Agoraphobia is an anxiety disorder. It can trigger intense fear in situations where escape may be difficult or help hard to access.
The name comes from the ancient Greek word “agora,” which refers to a place of assembly or a marketplace.
People often misunderstand agoraphobia as a fear of open spaces, but it is more complex than that. Situations that may trigger fear in people with agoraphobia include:
- crowded or enclosed spaces
- open and remote spaces
- being far from home
Some people with agoraphobia also have panic attacks or panic disorder. When the symptoms are severe, they can keep a person from leaving their home.
Agoraphobia can develop at any age, but the symptoms usually appear at around 25–35 years of age, and they affect females more often than males.
Here, learn more about agoraphobia, including how it can affect a person’s life and the types of help available.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classes agoraphobia as an anxiety disorder.
A person with this type of disorder has persistent feelings of anxiety that affect their ability to function in daily life.
Agoraphobia is an anxiety disorder that involves a fear of being in places from which it is hard to escape or receive help.
Feelings of embarrassment, helplessness, or being trapped can trigger agoraphobia. A person may have one or more of these feelings in crowded or remote areas or on bridges or public transport, for example.
Agoraphobia can develop after a person has had a panic attack. A fear of further attacks, for example, may cause the person to avoid the kinds of situation in which the first attack took place. Though agoraphobia may follow panic disorder, the DSM-5 considers them separate diagnoses.
People with agoraphobia may need help from a companion to visit public places. They may feel unable to leave home on their own or at all.
One or both of the following types of prescription medication may help:
- Selective serotonin reuptake inhibitors: Known as SSRIs, these antidepressants may help with agoraphobia, but they can take 2–4 weeks to start working.
- Benzodiazepines: These are sedative medications that can relieve the symptoms of anxiety in the short term, though they can become habit-forming.
It is important to note that antidepressants sometimes have unwanted effects at the beginning, which may make symptoms of the disorder seem worse. People should follow their doctor’s instructions and ask for advice if they have concerns about side effects.
In a psychotherapy appointment, a person works with a therapist to address the causes and symptoms of their anxiety. In the process, the person can find new ways of facing their fears.
CBT focuses on changing the way that a person thinks about and reacts to certain circumstances. The person may learn:
- new ways of facing the situations that trigger their symptoms
- new ways of managing stress and symptoms of agoraphobia
- techniques for managing fear, such as deep breathing exercises
To help a person overcome their fear, a therapist may start by walking a short way from home with them and gradually increase the distance over time. This can provide a safe way to confront unwanted feelings.
Initial treatment may take place online or by telephone, making it unnecessary for the person to leave their home.
Friends and loved ones can also help by learning about agoraphobia, showing understanding, and encouraging the person to take new steps as they feel ready.
Self-care tips for managing symptoms
Some helpful strategies for people with agoraphobia include:
Agoraphobia can involve a combination of fears, other feelings, and physical symptoms. These can all vary from mild to severe.
Some people can manage agoraphobia symptoms by following a routine. For others, it can be severely debilitating.
According to the DSM-5, a person with agoraphobia commonly fears:
- using public transportation
- being in open spaces
- being in enclosed spaces
- standing in line
- being in a crowd
- being outside of the home alone
The most characteristic fear involves a situation in which dangers arises and help is unavailable or escape is impossible. The fear can escalate until the person has a panic attack.
When agoraphobia occurs with panic attacks, the physical symptoms can include:
- a racing heart or rapid heartbeat
- shortness of breath or hyperventilating
- feeling sick
- chest pain or discomfort
- vomiting and other gastrointestinal symptoms
- flushing and chills
- a sense of disorientation
Also, a 2015 study found that levels of low-grade inflammation appeared to increase over time in people with agoraphobia. This suggests that people with the condition may have a higher risk of atherosclerosis and coronary heart disease.
Changes in behavior
A person with agoraphobia avoids certain triggering situations, and they may also:
- change their behavior at home, school, or work
- stop seeing friends
- do all their shopping online
- start misusing alcohol and drugs
A person may also become dependent on others or avoid leaving home for a long time.
The specific reasons why agoraphobia develops remain unclear, but changes in the areas of the brain that control the fear response may play a role.
The DSM-5 lists three types of risk factors:
- Environmental factors: Agoraphobia may develop after experiencing a crime, abuse, or a traumatic event.
- Genetic factors: There are signs that people can inherit it.
- Temperamental factors: Some people appear to be more prone to anxiety-related disorders.
Regarding the apparent link between panic disorder and agoraphobia, the DSM-5 reports that 30–50% of people with agoraphobia had a panic disorder diagnosis or panic attacks before the agoraphobia symptoms arose.
To diagnose agoraphobia, a healthcare professional will interview the person and ask about their symptoms. They may also ask how the person feels about leaving the house and being in certain situations.
Using criteria from the DSM-5, doctors can diagnose agoraphobia if a person experiences anxiety or extreme fear in at least two of the following situations.
- public transport
- open spaces
- enclosed spaces
- a crowd or a line
- out of the house alone
In addition, the doctor looks for the following features:
- The person avoids the triggering situation or refuses to be there without a trusted companion.
- The reason for the avoidance is a fear of being unable to escape, get help, or care for themselves if embarrassing or panic-like symptoms occur.
- The fear and anxiety are out of proportion to any real danger that may exist.
- The fear and anxiety cause profound distress and affect the person’s ability to function.
- There is no other explanation for the fear and anxiety.
The symptoms must be persistent, and the person must have experienced them for at least 6 months to receive a diagnosis.
The doctor also needs to establish that the symptoms do not result from another disorder, such as a specific phobia or social anxiety disorder. They may perform or order tests to rule out other conditions that could cause the symptoms.
A person with a diagnosis of agoraphobia may be eligible for a disability allowance.
The DSM-5 considers agoraphobia to be persistent and chronic if a person does not receive treatment. For many, it is a lifelong condition. However, treatment can help people manage the symptoms.
As many as 1 in 2 people with agoraphobia who receive treatment may make a full recovery. Others may see a significant improvement, with symptoms only reoccurring in times of stress.
Without treatment, around 10% of people experience significant or total relief from symptoms.
Agoraphobia can have a profound impact a person’s day-to-day functioning. Anyone experiencing the symptoms should seek treatment as soon as possible.