What is agoraphobia?
Agoraphobia is a type of anxiety disorder. Individuals with agoraphobia feel extreme fear, which makes them avoid places or situations that make them feel embarrassed, helpless, or threatened.
Anxiety disorders are psychological conditions that cause excessive worrying and feelings of nervousness, fear, and apprehension. These are normal emotions, but in people with anxiety disorders they are so overwhelming that they interfere with daily life.
People with agoraphobia are afraid of common daily activities like being in an open space outside, riding public transportation, crossing a bridge or being in crowds like at a shopping mall or concert. People with severe agoraphobia are afraid to go out of their homes.
How common is agoraphobia?
Slightly less than 2 percent of the adult population in the United States has been diagnosed with agoraphobia.
Who gets agoraphobia?
In general, women are more likely to have any anxiety disorder, and twice as many women as men have agoraphobia. Most people who have agoraphobia develop it before the age of 35.
Research has shown that some specific events also increase a person’s risk for developing agoraphobia. These include experiencing the death of a loved one, being attacked, and being abused. People who tend to be nervous or anxious and those with a relative with agoraphobia also have a higher risk of developing it.
What causes agoraphobia?
Researchers are still working to identify the biologic cause of agoraphobia, but they now know that it often is associated with panic disorder. Panic disorder is another type of anxiety disorder. People with panic disorder experience short, intense attacks of extreme fear for no specific reason. During a panic attack, the heart rate speeds up, the person may sweat, feel nauseous, and the need to flee or escape. An estimated one-third of people who have panic disorder develop agoraphobia. Agoraphobia also can occur on its own.
What are the symptoms of agoraphobia?
People who have agoraphobia feel anxious and stressed when they think about or are in places or situations where help may not be readily available, getting out may be difficult or embarrassing or feel a threat to their personal safety. The person with agoraphobia avoids situations that trigger these feelings.
Physical symptoms associated with agoraphobia may include symptoms of a panic attack, such as:
- Rapid heart rate
- Excessive sweating
- Trouble breathing
- Feeling shaky, numb, or tingling
- Chest pain or pressure
- Lightheadedness or dizziness
- Sudden flushing or chills
- Upset stomach or diarrhea
- Feeling a loss of control
- Fear of dying
If a person has symptoms of agoraphobia, when should that person see a physician?
When symptoms start to interfere with daily life, it’s time to get professional help. Getting help early can prevent symptoms from worsening. Agoraphobia is easier to treat in its earlier stages.
How is agoraphobia diagnosed?
A primary care doctor will ask the person about his or her symptoms, times and places where he or she felt fear or anxiety, how often symptoms occur, and how long he or she has had these feelings. The doctor may do a physical exam and order some lab tests to rule out other causes for these symptoms. Based on all of this information, the doctor will refer the person to a psychiatrist if necessary.
The psychiatrist or therapist will ask similar questions about symptoms in more detail to arrive at a diagnosis. A diagnosis of agoraphobia is based on standards developed by the American Psychiatric Association. To have a diagnosis of agoraphobia, a person must feel extreme fear or panic in at least two of the following situations:
- Using public transportation, such as a bus or plane
- Being in an open space, such as a parking lot, bridge or large mall
- Being in an enclosed space, such as a movie theater, meeting room or small store
- Waiting in a line or being in a crowd
- Being out of the home alone
What is the treatment for agoraphobia?
Treatment for agoraphobia combines medication with a type of mental health treatment called cognitive behavior therapy (CBT). Although each type of treatment can be used separately, research suggests that the combination of medication plus therapy gives the best, longest-lasting results. Medication relieves feelings of anxiety temporarily. Over time, CBT permanently changes pathways in the brain that eliminate anxiety and panic feelings, allowing the patient to function normally.
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that usually is the first choice for treating agoraphobia. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that is prescribed for some patients. Antidepressants do not start working immediately. The medication must build up in the body over a few weeks to be effective. The psychiatrist may prescribe a different anti-anxiety medication to help the patient during this period. Other types of anti-anxiety medications also can be prescribed if SSRIs or SNRIs do not work.
Cognitive behavior therapy
The therapist helps patients recognize the thoughts that cause anxiety and teach how to react differently to those thoughts.
The therapist will also help patients learn stress management and relaxation techniques to reduce fear and anxiety. He or she will encourage the patient to imagine stressful situations during a treatment session and work through the feelings associated with them. In the later stage of therapy, the psychiatrist will guide the patient through real-life situations that cause anxiety and help the patient overcome these feelings.
CBT usually requires 12 to 20 weeks of treatment when combined with medication. Without medication, CBT may need to continue for a year for treatment to be effective.
As with most health conditions, exercising, getting enough sleep and eating right can help a person with agoraphobia feel better.
What is the outlook (prognosis) for people with agoraphobia?
The combined medication-CBT approach can help most people with agoraphobia gradually reduce their feelings of fear and anxiety to the point where they can function normally and enjoy life again.
- National Institute of Mental Health: Anxiety Disorders
- American Psychiatric Association Practice Guidelines: Practice Guideline for the Treatment of Patients with Panic Disorder
- National Institutes of Health - National Institute of Mental Health: Health and Education
- American Psychiatric Association: Panic Disorder
- American Psychiatric Association: Social Phobias
- Gloster AT, Hauke C, Höfler M, et al. Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: a two-year follow-up study. Behav Res Ther. 2013 Dec;51(12):830-9.
© Copyright 1995-2017 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/8/2015…#15769