Agoraphobia

Based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders—published by the American Psychiatric Association—a diagnosis of agoraphobia requires a person to experience intense fear in at least two of the following five scenarios:

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in crowds or lines
• Being outside of the home alone

Someone with agoraphobia may feel anxiety disproportionate to the danger of the situation. A diagnosis cannot be made unless symptoms persist for six months or longer and cause significant distress² for the individual. Certain psychological and physical symptoms may present in a person who has agoraphobia.

Psychological symptoms

Below are some of the most common psychological symptoms in individuals with agoraphobia: 

• Fear of spending time alone
• Fear of going places without an easily accessible exit
• Staying in the home for extended periods 
• Sense of impending doom 
• Adopting safety behaviors (having groceries delivered instead of going to the store)
• A sense of being detached from others
• Perceiving that the body is not real
• Loss of self-confidence

Physical symptoms

Below are some of the physiological symptoms of agoraphobia, often only present when the person is in a situation where they are experiencing anxiety or panic: 

• Heart palpitations or a racing heart
• Lightheadedness
• Hyperventilating
• Chest pain
• Shortness of breath
• Trembling
• Dizziness or fainting
• Hot flashes or chills

Over time, the symptoms of agoraphobia can decrease a person’s quality of life. They may struggle to participate in activities outside of the home such as work, hobbies, and exercise. Individuals with this condition may also experience financial hardships, isolation, and boredom within the walls of their homes and utilize unhealthy coping strategies such as binge eating or alcohol use to cope. According to the American Psychiatric Association, the symptoms of agoraphobia can prevent an individual from leaving home at all. The negative sensations associated with the condition may contribute to other mental health challenges, such as depression.

The exact cause of agoraphobia isn’t fully understood. However, it may develop as a complication of panic disorder. Panic disorder is an anxiety disorder characterized by ongoing panic attacks and, often, a persistent fear of their recurrence. When a person has a panic attack, they may try to avoid places or scenarios they think could incite another panic attack, slowly limiting the number of places they believe are safe to go to. 

Some psychological risk factors can increase the likelihood that an individual will develop agoraphobia, including but not limited to: 

• Experiencing a stressful life event (death of a loved one, major car accident, job loss)
• A traumatic childhood experience (abuse, death of a parent, major move)
• Alcohol or drug misuse
• A personal or family history of mental illness
• Having an anxious or nervous personality

An individual can also develop agoraphobia without experiencing a panic attack or having a panic disorder. This development often occurs because the person has an irrational phobia such as the fear of being involved in a terrorist attack in a public place or becoming seriously ill because they were infected in a crowded space. 

Common treatments of agoraphobia include therapy (e.g., cognitive-behavioral therapy),³ medication (e.g., selective serotonin reuptake inhibitors), and lifestyle changes (e.g., maintaining a balanced diet). The goal of treatment⁴ is to reduce symptoms of the condition so that it has a lesser impact on an individual’s day-to-day functioning. Like other anxiety disorders, agoraphobia may not disappear without treatment. Without treatment, remission of agoraphobia averages at about 10%. 

Experts often recommend a stepped approach to treat agoraphobia and any underlying panic disorder. This approach can involve learning more about the condition, making lifestyle changes to decrease symptoms, and utilizing self-help techniques. Individuals may also enroll in a guided self-help program. If symptoms⁵ are still interfering with functioning, individuals can participate in more intensive treatments like medication or long-term therapy. 

Self-care, self-help, and lifestyle changes

It may be beneficial to learn techniques that elevate control of your emotional response during a panic attack. These techniques may increase your confidence when you are in uncomfortable or unfamiliar situations. 

If you sense panicked or anxious thoughts arising, you can: 

• Take slow, deep breaths to combat the temptation of breathing too quickly, which can increase feelings of anxiety. 
• Remain where you are instead of giving in to the urge to escape to somewhere that feels safe. 
• Focus your attention on a sensory experience or item that isn’t threatening and remind yourself that the anxiety will soon pass.
• Visualize a situation or environment that brings you peace and focus your attention on this visual image. 

Lifestyle changes that can help reduce anxiety include:

• Regular exercise
• Eating a healthy diet and staying hydrated
• Avoiding caffeine, as it is a stimulant

Medication

Selective serotonin reuptake inhibitors (SSRIs), often used to treat depression, have been proven to effectively treat mood disorders and agoraphobia. Individuals with agoraphobia may take an SSRI for six months or over a year. Alternatively, individuals may be prescribed serotonin-norepinephrine reuptake inhibitors (SNRIs). According to the American Psychiatric Association, beta blockers may also be used to alleviate the physical effects of agoraphobia. 

If your doctor does prescribe a medication to treat agoraphobia, follow the dosage instructions. When you and your provider decide to end the medication, they can help you slowly taper off by reducing your dosage. Consult your doctor before starting, changing, or stopping a medication. 

Agoraphobia symptoms can be different for each individual. One way to learn more about the condition and treatment options is by working with a mental health professional. A therapist can make an official diagnosis and work with you to create a treatment plan. Online platforms like BetterHelp are designed to facilitate therapy through a device via phone, video, or live chat sessions with a therapist, which can help you participate in therapy even if you struggle to leave your home.  

Other online resources can help you learn more about agoraphobia and current treatment options, including the following: 

• NHS.uk offers a detailed overview of the symptoms, causes, diagnosis, and treatment of agoraphobia. 
• In the NIH National Library of Medicine, you can find a complete summary of agoraphobia designed to educate healthcare professionals on the condition, as well as dozens of additional books that provide information on the condition.
• The Mental Health Foundation reviews the symptoms, diagnosis criteria, complications, and treatment associated with agoraphobia. It also offers an entire page of resources available to those with mental health challenges.
• Self-help resources for panic are available from the Centre for Clinical Interventions in Perth, Western Australia.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

According to the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of agoraphobia requires clients to experience intense fear in two of five scenarios. Researchers in Iran studied which of these scenarios most produced feelings of panic or anxiety. They discovered that the four most anxiety-provoking situations were being home alone, leaving home alone, being in a crowd, and standing in a line. The authors of the study suggest this phobia may be the most disabling because it can severely restrict a person’s career and social life outside the home. Researchers call for more screening and treating programs to support clients living with the condition.  

As web-based therapy options continue to emerge, a growing body of research is demonstrating the effectiveness of these online solutions. Online therapy can be especially beneficial for people with agoraphobia who find it difficult to leave the safety of their homes. 

A recent study examined the efficacy of a self-guided mobile-based intervention designed to decrease symptoms of agoraphobia. Participants were split into two groups—one group used an app designed to target agoraphobia called Agoraphobia Free, and the other group used an app designed to decrease general symptoms of anxiety called Stress Free. By the end of the study, participants in both groups who completed the intervention showed marked improvement in the severity of their symptoms. 

1/3 of participants in an agoraphobia study maintained symptom improvement

Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) techniques has been found to reduce symptoms of agoraphobia, with a third of study participants maintaining symptom improvement up to two years after treatment ended.¹

¹Behaviour Research and Therapy Journal

Below are more statistics on agoraphobia:

• A survey was completed to determine the severity of agoraphobia using the Sheehan Disability Scale. Of adults with the condition, 28.7% of people had a mild impairment, 30.7% had moderate impairment, and 40.6% had serious impairment. 
• According to the National Institute of Mental Health, 1.3% of Americans will develop agoraphobia at some point in their lives, and 0.9% of the population experience it each year. 
• Women are more likely to experience agoraphobia. Men have a lifetime prevalence of 0.6%, while women have a lifetime prevalence of 1.5%.
• Veterans may be more likely than civilians to experience agoraphobia. Approximately 11.9% of veterans who served in the Australian Defense Force are diagnosed with agoraphobia.