Agoraphobia

What Is Agoraphobia?

Agoraphobia is a rare type of anxiety disorder. If you have it, your fears keep you from getting out into the world. You avoid certain places and situations because you think you’ll feel trapped and not be able to get help.

For example, you might worry or panic when you are in:

  • Public transportation (buses, trains, ships, or planes)

  • Large, open spaces (parking lots, bridges)

  • Closed-in spaces (stores, movie theaters)

  • Crowds or standing in line

  • Being outside your home alone

You may be willing to go just a handful of places, or you may even dread leaving your house. 

Agoraphobia Causes and Risk Factors

Doctors aren't sure what causes agoraphobia. They think it runs in families. You may get it if you have a lot of panic attacks. That's when you have bursts of fear that come out of the blue and last for a few minutes. These happen when there's no real danger.

Less than 1% of people in the U.S. have agoraphobia. Women are two to three times more likely to have it than men, and it's more common in teenagers and young adults. 

A few other things that can raise your chances of it include having:

  • Panic disorder, especially if it’s not treated

  • Other phobias

  • A family member who has agoraphobia

  • A history of very stressful or traumatic events

Agoraphobia Symptoms

If you have agoraphobia and end up in a place that scares you, you can become very anxious or panic. Physical symptoms of this can include:

  • Fast, pounding heart

  • Sweating, trembling, shaking

  • Breathing problems

  • Feeling hot or cold

  • Nausea or diarrhea

  • Chest pain

  • Problems swallowing

  • Dizziness or feeling faint

You may feel like: 

  • You might not survive a panic attack.

  • You’re not in control. 

  • You’ll look bad in front of others or that they’ll stare at you.

  • You need to be with someone you trust when you go anywhere.

You also might have:

  • A fear of being alone in your house

  • A general feeling of dread

Agoraphobia Diagnosis

A lot of the symptoms caused by agoraphobia are the same as those of other medical conditions like heart disease, stomach issues, and breathing problems. So you may make several trips to the doctor or emergency room before you and your doctor figure out what's really going on.

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Your doctor may ask:

  • Do you find it scary or stressful to leave your house?

  • Do you have to avoid some places or situations?

  • What happens if you end up in one of them?

They’ll do a physical exam and maybe some tests to rule out any other medical problems. If they don’t find a physical reason for your symptoms, they’ll probably recommend that you see a psychiatrist or therapist. 

At your session, you’ll answer questions about your feelings and your behavior. According to standards created by the American Psychiatric Association, you could be diagnosed with agoraphobia if you feel extreme fear or panic in at least two of these situations:

  • Outside your house by yourself

  • In an open space, like a parking lot or mall

  • In an enclosed space, like a theatre or small office

  • In a line or in a crowd

  • On public transportation, including planes

Agoraphobia Treatments

Your doctor will usually treat agoraphobia with therapy, medication, or a combination of the two. 

Therapy. Cognitive therapy can teach you new ways to think about or face situations that cause panic and help you be less afraid. You may also learn relaxation and breathing exercises. Sometimes your therapist may suggest exposure therapy, in which you gradually start to do some of the things that make you anxious.

Medicine. There are many drugs that your doctor might suggest for agoraphobia, but the most common are antidepressants. Doctors often start with a low dose of one of these medicines that raises the level of a "feel-good" chemical in your brain called serotonin. Some medications that help balance serotonin are citalopram (Celexa), escitalopram oxalate (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), and venlafaxine (Effexor).

You'll probably take medicine for at least 6 months to a year. If you feel better and no longer are stressed when you're in places that used to scare you, your doctor may begin tapering off your medicine.

For short-term relief, your doctor may recommend anti-anxiety medications, called benzodiazepines, in addition to antidepressants. These are sedatives that can help with your symptoms. You can start to depend on them, so you shouldn’t take them for long. And be sure to tell your doctor if you’ve had any issues with alcohol or drug abuse.

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Alternative therapies.Applied relaxation is a series of exercises that help you notice when you start to feel tense and learn how to relax your muscles and ease that tension. It typically takes an hour-long session each week for 12 to 15 weeks.

Other alternative therapies that may help include breathing exercises and meditation.

Lifestyle changes. It can help to exercise regularly and eat a healthy diet. Skip caffeine and alcohol. They can make your symptoms worse.

Agoraphobia Outlook

The right combination of medication and therapy can help manage agoraphobia and make living with it easier. A few other things to keep in mind:

  • Get help when you need it. Family and friends can help you work through your fears, and a support group lets you connect with people who are going through the same things you are.

  • Manage anxiety and stress. Talk with your therapist about ways to calm yourself and find relaxation techniques that work for you.

  • Follow your doctor’s guidance.It’s really important to take medication as directed and keep your therapy appointments. Stay in touch with your health team so they can do their best for you.   

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on June 15, 2020

Sources

SOURCES:

Anxiety and Depression Association of America: "Panic Disorder & Agoraphobia."

Medscape: "Phobic Disorders."

National Institute of Mental Health: "Panic Disorder."

NHS: "Agoraphobia."

Cleveland Clinic: “Agoraphobia: Diagnosis and Tests.”

Victoria State Government: “Agoraphobia.”

Mayo Clinic: “Agoraphobia.”

Mount Sinai Health System: “Agoraphobia.”

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