What Is Agoraphobia?

Agoraphobia is an intense, often extreme fear of being in places where it's hard to escape or where help might not be available if something happens. Agoraphobia usually involves fear of being in a public place rather than at home.

In severe cases, a person with agoraphobia may become afraid of leaving the house at all.

Here's what to know about symptoms, causes, and treatments of agoraphobia and how to cope if you think you might have it.

Causes and Risk Factors

It's hard to know why some people develop agoraphobia, Luana Marques, PhD, associate professor in the department of psychiatry at Harvard Medical School and associate director and director of research at the Center for Anxiety and Traumatic Stress Disorders Program at Massachusetts General Hospital, told Health. "People have some vulnerability, and increased anxiety can make them more fearful. That can certainly make someone develop agoraphobia," said Marques.

Agoraphobia is also often linked to panic attacks, said Marques. An example is when someone has had a panic attack in the past and then starts to be afraid of situations that might lead to another one. "If you were on a subway and had a panic attack, then you start to avoid the subway. Then you start to avoid a lot of things, and that's when we get to agoraphobia," said Marques.

There are people who have agoraphobia without the panic attack link, added Marques, but the condition is more commonly tied to panic disorder.

Continuing to avoid leaving the house can make agoraphobia worse, Alicia H. Clark, PsyD, author of "Hack Your Anxiety," told Health. "When you avoid something scary, it tends to get scarier," said Clark.

Signs and Symptoms

Symptoms of agoraphobia include:

• Fear of leaving home or being in social situations alone
• Fear of open spaces, bridges, or shopping centers
• Fear of enclosed spaces or buildings
• Fear of losing control in a public place
  
• Fear of places where escape might be difficult
• Fear of public transportation
• Feeling detached or separated from others
• Feeling helpless
• Feeling that your body is not real
• Feeling that your environment is not real
• Staying in your house for long periods

Someone with agoraphobia may be aware that their fear is irrational yet are unable to overcome it. In severe cases, people with agoraphobia may become completely homebound and dependent on others for anything that requires leaving their home.

Diagnosis

There is no physical test that can help diagnose agoraphobia. A mental health professional will do an extensive interview with the person.

To meet the criteria for agoraphobia in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), a person must have an intense fear of at least two of the five following situations for at least six months:

• Using public transportation (e.g., automobiles, buses, trains)
• Being in open spaces (e.g., marketplaces, parking lots)
• Being in enclosed spaces (e.g., theaters or malls)
• Standing in lines or crowds
• Being outside of the home alone

The person also must be attempting to find ways to avoid situations that trigger symptoms. Other psychiatric and medical diagnoses must be ruled out and must not be related to substance use or withdrawal.

Treatment

If you're feeling fearful of leaving your home, it's a good idea to try your best to push past it. It's important to not avoid certain everyday situations out of fear that something could happen, Bunmi O. Olatunji, PhD, associate professor of psychiatry at Vanderbilt University, told Health. "It's important for people to learn that they can tolerate those symptoms," said Olatunji.

However, if you find that you're trying to get out more and you're still struggling, Olatunji said it's time to consult a mental health expert for help. "There are very good treatments out there for agoraphobia," said Olatunji.

Try to seek treatment as soon as symptoms arise because, left untreated, agoraphobia tends to get worse over time. According to the DSM-5, agoraphobia only resolves without treatment in about 10% of people with the disorder.

Treatment options typically include a combination of both medication and psychotherapy.

Cognitive behavioral therapy (CBT) has been shown to be especially effective in managing agoraphobia. A 2018 study found that CBT for agoraphobia has profound positive effects on neural pathways in the amygdala, the part of the brain that processes emotions.

CBT for agoraphobia tries to encourage the patient to expose themselves slowly to situations that scare them, explained Marques. "We recommend finding a way to approach a situation in a way that their body can handle."

Even a walk around the block can feel like a lot for some people with agoraphobia, so healthcare providers may recommend doing a short walk with a friend, building up to something like lunch outside. "It's about creating situations that are lessening anxiety, and doing it often enough," said Marques.

A 2017 study showed that online and text-based therapy apps are particularly helpful for people with agoraphobia since the disorder can prevent them from going to in-person appointments.

Medications used for agoraphobia include antidepressants like selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and Zoloft (sertraline) and selective serotonin-norepinephrine inhibitors (SNRIs) such as Effexor (venlafaxine).

Living With Agoraphobia

Coping with agoraphobia can be challenging. In addition to seeking help from a mental health professional, there are things you can do to manage stress and reduce anxiety.

Some "DIY" strategies include:

• Practicing mindfulness meditation
• Eating a healthy and nutritious diet
• Getting regular physical exercise (to boost natural "feel good" endorphins)
• Avoiding drugs and alcohol
• Limiting caffeine intake

Being honest about your disorder with family and friends can help them provide you with support. Online support groups for people with panic disorders, phobias, and agoraphobia can also be a good way to feel less isolated. The Anxiety and Depression Association of America offers information about various support groups.

A Quick Review

Agoraphobia is an intense, often extreme, fear of being in places that are hard to escape. Experts aren't sure what causes it, and agoraphobia is often linked to panic attacks.

There are several treatment approaches that can help, but symptoms do tend to get worse without treatment. If you're experiencing signs and symptoms of agoraphobia, try to get an evaluation from a mental health professional.

Effectively managing stress and anxiety can also help you live with agoraphobia.