What is agoraphobia?
Agoraphobia is a fear of being in a situation you cannot physically escape from or in which you feel help may not be available if you should need it. The term comes from the Greek word for “marketplace” (agora), plus the English word for “fear” (phobia). While some people experience agoraphobia while alone or surrounded by only a few people, classic agoraphobia is a fear of being outdoors in a crowd.
Many people may feel uneasy walking about in a crowd, but people with agoraphobia experience a very intense, panicky response to this situation. Agoraphobia usually refers to experiencing feelings of anxiety and helplessness in open spaces, but it also can occur within an enclosed space, like an elevator or subway car. This type of agoraphobia is called “claustrophobia.”
Agoraphobia affects the sympathetic nervous system, which is the aspect of the brain and spinal cord that triggers the “fight-or-flight” response when a person feels endangered. During an episode of agoraphobia, you may experience classic signs and symptoms of fight-or-flight: elevated heart rate and breathing, dry mouth, dilated pupils, and other symptoms caused by a sudden release of hormones including epinephrine into your body.
Anyone can experience episodic or chronic agoraphobia. It most often occurs in teenagers and in women. Agoraphobia symptoms usually begin before the age of 35. People with any kind of anxiety disorder face a higher risk of agoraphobia, and the condition also can be triggered by life events, such as being abused or losing a loved one.
Treatment for agoraphobia involves addressing the underlying anxiety and any other mental health issues that may be contributing to the agoraphobia. Agoraphobia treatment might include medications and cognitive behavioral therapy. If left untreated, agoraphobia can lead to anxiety so great that a person never leaves their home, which can be detrimental to their overall health and wellbeing.
What are the symptoms of agoraphobia?
The symptoms of agoraphobia are similar to those of any other type of panic disorder. However, agoraphobia usually is situational, which means the symptoms only occur in specific situations, such as getting caught up in a crowd.
Common symptoms of agoraphobia
The most common symptoms of agoraphobia are:
- Chest pain
- Dry mouth
- Extreme anxiety
- Lightheadedness or fainting
- Racing pulse
- Shaking or trembling
Serious symptoms that might indicate a life-threatening condition
Never assume that a person experiencing sudden chest pain along with anxiety and other symptoms is simply experiencing agoraphobia. These signs and symptoms could indicate heart attack. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Chest pain
- Confusion or loss of consciousness
- Difficulty breathing
- Pain in the mid-back, left arm, or left jaw/neck areas
What causes agoraphobia?
The exact cause of agoraphobia is unknown. As with so many anxiety disorders, agoraphobia occurs for no rational reason.
Certain risk factors may make a person more vulnerable to agoraphobia. For instance, people with a generalized anxiety disorder may be more likely to develop agoraphobia. However, agoraphobia also can occur on its own.
What are the risk factors for agoraphobia?
These risk factors may increase the risk of developing agoraphobia:
- Acutely stressful life event, such as the death of a loved one, being subjected to abuse, experiencing a physical attack (such as a mugging), or experiencing some other traumatic event
- Age younger than 35
- Coexisting anxiety disorder, such as generalized anxiety disorder or panic attacks
- Experiencing other fears or phobias
- Having a generally anxious nature
- Sex: women experience agoraphobia at a higher rate than men do
Reducing your risk of agoraphobia
You may be able to lower your risk of agoraphobia by:
- Avoiding caffeinated beverages like coffee and cola, which can increase feelings of nervousness
- Exercising regularly to reduce feelings of stress
- Practicing stress-reduction techniques, like mindfulness, deep breathing, yoga, meditation, prayer, or other calming practices
- Treating any coexisting anxiety disorders
If you experience agoraphobia symptoms or panic attacks on a regular basis, you should see your primary care provider or a behavioral health specialist as soon as possible. Earlier intervention not only can relieve feelings of anxiety caused by agoraphobia but can prevent those feelings from escalating over time.
What are some conditions related to agoraphobia?
Agoraphobia is a type of anxiety disorder, and all anxiety disorders are related.
A few other types of anxiety disorders that could be related to agoraphobia include:
- Generalized anxiety disorder
- Panic disorder
- Separation anxiety disorder
- Social anxiety disorder
How do doctors diagnose agoraphobia?
To pinpoint a diagnosis of agoraphobia, your doctor will ask you some very specific questions about your symptoms, when they occur, how long you have been experiencing them, and how they impact your life. The American Psychiatric Association requires a diagnosis of agoraphobia to include experiencing panic or extreme anxiety in at least two of the following situations:
- Being inside an enclosed space, such as a small retail shop or a movie theater
- Being in an open space
- Being outside your home alone
- Standing in line or being in a crowd
- Using public transportation
In addition to assessing the situations in which you feel the symptoms of agoraphobia, your doctor will ask you how long the symptoms have been occurring and how much of an impact they have on your everyday life. Agoraphobia can be diagnosed when the symptoms have occurred for at least six months and interfere with your ability to complete essential tasks like grocery shopping.
What are the treatments for agoraphobia?
Agoraphobia is treatable. Depending on your unique needs, your behavioral health provider may suggest medications, therapy, support groups, and lifestyle changes. The most common treatments for agoraphobia include:
- Anti-anxiety medications
- Cognitive behavioral therapy to learn different ways of thinking about and responding to fearful situations
- Other types of psychotherapy (“talk therapy”)
- Self-care, including lifestyle changes that include adding more physical activity to your life and eating a healthy, caffeine-free diet
- Stress management practices, such as meditation
- Support groups
What are the potential complications of agoraphobia?
If left untreated, agoraphobia symptoms can worsen and lead to serious complications, including:
- Alcohol misuse
- Inability to leave the house
- Other anxiety disorders
- Substance misuse