Agoraphobia is a persistent fear of being trapped in situations or places without a way to escape easily and without help. Diagnosis is based on clinical criteria. Treatment is mainly with behavioral therapy.
(See also Agoraphobia in adults.)
Agoraphobia is an anxiety disorder characterized by an intense fear or anxiety about being in situations where escape might be difficult or help unavailable should a panic attack or other incapacitating symptoms occur. This fear can lead individuals to avoid situations and environments that might provoke such feelings. Agoraphobia is uncommon among children, but it may develop in adolescents, particularly those who also have panic attacks. During a typical agoraphobic situation (eg, standing in line, sitting in the middle of a long row in a classroom), some people have panic attacks; others simply feel uncomfortable.
Agoraphobia often interferes with function and, if severe enough, can cause people to become housebound.
In the United States, the lifetime prevalence of agoraphobia was estimated to be 2.4% of adolescents, and all had severe impairment (1). There is a female preponderance.
General reference
1. Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980-989. doi:10.1016/j.jaac.2010.05.017
Diagnosis of Agoraphobia
Psychiatric assessment
Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, Text Revision (DSM-5-TR) criteria
For agoraphobia to be diagnosed, patients must consistently have unreasonable fear or anxiety about ≥ 2 of the following for ≥ 6 months (1):
Using public transportation
Being in open spaces
Standing in line or being in a crowd
Being outside the home alone
Claustrophobia (fear of enclosed spaces) may paradoxically occur in some patients with agoraphobia (fear of open spaces, as children may be afraid of being unable to escape)
Also, the fear must cause patients to avoid the distressing situation to the extent that they have difficulty functioning (eg, going to school, visiting the mall, doing other typical activities).
Agoraphobia must be distinguished from the following:
Specific phobias (eg, to a certain situation)
Depression, which can cause patients to avoid leaving the house for reasons unrelated to anxiety
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), Washington: American Psychiatric Association, 2022.
Treatment of Agoraphobia
Behavioral therapy
Behavioral therapy is especially useful for agoraphobia symptoms. Medications are rarely useful except to control any associated panic attacks.
