Agoraphobia: An Overview

A common misconception regarding agoraphobia is the notion that it’s simply the fear of open spaces. However, most people with this anxiety disorder experience a dread of leaving the house, because of concern about something bad happening, including the fear of having a panic attack. Many people who have agoraphobia experience panic attacks, and leaving the house or going to places where help may not be immediate makes them extremely worried. Common places that worry people with agoraphobia include shopping malls, large crowds, long lines, and open or enclosed spaces, depending on the person.

The root of almost all cases of agoraphobia is the fear of having a panic attack in public, which is why many patients stay at home as much as possible and dread even the thought of going outside. Many agoraphobics simply don’t feel safe in places where there are usually crowds. The severity of the condition depends on the person, but it can range from needing a friend to accompany them outside of the house to not leaving their home at all.

Risk factors: What causes agoraphobia?

Agoraphobia is typically the result of biological predisposition and environmental stressors. Here are some possible risk factors that could lead to the manifestation of agoraphobia:

• Having an anxious or nervous nature.
• Being previously diagnosed with panic disorder or other mental illnesses or phobias.
• Having a relative diagnosed with agoraphobia.
• Having a history of panic attacks.
• Going through trauma, such as the death of a loved one, or being a survivor of abuse.
  Note: If you or a loved one has experienced abuse, reach out for help today. The National Domestic Violence Hotline: 1-800-799-SAFE (7233) is available 24/7 to help.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Symptoms and what to expect

Just like any mental disorder or illness, symptoms of agoraphobia can largely depend on the patient and their unique experiences.

There can be overlap between panic disorder and agoraphobia. Panic disorder is defined as a tendency to experience an unforeseen attack of overwhelming anxiety, panic, and fear. Many people have said that panic attacks make them feel like they’re about to die, or that they’re quickly losing control of their life and surroundings. Many individuals with agoraphobia also experience panic attacks, which usually consist of:

• Hyperventilating
• Chest pain
• Shaking
• Chills
• Excessive sweating
• Feeling numb or a tingling sensation
• Nausea and upset stomach
• Dizziness or feeling lightheaded
• Accelerated heartbeat
• Fear that they are dying

Since many agoraphobics dread leaving the house, it can have adverse effects on their emotional and social well-being. Here are just some of the negative results of agoraphobia, especially when it goes untreated:

• Being bound to one’s house or feeling trapped inside your own home
• Becoming disconnected from society or feeling like an outcast in your community
• Inability to go to school or work
• Disconnection from family and friends
• Becoming dependent on others
• Developing or worsening symptoms of depression
• Becoming dependent on drugs or alcohol
• Developing additional mental disorders, especially anxiety disorders and personality disorders

Treatment options

Mental health professionals recommend that patients diagnosed with agoraphobia undergo some therapy combined with medication. Psychotherapy is the most commonly used, specifically cognitive behavioral therapy.

Cognitive behavioral therapy often referred to as CBT, involves the patient and a therapist or psychiatrist. On a regular basis, the two will meet to discuss the patient’s unique needs and circumstances, including what triggers the individual. After this is identified, the therapist will work with the patient to find coping mechanisms and exercises to prevent or reduce panic attacks, thus decreasing the amount of worry one has about having an attack in a public setting.

Here are some of the things that are discussed and learned through cognitive behavioral therapy:

• Coping mechanisms and ways to eradicate anxious feelings
• Understand what kinds of situations cause the brain to go into a panic attack, as well as preventing both the situation and the attack itself
• Using exposure therapy to desensitize the patient by gradual exposure to increasingly stressful situations.

Since agoraphobia is unique in that it can cause a person to become housebound, many therapists are willing to be flexible in how they are contacted. Plenty of therapists and psychiatrists can be contacted over the phone, through the computer, or they may come to the patient’s house for the first couple of sessions. The ultimate goal is to get the patient to a place where they feel comfortable in leaving the house to attend their sessions. The ultimate goal is that the patient will be able to leave the house on their terms, not only for therapy appointments but in general.

Psychiatrists may prescribe antidepressants and anti-anxiety medications to a patient with agoraphobia. Similar to any other mental illness, it may take several attempts to find the medication, or combination of medications, that work.

Selective serotonin reuptake inhibitors are typically the kind of antidepressants that are prescribed to individuals with agoraphobia. These medications are used to treat the panic disorder that usually accompanies agoraphobia. For anti-anxiety medications, benzodiazepines are prescribed to reduce anxiety in stressful environments. It’s much more of a situational kind of medication, a sedative that can calm a patient when they are feeling panicked or overwhelmed. However, benzodiazepines usually aren’t prescribed to those who have a history of addiction, as it is possible to develop a dependency on them.

Note: Please consult with your doctor or primary care physician before considering any medication options for agoraphobia treatment.

How to help

Agoraphobia, like most mental illness, is easier to recover from with the support of one’s family and friends. It can be a bit difficult to understand, as many patients do have the overlap of panic disorder, agoraphobia, and other possible mental illnesses. Fortunately, there are many commonalities between panic disorder and agoraphobia; regardless, it’s important for one to know the difference between the two.

Here is what loved ones can do to help someone with agoraphobia:

• Learn as much as possible about both agoraphobia and panic disorder
• Encourage treatment without being overbearing or too pushy – encourage, but don’t be forceful
• Understand that they’re trying their hardest, and try not to blame them
• Be supportive, and remind them that they have a support system
• Accompany them to places that give them anxiety, unless requested not to by a therapist.

Panic attacks are arguably one of the scariest things that a person can go through, and will likely worsen or last longer when an individual is forced to work through it on their own. Every person is different regarding methods that help them to calm down, so it’s important to establish what does and doesn’t work for them. For example, some people need to be held or hugged and be reassured that they are safe and they are going to be okay. However, some people may hate being touched during an attack and would like anyone around them to keep their distance. Here are some general tips for what to do if someone is having or is about to have a panic attack:

• Try to speak with them, but don’t push it. Many people aren’t able to articulate how they feel or what they want while they have a panic attack.
• Remind them that you are there to help and that they have nothing to be afraid of. Make sure that they know that they’re in a safe place, and if they don’t feel safe, do your best to take them somewhere quiet.
• Try to influence them to practice breathing exercises. Help them calm their breathing and heart rate by breathing slowly in through the nose, and out through the mouth. If they’re struggling to do it on their own, do it yourself and encourage them to mimic your actions.
• If they insist that you leave, remember that leaving them alone in this vulnerable state could do much more harm than good. If they continue, keep in mind that they probably don’t mean it and that their brain is in overdrive. An option is to move out of their view, but stay close enough to help if requested.
• Try not to use words like “calm down” or “relax,” as it can be very distressing. It can also be counterproductive to ask why they are panicking, as many people don’t know why. It may seem irrational, but it isn’t for them, so try to be as understanding as possible.
• Be patient! Panic attacks can range from seconds to over an hour, and it can be immensely terrifying for the person having it, as well as the person witnessing it.

Online therapy for agoraphobia

If you or someone you know is experiencing symptoms of agoraphobia, consider reaching out to the mental health professionals working with BetterHelp. BetterHelp offers online counseling options that can be uniquely helpful for people exhibiting symptoms of agoraphobia. Find out more today.