental health condition
- Women are twice as likely as men to develop agoraphobia
- Women with agoraphobia are more likely to be severely impaired by the disorder than men
Agoraphobia usually develops in adulthood, with an average age of onset between 25 and 30 years old.5 According to the NIH, 2.4% of teens between the ages of 13 and 18 are diagnosed with agoraphobia and only a very small number of children are diagnosed.1 Regardless of age, the signs of agoraphobia are similar, with fear and avoidance of public places being the primary indicators.
Agoraphobia can look very different depending on the individual and their situation. Some people may never leave their home, while others could frequently venture out into the community.
Here are a few examples of what agoraphobia could look like:
- A person could seem like a highly functioning individual except that they cannot ride elevators and hate public transportation. They avoid these situations at all costs, and panic when they are unavoidable.
- Someone could do well in most situations but then become very anxious and tense when waiting in lines. Because of this, grocery stores, amusement parks, and fast food restaurants present a great challenge for them and may also incite panic.
- For some, the agoraphobia may be so widespread that they refuse to leave their home. In extreme cases, they may feel unable to leave their bedroom and rely on others to bring them basic supplies, food, and water.
Agoraphobia Vs. Social Anxiety
Agoraphobia and social anxiety overlap greatly, so distinguishing between the two may be challenging. To best identify the differences, focus on the primary motivations:
- A person with agoraphobia may worry about being in public places because they fear they will be unable to escape to safety as their anxiety grows. They will miss the safety of their “comfort zone” when they venture out.
- A person with social anxiety will be motivated by fear of the people. They will worry about judgment, ridicule, and embarrassment levied against them from others.
More than other types of anxiety disorders, agoraphobia is most clearly identified by changes in behavior. The most obvious signs of the disorder are avoidance of certain places. People with agoraphobia may begin making excuses, procrastinating, or avoiding going out in public. This avoidance may have a specific pattern (e.g. of places that are crowded or enclosed) or may be more general and include most or all public places.
The symptoms of agoraphobia can include:3
- Intense fear or anxiety prompted by the actual or predicted exposure to being in open areas, using public transportation, being in closed-off areas, standing in line or a crowd, or being alone outside of the house
- Avoiding the above situations because the individual believes they may become stuck or help might be unavailable in the event that the individual begins to panic
- The listed situations almost always cause fear or anxiety
- The listed situations are avoided, require help from a loved one, or are endured with a lot of anxiety and distress
- The fear is out of proportion to the actual possibility of danger.
- The fear or avoidance is persistent, typically lasting for 6 months or longer
- The fear or avoidance causes significant distress or keeps them from being able to function normally in one or more areas of life
- The symptoms are not better described by another underlying medical issue
- The symptoms are not better explained by the symptoms of another mental health condition
Panic Disorder With Agoraphobia
A strong link exists between panic disorder and agoraphobia. Most people with agoraphobia have had a previous or current diagnosis of panic disorder or a history of having panic attacks.3 Interestingly, the fear of panic attacks is usually a primary reason why a person with agoraphobia avoids certain public places or situations.
Panic attacks are sudden and intense symptoms of anxiety which include four or more of the following symptoms and usually last ten minutes or less:3
- Heart palpitations or racing heart
- Shortness of breath
- Feeling choked
- Tightness or pain in the chest
- Nausea or abdominal distress
- Shaking or trembling
- Dizziness or unsteadiness
- Feeling disconnected from yourself
- Feeling disconnected from your surroundings
- Fear of losing control or dying
- Fear of losing control or going crazy
- Numbness or tingling
- Feeling hot or cold
What Causes Agoraphobia?
No singular cause for agoraphobia exists. Instead, several biological, social, and psychological factors are involved in the development of any mental health disorder, including agoraphobia.
Potential risk factors for developing agoraphobia can include:4,6
- Being diagnosed with another anxiety disorder, especially generalized anxiety disorder, panic disorder, or social anxiety disorder
- Being diagnosed with a substance use disorder
- Having a history of physical or sexual abuse or other traumatic events
- Having overprotective parents
- Losing a parent to death or separation
- Having a neurotic personality
- Having a history of panic attacks
- Having a history of panic attacks that occur in public
- Having a family history of anxiety disorders
Agoraphobia can also develop after certain stressful or traumatic experiences, like a person getting into a car accident or being the victim of a crime. In some instances, agoraphobia can develop when people have lifestyle changes that result in fewer outings and social interactions, like transitioning from working in an office to working at home, retiring, or moving to a new city.
Complications From Fear of Leaving the House
Living with agoraphobia can be very limiting. People with the condition often describe that their symptoms have impacted their ability to work, maintain relationships, and in some cases even prevented them from being able to live independently. Over time and without treatment, many people with agoraphobia find that their symptoms worsen, and that their list of feared places grows. Sometimes, the condition can progress to the point of not leaving home for several months or longer, depending on other services and people to meet their needs.
Getting help early on when symptoms begin can make treatment easier and faster. Because avoidance makes anxiety worse in the long run, recovery involves intentionally going to places that make them anxious. While doing so will result in temporary increases in anxiety, it will also help to build confidence and prevent their symptoms from disrupting their ability to function.
How to Cope With Agoraphobia
The best way to cope with agoraphobia is to seek out professional treatment and follow the treatment plan as closely as possible. Like other mental health conditions, agoraphobia rarely goes away without professional treatment plans.
Some other ways to cope with agoraphobia include:
- Caring for your physical health: Sleep, diet, and exercise can all play a part in countering the influence of agoraphobia
- Seeking out opportunities for relaxation and meditation: Learning and practicing meditation for anxiety and relaxation techniques can reduce anxiety and build calm.
- Feeling connected: When going out into the world feels stressful, it can be challenging to maintain social relationships, but social support can fight back against anxiety.
- Quitting negative coping skills: Drugs, alcohol, spending excess amounts of money, and other negative coping skills are tempting when anxiety is high, but they only create new problems. Avoid these and focus on coping mechanisms that benefit your mind and body.
When Is Agoraphobia Diagnosed?
Agoraphobia can only be diagnosed by a medical or mental health professional who believes that all of the criteria for agoraphobia are met. The person must have all the symptoms as well as the duration and intensity of symptoms. If the person’s life has become unmanageable because agoraphobia disrupts work, school or homelife, a diagnosis of agoraphobia will be likely.
Phobias are highly treatable. With therapy, medication, or a combination of the two, it is possible for people with agoraphobia to reduce their symptoms and even make a full recovery. For those with this disorder, a full recovery is indicated by their ability to leave their homes and return to their normal routine and activities.
The most effective form of treatment for agoraphobia is exposure therapy, involving gradually facing feared situations that were previously avoided.4 Before any exposure work begins, therapists help clients learn relaxation skills to help them cope with distress and anxiety. Once these skills have been developed, exposure therapists work collaboratively with the client to develop a plan to begin gradually facing feared situations and places. This can be done with imagination, “in-vivo” (real-life scenarios), or even with virtual realit exposure therapy.
Eventually, the therapy would progress to exposures like taking walks around the neighborhood or short drives to the store. While exposure therapy is scary and uncomfortable at first, most people experience a drastic reduction in their symptoms if they complete the treatment, gaining the ability to return to their normal life and routine.
Cognitive Behavioral Therapy
Another effective form of therapy for agoraphobia is cognitive behavioral therapy (CBT).4,7 Exposure therapy is one branch of CBT, but other branches of the treatment include ones which can help people challenge irrational thoughts and fears. CBT treatment addresses the link between thoughts, behaviors, and feelings.
When people adjust their ways of thinking and behaving, they often experience a change in the way they feel. For example, a person with agoraphobia can reduce anxiety by interrupting worried thoughts about bad things that might happen, while also putting themselves in the situations they fear.
Anti-anxiety medication is sometimes recommended in addition to therapy for people diagnosed with agoraphobia. A medical professional’s decision to prescribe medication depends on the individual symptoms a person is experiencing, how severe these are, and whether they have other mental health issues.
Complementary and alternative medicine (CAM) options for anxiety and agoraphobia may be helpful for some, but at this point, there is not enough solid information to fully endorse many choices.
Some CAM options for anxiety include:8
- Hypnosis for anxiety
- Therapeutic music
- Herbs and supplements
- Meditation movements, like yoga and tai chi
Be sure to check with your treatment team for specific recommendations before beginning any alternative treatments for agoraphobia.
How to Get Help for Agoraphobia
The first step is to find a therapist who specializes in treating anxiety and phobias. Meeting with a therapist will help you confirm your diagnosis and also learn more about what treatment options would meet your needs (i.e. therapy, medication, or both). Because many people with agoraphobia feel unable to leave their homes, online therapy may be a great option. Those interested in online therapy should check with their insurance providers to ensure that telehealth sessions are covered under their plan.
If you have health insurance, you can call the number on the back of your card or go online to find a list of in-network therapists. You could also use an online therapist directory, which allows you to filter results based on location, specialties, and insurance type. Most of the time, therapists are also willing to offer free phone or in-person consultations in which you can ask questions and learn more about their experience and approach. This can help you make an informed choice, increasing the likelihood that you will be matched with a therapist who is a good fit for your needs.
Can Agoraphobia Be Prevented?
Situational and environmental triggers may spark agoraphobia, and other times it seems to have no external source. Either way, preventing agoraphobia is extremely difficult. It is hard to predict what stress or situation will set the disorder in motion, making it difficult to prevent.
What Is the Outlook for People With Agoraphobia?
Agoraphobia is a complex and challenging condition, and although it can be treated, it takes diligence and persistence paired with an effective treatment plan to contain. Only about 10% of people find that their symptoms diminish naturally, so professional treatment is almost always necessary.
More severe cases with intense symptoms are resistant to treatment, and having other mental health issues can further complicate the situation. Substance use, personality disorder, and depressive disorders can reduce positive outcomes.
There is always hope, though. Effective treatments for agoraphobia from mental health experts are available and can make a big difference in how you feel.