Agoraphobia is fear of and anticipatory anxiety about being trapped in situations or places without a way to escape easily and without help if intense anxiety develops.
The situations are avoided, or they may be endured but with substantial anxiety. About 30 to 50% of people with agoraphobia also have panic disorder (see Panic Attacks and Panic Disorder).
Agoraphobia without panic disorder affects about 2% of women and 1% of men during any 12-mo period. Peak age at onset is the early 20s; first appearance after age 40 is unusual.
Common examples of situations or places that create fear and anxiety include standing in line at a bank or at a supermarket checkout, sitting in the middle of a long row in a theater or classroom, and using public transportation, such as a bus or an airplane. Some people develop agoraphobia after a panic attack in a typical agoraphobic situation. Others simply feel uncomfortable in such a situation and may never or only later have panic attacks there. Agoraphobia often interferes with function and, if severe enough, can cause people to become housebound.
Diagnosis is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
To meet the DSM-5 criteria for diagnosis, patients must have marked, persistent (≥ 6 mo) fear of or anxiety about ≥ 2 of the following situations:
Fear must involve thoughts that escape from the situation might be difficult or that patients would receive no help if they became incapacitated by fear or a panic attack. In addition, all of the following should be present:
The same situations nearly always trigger fear or anxiety.
Patients actively avoid the situation and/or require the presence of a companion.
The fear or anxiety is out of proportion to the actual threat (taking into account sociocultural norms).
The fear, anxiety, and/or avoidance cause significant distress or significantly impair social or occupational functioning.
Also, the fear and anxiety cannot be more correctly characterized as a different mental disorder (eg, social anxiety disorder, body dysmorphic disorder).
If untreated, agoraphobia usually waxes and wanes in severity. Agoraphobia may disappear without formal treatment, possibly because some affected people conduct their own form of exposure therapy. But if agoraphobia interferes with functioning, treatment is needed.
Cognitive-behavioral therapy is effective for agoraphobia. Cognitive-behavioral therapy involves teaching patients to recognize and control their distorted thinking and false beliefs as well as instructing them on exposure therapy (see Specific Phobic Disorders : Exposure therapy).
Many patients with agoraphobia benefit from drug therapy with an SSRI.