Agoraphobia

Agoraphobia (pronounced “uh-gaw-ruh-FOE-bee-uh”) is an intense fear of being in a situation where you feel trapped or helpless. You worry about having a panic attack or other symptoms and being unable to escape or get help. Because of this fear and anxiety, you avoid at least two of the following places or situations

• Large, open areas
• Enclosed spaces
• Crowds or standing in line
• Using public transportation
• Places outside of your home

You don’t fear these places specifically. You fear what you may experience (like a panic attack) while you’re in these areas.

It’s most common for agoraphobia to develop when you’re a teenager or in your 20s. But it can also develop in older adults. The condition can range from mild to severe. In its most severe form, you may never leave your home.

Everyone experiences anxiety sometimes. But agoraphobia is an anxiety disorder. It causes excessive worry that affects your daily life. Agoraphobia can make you feel extreme fear and stress. It prevents you from living life how you want to.

Symptoms of agoraphobia

The main symptom of agoraphobia is fear that you’ll have a panic attack in places where you can’t escape or get help. You may fear causing a scene or being embarrassed, like if you faint or get sick to your stomach.

Features that make agoraphobia distinct from everyday anxiety include:

• The same situations almost always trigger fear or anxiety.
• The fear is bigger than the actual danger of the situation.
• You avoid the situation, need someone to be with you or you deal with it, but you’re very distressed.
• The fear gets in the way of your daily life, like your ability to work, date or socialize.
• The fear and avoidance of places lasts six months or longer.

What does it feel like?

You may have these symptoms when you’re in situations that cause fear:

• Racing thoughts
• Chest pain or rapid heart rate
• Trembling or shaking
• Trouble breathing, like hyperventilating
• Feeling lightheaded or dizzy
• Sudden chills or flushing
• Sweating a lot
• Upset stomach or nausea
• Diarrhea

These symptoms can be very intense. You may feel detached from yourself or like you’re going to die.

Living with agoraphobia often feels overwhelming. You may feel trapped or stuck by the condition, like you can’t break free of it. And you may be ashamed or embarrassed about not going to places as easily as other people do.

Agoraphobia causes

Researchers don’t know the exact cause of agoraphobia. But it’s often linked to panic disorder. Panic disorder causes short, intense attacks of fear for no obvious reason. About a third of people who have agoraphobia also have panic disorder. But agoraphobia can also occur alone.

Genetics may play a role in agoraphobia that happens alongside panic disorder. You’re more likely to have both conditions if you have a biological relative with both.

Certain childhood experiences may contribute to the development of this condition, such as:

• Adverse childhood experiences (ACEs), like grief or trauma
• Lack of affection and emotional support from parents
• Overly protective parents
• Childhood fears or night terrors

There’s no way to prevent agoraphobia. But getting treatment early on can help prevent the symptoms from getting worse.

Complications

Agoraphobia can take a heavy toll on your life and well-being. It may lead to:

• Difficulty working and a lack of income
• Difficulty with dating or finding a life partner
• Reliance on others for things like groceries and running errands
• Isolation
• Self-medication with alcohol or other substances

About 9 in 10 people with agoraphobia have other mental health conditions, like:

• Other anxiety disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Substance use disorder

You’re also at a higher risk of having suicidal thoughts or behaviors.

Get help immediately if you’re having suicidal thoughts. You can call the U.S. National Suicide Prevention Lifeline, now known as the 988 Suicide & Crisis Lifeline, any time of day.

Treatment can help prevent these complications. It’s important to seek medical help sooner rather than later.

How doctors diagnose this condition

If you think you have agoraphobia, you should talk to a primary care physician or a mental health provider. If visiting a medical office triggers your symptoms, see if you can schedule a video (virtual) appointment.

There’s no test for this condition. Instead, a provider may ask you questions like:

• Do you get stressed about leaving your house?
• Which places or situations do you avoid? Why do they cause fear?
• Do you rely on others to go shopping and run errands?

A provider can diagnose it based on your symptoms, how often they happen and how severe they are. It’s important to be open and honest with your provider.

How is agoraphobia treated?

Agoraphobia treatment usually involves a combination of methods, including talk therapy and medication. Combined treatment is often more effective than either treatment alone.

Talk therapy

A mental health provider can help you work through fears. Using cognitive behavioral therapy (CBT), a therapist can help you recognize thoughts and situations that cause anxiety. Then, you’ll learn how to react in a healthier way. Therapy takes time, often months, to see the full benefits.

Your therapist may use relaxation and desensitization techniques. Exposure therapy is a core component of CBT for agoraphobia. It includes creating a list of feared activities from the least to the most feared. You slowly expose yourself to them to train your brain to feel less anxious in those situations and environments over time.

For example, if you have a fear of being in the grocery store, you may start exposure therapy by looking at pictures of grocery stores. Later, you’ll sit in the parking lot of a grocery store and then go into the store for a short duration. Therapy using virtual reality (VR) technology to simulate exposure to the feared environment can also help.

Over time, therapy can train your brain to think and respond differently. Research shows that therapy phone app use, in addition to traditional therapy, can further improve progress.

Medication

Your healthcare provider also may suggest medications called SSRIs, like sertraline or escitalopram. They help treat anxiety disorders and depression.

It can take time for SSRIs to take full effect — typically four to six weeks. So, you might not have symptom relief right away. Try to be patient. In the meantime, your provider may recommend using anxiety coping techniques or as-needed anxiety medication.

What can I expect if I have this condition?

It’s rare for agoraphobia to go away without treatment, especially if it’s severe. But the good news is that talk therapy and/or medication can help calm the symptoms.

Treatment can take time. But starting the process of managing this condition brings you one step closer to feeling better. It may also help to join a support group to relate to others living with agoraphobia.