Agoraphobia is an anxiety disorder characterized by the fear of not being able to receive help in certain situations, which leads to an avoidance of leaving home or dependence on a companion for support.
While agoraphobia has a 2.6% lifetime prevalence rate, anxiety disorders in general are very common, impacting roughly 34% of people at some point in their lives. Although between 30% to 50% of those with agoraphobia also experience panic disorder, the two are distinct conditions with their own symptoms and challenges.
If you’ve been diagnosed with agoraphobia or think you might have it, you may have many questions or concerns. This guide will help you understand what agoraphobia is, why it develops, and how effective treatments and support can help you regain confidence and feel more like yourself again.
Key takeaways
- Agoraphobia is an anxiety disorder involving fear of situations where escape or help may be difficult.
- Symptoms include intense fear, physical anxiety, and avoidance of public or enclosed spaces.
- Causes may include genetics, childhood trauma, panic disorder, and personality traits like avoidant tendencies.
- Effective treatments include cognitive behavioral therapy, exposure therapy, and, in some cases, medication.
- Diagnosis requires persistent fear in at least two settings for six months, causing significant life disruption.
What is agoraphobia?
Agoraphobia involves having strong fears and aversions about situations or places where it may be difficult to escape or that you perceive are unsafe. Often, these anxieties are associated with fears of having panic attacks in these situations. In some cases of severe agoraphobia, people are unable to leave their homes.
Tahara DeBarrows, a licensed marriage and family therapist (LMFT) with Grow Therapy, explains that agoraphobia is diagnosed based on specific criteria outlined in the DSM-5, a manual used by mental health professionals.
“According to the DSM-5, individuals with agoraphobia have a marked fear or anxiety about using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside of the home alone.”
She also explains, “to receive a diagnosis, the person must experience significant fear or anxiety about at least two or more of these situations, along with other factors mentioned in the manual.”
In addition, as noted in the DSM-5, in order to be diagnosed with agoraphobia, these anxieties aren’t usually associated with realistic threats, substance use, social factors, or cultural considerations. Typically, you must have these symptoms for at least six months to be diagnosed with agoraphobia.
What are the causes of agoraphobia?
At this time, it’s not known what causes agoraphobia. But it’s known that agoraphobia tends to occur with other types of anxiety, especially panic disorder. Similar to anxiety, the causes of agoraphobia are multifactorial, meaning that more than one factor is responsible for the development of the condition. It’s theorized that genetic factors may be at play, as well as additional contributing factors like early grief or trauma, anxiety sensitivity, and avoidant or dependent tendencies.
Certain situations are more likely to trigger agoraphobia in people, including:
- Standing in line at stores, banks, post offices, or other public places
- Using public transportation, including buses, trains, or airplanes
- Sitting in the middle of a row of seats, such as in a theater, classroom, or mode of public transportation
- Being in any kind of enclosed space or, conversely, being in a wide, open space
- Being a crowded or busy place or situation
- Leaving home
What are the common symptoms of agoraphobia?
When you experience agoraphobia, you’ll experience fear and anxiety when you are in situations or public spaces that trigger you. But it’s also possible to experience these feelings just by thinking about these situations or places.
Some agoraphobia symptoms may include:
- Fear of places that are confining or that may be hard to escape from
- Fear of having a panic attack in a place or situation you fear
- Feeling scared to leave your home
- Being overly reliant on others, or feeling more detached or isolated from others
- Feeling helpless or stuck
- Feeling disconnected from yourself or your surroundings
- Finding yourself easily agitated
- Physical anxiety symptoms, like a racing heart, shortness of breath, sweating, and dizziness
What are the risk factors of agoraphobia?
While the specific risk factors for agoraphobia aren’t fully known at this time, some factors may be more likely to contribute. For example:
- People who experienced childhood traumas or adverse childhood events may be more likely to experience agoraphobia
- Growing up with overprotective parents or a shortage of parental warmth may contribute
- People who had serious childhood fears or night terrors may be more likely to develop the disorder
- Experiencing grief and loss in early childhood may increase your risk
- People with personality traits like neuroticism, introversion, or avoidant/dependent tendencies may have an increased risk of agoraphobia
How is agoraphobia diagnosed by healthcare professionals?
Agoraphobia is typically diagnosed by a licensed mental health professional, such as a psychologist, psychiatrist, or therapist. During the evaluation, your clinician will ask detailed questions about your symptoms, life experiences, and specific situations that trigger your anxiety or avoidance. They’ll also explore how long you’ve been experiencing these symptoms and how much they interfere with your ability to function day-to-day, such as leaving home, working, or socializing.
Mental health professionals use the DSM-5, a professional reference manual, to classify and diagnose mental disorders. The agoraphobia diagnosis includes the following criteria:
- Experiencing fear and avoidance of at least two specific situations, which may include the use of public transportation, being in open spaces, being in enclosed spaces, being in crowds, standing on a line, or being outside your home
- Finding that these situations always, or almost always, trigger feelings of fear or anxiety
- Experiencing anxiety or fear that doesn’t match the actual danger of the situation
- Experiencing clinically significant difficulty functioning or high levels of distress
- Having experienced anxiety, fear, and avoidance of specific situations for at least six months
What is the best treatment for agoraphobia?
If you are living with agoraphobia, it’s understandable that you might feel helpless and unsure of what to do. There’s hope, though. Agoraphobia is treatable, and the benefits of getting agoraphobia treatment are immense.
Cynthia Mobley, a licensed independent clinical social worker and certified clinical trauma professional (LICSW, CCTP) with Grow Therapy, emphasizes the importance of reaching out for support.
“Getting help for agoraphobia is important to help individuals experiencing agoraphobia enjoy a fulfilled life and avoid social isolation and decreased health/mental health.”
Treatment for agoraphobia typically involves a combination of proven strategies designed to reduce anxiety and increase independence.
Therapy
The main way that agoraphobia is treated is through therapy with a licensed mental health professional. “Most therapists will be able to offer suggestions and coping skills,” says Mobley. “It may be most helpful to seek a therapist who has experience with cognitive behavioral therapy or trauma work.” Other effective therapies for agoraphobia include exposure therapy.
Cognitive behavioral therapy (CBT) is the type of therapy with the most evidence of effectiveness in treating agoraphobia. In cognitive behavioral therapy, you work with your therapist to help identify and understand the thoughts and feelings that shape your agoraphobia. Then, you work on methods for managing your thoughts and feelings more effectively, as well as tools for coping with anxiety, such as relaxation and breathing techniques. As another part of CBT, exposure therapy is also known to be effective in treating agoraphobia. During exposure therapy, you gradually and safely face avoided situations, but do so under the care and guidance of your therapist.
Medication
In some cases, medication is used alongside therapy to help reduce symptoms, especially for people experiencing more severe agoraphobia or co-occurring conditions. Other options may include serotonin-norepinephrine reuptake inhibitors (SNRIs) or, in some cases, tricyclic antidepressants. Benzodiazepines may be used short-term for acute symptoms, particularly when panic disorder occurs alongside agoraphobia; however, because they can be habit-forming and carry a risk of dependence, clinicians typically use them cautiously and avoid long-term use.
How to find a therapist for agoraphobia
Deciding to seek therapy for agoraphobia is an important first step toward your recovery. Still, you may feel unsure of where to start to search and what to look for.
It’s important to find a therapist who has experience in anxiety disorders as well as treating patients who have agoraphobia. DeBarrows says that “clients should seek therapists trained in CBT (cognitive behavioral therapy).” Other appropriate therapy types include exposure therapy.
In addition to this, it’s vital to find a therapist whom you feel comfortable with and who helps you feel seen and understood. Sometimes this involves interviewing several therapists until you find a good match for you.
At Grow Therapy, you can choose from many different therapists, and you can search by specialty. Therapy can take place in person or virtually, and your therapist will help you feel comfortable and supported through every step of the process.