What is Agoraphobia?
Agoraphobia is an irrational fear of entering open, crowded, or confined places—but it is less about the kind of space and more about the feelings that those spaces can trigger. At the heart of agoraphobia is the fear of being in situations in which someone may feel cornered or powerless, and cannot escape. It is not the anxiety that occurs while in helpless situations, but rather the fear that one could lose control within a location that makes agoraphobia so disturbing to people.
People who live with agoraphobia experience such intense fears of specific situations that they may avoid them altogether as a way to cope. Avoiding triggering places may lessen the chances of experiencing this phobia but it also interrupts everyday life, and limits a person’s ability to do what they need each day.
Signs and Symptoms of Agoraphobia
Agoraphobia is not the fear of just one thing. There are so many more signs and symptoms that appear with agoraphobia. Someone can have many specific phobias that, when analyzed together, lead to an agoraphobia diagnosis. Someone with agoraphobia will have an extreme fear of at least two of the following:
- Utilizing public transportation (including taxis, buses, trains, boats, airplanes, and more)
- Being in open spaces in which they feel exposed (including parking lots, marketplaces, and bridges)
- Being enclosed in spaces (such as theaters or elevators)
- Being in long lines or large crowds
- Leaving home without someone else to accompany them
Someone experiencing the signs and symptoms of agoraphobia may experience all of these fears, one of them, or another more specific worry. Due to the fear, people with agoraphobia will have at least one of the following behavioral or emotional symptoms:
- Avoid their agoraphobic fears
- Endure the situations, but with extreme anxiety
- Only face agoraphobic situations with the help of another person
- Experience the fear so intensely that they trigger a panic attack with physical symptoms
Panic Attacks with Agoraphobia
Panic disorder with agoraphobia is common. People who have agoraphobia may experience panic attacks when they find themselves in situations they perceive as helpless. As such, many of the physical symptoms of agoraphobia overlap with those for panic attacks, including:
- Trouble breathing
- Sudden sweating
- Feelings of dread
- Rapid heartbeat
- Chest pain or pressure
- Feeling flushed in the face
- Chills, shakiness, or numbness
- Feeling like they are dying
- Digestive issues, including vomiting, and diarrhea
- Lightheadedness or dizziness
What Causes Agoraphobia?
In many cases, agoraphobia develops when someone has another anxiety disorder or panic attacks that go untreated for too long. After having a panic attack in public, people may begin to fear the next panic attack, leading to agoraphobia.
Not everyone with an anxiety disorder will develop agoraphobia. Some people without previously diagnosed anxiety disorders develop agoraphobia first.
Other risk factors that increase someone’s chances of living with agoraphobia include:
- Traumatic life events, such as being the victim of abuse or a violent crime
- A nervous or anxious temperament
- A close biological relative who lives with agoraphobia
People can develop agoraphobia in childhood, and most people who will have the disorder show symptoms by age 35. However, some patients do not have symptoms until late adulthood.
As with all types of anxiety, professionals may recommend prescription medication, therapy, or a combination of both, to treat agoraphobia. Exposure therapy is a popular therapy for patients with agoraphobia.
Medication Treatment for Agoraphobia
Medication can be used as a sole treatment for agoraphobia, but in many cases, it will be used in combination with therapies such as Applied Relaxation or Cognitive Behavioral Therapy. There aren’t any FDA-approved medications specifically for agoraphobia, but several different antidepressant and anti-anxiety medicines may help relieve your symptoms. Selective serotonin reuptake inhibitors (SSRIs) are typically prescribed for agoraphobia. They are also used to treat panic disorders, which are one of the symptoms of agoraphobia. It may take weeks for medication to relieve symptoms, and you may have to try several different medications before you find the one that works best for you.
Exposure Therapy for Agoraphobia
In exposure therapy, a person gradually faces fears. For example, a person who is afraid to leave home alone may start by just stepping outside or walking around the block. When nothing bad happens, they are often emboldened to repeat this action. Eventually, they come to realize that walking around the neighborhood isn’t as dangerous as they had feared.
The counselor may then have the person try to go to the market. After several times, they may see that this is also safe. After several rounds of this, the patient may live without symptoms of their agoraphobia.
As patients go through exposure therapy, they may need prescription medications to cope with the anxiety. Some people need to stay on the medication for the long term, while others rely on them only for a short while.
Telehealth for Agoraphobia
Due to the nature of agoraphobia, many patients may prefer online therapy and psychiatric services to in-person appointments. Many of the treatment options for agoraphobia are available through these telehealth options, including medication for panic attacks and individual treatment.
LifeStance Health offers telehealth services through secure video conferencing software. We make it as easy as possible to get the care you need—from online booking to convenient telehealth appointments and insurance billing; we’re here to help.
Popular culture often portrays people with agoraphobia as unable to leave their homes. While this is one way that this anxiety disorder can present itself, many people with agoraphobia can leave home and function in a limited way outside their homes. However, to cope, they may avoid specific types of situations, like public transportation, which severely limits their ability to live, and may in itself cause feelings of fear.
The stigma surrounding agoraphobia keeps some people from seeking treatment. For example, someone may believe that their anxiety isn’t “severe enough” to warrant therapy because they can leave their homes. This type of thinking can be a form of avoidance. Getting treatment for agoraphobic feelings can free you both physically and mentally.
One of the unexpected effects of the ongoing pandemic has been a surge in cases of agoraphobia.
The COVID-19 pandemic may have prompted some people who had their agoraphobia under control to backslide. General anxiety about the coronavirus may also be contributing to the development of new cases of what is now being called Pandemic Agoraphobia.
It is important to note that many of these new cases are occurring in young people. Pandemic-related disruptions to schooling, socializing and family life have created a situation that the U.S. Surgeon General has described as a “youth mental health crisis.”
For a better understanding of this situation please read our recently released 2022 State of Youth Mental Health Report. And to learn more about COVID’s effect on mental health please read our blog post Mental Health After COVID-19.