Agoraphobia: Fear of Certain Places or Situations (2023)

Agoraphobia is an anxiety disorder that causes intense anxiety in certain situations that make it difficult to escape or access help if panic or other upsetting symptoms develop.

In some but not all cases, agoraphobia coincides with panic attacks as people learn to avoid certain situations that could trigger future attacks. As a result, their list of safe places shrinks over time.

If you or someone you care about may be living with agoraphobia, the sooner you get help the better. With treatment, you can begin to cope with your condition and take back control of your life.

Symptoms

Left untreated, agoraphobia can often become worse over time. This condition is characterized by intense fear in situations such as the following:

• Using public transportation such as a bus, subway, or plane
• Being in open spaces like large shopping centers or parking lot
• Being in enclosed spaces like elevators or small stores
• Being on a bridge
• Having to wait in line or enter a crowd of people
• Leaving your home by yourself

What makes these situations so scary is that they’re difficult to get out of or seek help in if you begin to experience upsetting or embarrassing symptoms. You might know the anxiety or panic you’re feeling is irrational, but you can’t help but feel overwhelmed by it.

In light of this, agoraphobia can lead to additional symptoms including:

• Persistent fear or anxiety when exposed to a certain situation that’s out of proportion to any real-life dangers presented by it
• Avoidance of upsetting situations unless you have someone with you
• Severe distress or struggles with your social life, work, or other areas of your life due to anxiety or avoidance

For people who experience agoraphobia associated with panic disorder, symptoms of panic attacks include:

• Sudden extreme fear that you’re having a heart attack, losing control, or dying
• Rapid heart rate
• Difficulty breathing or a choking sensation
• Lightheadedness or dizziness
• Chest pain or discomfort
• Feelings of shakiness, numbness, or tingling
• Sweating or chills
• Abdominal distress

Causes and Risk Factors

The exact causes of agoraphobia are unknown. Like other anxiety disorders, agoraphobia is likely caused by a complex combination of factors including your genetics and environmental stressors.

Risk factors for developing agoraphobia include:

• Previous panic attacks followed by excess fear or anxiety
• Phobias such as claustrophobia
• Other mental health disorders such as depression
• Stressful life experiences such as the death of a loved one or abuse
• Substance abuse
• A family history of agoraphobia

While adolescents and adults of all ages can be affected by agoraphobia, the average age of onset is between 21 and 35 years old.

Diagnosis

In order to diagnose you with agoraphobia, a mental health professional will ask you a series of questions or provide a screening test on your symptoms, what situations cause them, and how severe they are. If you’re unable to visit a medical center in person, ask about scheduling an appointment over the phone or via video.

An official diagnosis of agoraphobia must meet the criteria specified by the American Psychiatric Association (APA) in the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5). In the past, agoraphobia was classified as a feature of panic disorder, but it is now considered a separate anxiety disorder.

Here are the diagnostic criteria for agoraphobia, per the DSM-5:

1. Marked fear or anxiety about two or more of the following: Using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside the home alone
2. These situations almost always cause out-of-proportion fear or anxiety and are avoided, cause marked distress, or require the presence of a companion
3. Anxiety or avoidance not better accounted for by a different mental disorder
4. Symptoms are persistent, typically lasting six months or longer, and cause clinically significant distress or impairment in functioning

Treatment

Agoraphobia can be treated with a combination of therapy, medication, and lifestyle changes.

Psychotherapy

With the help of a therapist, you can learn how to deal with anxiety, face your fears, and gradually return to the situations you’ve been avoiding.

• Cognitive behavioral therapy (CBT) is the most effective form of therapy for agoraphobia. You can use CBT to identify and deal with distorted thoughts and feelings that trigger panic or anxiety in certain situations, replacing them with healthier responses.
• Desensitization (exposure therapy) can help you learn how to better manage anxiety-inducing situations by gradually exposing yourself to scenarios with your therapist’s guidance.
• Relaxation techniques can give you the tools you need to relax in order to manage anxiety and panic when they arise.

Medication

Along with therapy, medications for anxiety disorders may help ease symptoms of agoraphobia. These include:

• Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) or Paxil (paroxetine)
• Serotonin-noradrenaline reuptake inhibitors (SNRIs) such as Effexor (venlafaxine) or Cymbalta (duloxetine)
• Anti-anxiety medications or sedatives such as benzodiazepines like Klonopin (clonazepam) or Xanax (alprazolam)

Coping

In order to cope with agoraphobia, you'll need to continue practicing the skills that allow you to manage your anxiety and expand the situations you feel comfortable in. These lifestyle changes can help you stay on track:

• Eat a healthy and balanced diet
• Incorporate regular exercise into your routine
• Join an online or in-person support group
• Manage stress
• Avoid alcohol, drugs, and caffeine
• Talk to your healthcare provider before taking any other supplements or medication

A Word From Verywell

If you or someone you love is struggling with agoraphobia, the nature of this condition can make it very difficult to reach out for help, but you can get your life back with the help of a mental health professional. While the healing process may be uncomfortable, challenging, and scary at first, with each step forward, the next one becomes a little easier.