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* This is the Consumer Version. *

Agoraphobia ˌag(-ə)-rə-ˈfō-bē-ə

By John H. Greist, MD, University of Wisconsin, School of Medicine and Public Health

Agoraphobia is anxiety about being trapped in situations or places with no way to escape easily if anxiety or panic develops. These situations or places are often avoided or endured with much distress.

Agoraphobia is a type of anxiety disorder. About 30 to 50% of people with agoraphobia also have panic disorder. About 2% of women and 1% of men have agoraphobia without panic disorder during any 12-month period. Most people with agoraphobia develop it in their early 20s. It rarely develops after age 40.

Although agoraphobia literally means “fear of the marketplace,” the term more specifically describes the fear of being trapped, often in a busy place filled with people, without a graceful and easy way to leave if anxiety becomes severe.

Typical situations that are difficult for people with agoraphobia include the following:

  • Riding on a bus or airplane

  • Being in a open space, such as parking lot or marketplace

  • Being in an enclosed space, such as a shop or theater

  • Standing in line at a bank or supermarket or being in a crowd

  • Sitting in the middle of a long row in a theater or classroom

  • Being alone outside the home

Some people develop agoraphobia after experiencing a panic attack in one of these situations. Other people simply feel uncomfortable in these settings and may never, or only later, have panic attacks there. Agoraphobia often interferes with daily living, sometimes so drastically that it makes people housebound.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors diagnose agoraphobia when people have fear or anxiety that is all of the following:

  • Is intense and has been present for 6 months or longer

  • Occurs in two or more situations typically associated with agoraphobia

  • Nearly always occurs in the same situation

  • Includes thoughts that escape from the situation might be difficult or that people would receive no help if they became incapacitated by fear or a panic attack

  • Makes them change their behavior to avoid the situation or makes them require a companion

  • Is out of proportion to the actual danger

  • Causes significant distress or significantly impairs functioning

Also, doctors rule out other mental disorders that can cause similar symptoms, such as social phobia or body dysmorphic disorder.

Treatment

  • Exposure therapy

  • Cognitive-behavioral therapy

  • Sometimes antidepressants called selective serotonin reuptake inhibitors

If agoraphobia is not treated, it usually waxes and wanes in severity and may even disappear without formal treatment, possibly because people have used their own form of exposure therapy, exposing themselves repeatedly to the situation that triggers their fears until the fears subside.

Exposure therapy (see What Is Exposure Therapy?) helps more than 90% of people who practice it faithfully.

Cognitive-behavioral therapy may also help. With this therapy, people learn to recognize when their thinking is distorted, to control the distorted thinking, and to modify their behavior accordingly. Substances that depress the central nervous system (brain and spinal cord), such as alcohol or large doses of antianxiety drugs, may interfere with behavioral therapy and are often tapered off before therapy is begun.

People with agoraphobia may benefit from taking a selective serotonin reuptake inhibitor (SSRI), which is an antidepressant.

* This is the Consumer Version. *