Agoraphobia is fear or anxiety about being in situations or places (for example, in crowds and shopping malls or while driving) with no way to escape easily or in which help might not be available if intense anxiety 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 people have agoraphobia yearly. Agoraphobia often develops in adolescence and young adulthood but can also develop among older adults.
Common examples of situations or places that create fear and anxiety include the following:
Standing in line at a bank or at a supermarket checkout
Sitting in the middle of a long row in a theater or classroom
Using public transportation, such as a bus or an airplane
Leaving 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 of Agoraphobia
A doctor's evaluation, based on standard psychiatric diagnostic criteria
Doctors diagnose agoraphobia when the fear, anxiety, or avoidance lasts 6 months or more and involves at least 2 of the following situations:
Using public transportation
Being in a open space, such as a parking lot or marketplace
Being in an enclosed space, such as a shop or theater
Standing in line or being in a crowd
Being alone outside the home
The fears must involve concerns that escape might be difficult or that help will be unavailable if people panic or become incapacitated.
In addition, all of the following must be present:
Symptoms are almost always triggered by the same situations
People change their behavior to avoid the situation or need a companion to help them tolerate it
Symptoms are out of proportion to the actual danger
Symptoms cause significant distress or significantly impair functioning
Symptoms are not caused by another mental disorder such as social anxiety, or a general medical condition such as inflammatory bowel disease
Treatment of Agoraphobia
Exposure therapy
Cognitive-behavioral therapy
Sometimes antidepressants called selective serotonin reuptake inhibitors (SSRIs)
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. Others no longer complain about agoraphobia symptoms because they have learned to avoid situations (such as airplanes or crowds) that trigger their anxiety. However, simply avoiding situations may significantly restrict a person's life. Because treatments often increase anxiety at first, treatment of agoraphobia (and other anxiety disorders) often involves learning relaxation strategies.
Exposure therapy helps more than 90% of people.
Cognitive-behavioral therapy may also help. With this therapy, people learn to do the following:
Recognize when their thinking is distorted
Control the distorted thinking
Modify their behavior accordingly
People with agoraphobia may benefit from taking an SSRI. Although SSRIs are considered to be antidepressants, they may also work well for some anxiety disorders.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
National Institute of Mental Health, Agoraphobia: General information on many aspects of agoraphobia, including prevalence statistics
