Agoraphobia: Definition, Symptoms, And Treatment
Agoraphobia is an anxiety disorder characterized by a fear of being in certain, specific places or situations. Although it’s often associated with the fear of open spaces, agoraphobia is actually a much broader phobia—one that can relate to almost any situation that an individual views as precarious, unsettling, or unsafe. Sometimes, this fear can be so broad and/or debilitating that it may cause an individual to be reluctant or even unable to leave their home, resulting in a significant negative impact on quality of life. Below, we’re going to cover what agoraphobia is, its symptoms, and how it can be treated.
What is agoraphobia?
Specific settings a person might avoid due to agoraphobia could include enclosed spaces (e.g., subways or elevators), crowded public areas (e.g., parks or large cities), or open spaces (e.g., festivals or golf courses), for example.
An individual with agoraphobia might experience a panic attack when thinking of or faced with certain situations, and panic disorder is often a comorbid condition with this phobia. In fact, about a third of people with agoraphobia also have panic disorder. Even experiencing one panic attack and fearing another can cause symptoms of agoraphobia to develop.
Agoraphobia can be debilitating, to the point where an individual can no longer leave their home. This tendency along with the symptoms of anxiety may also negatively impact an individual’s physical health, relationships, work, and quality of life. In the most extreme cases, a person with agoraphobia may also avoid activities like going outside to get the mail or take out the trash. As a result, some with this phobia may become dependent on others for daily help.
Symptoms of agoraphobia
Again, one of the primary symptoms of agoraphobia is a disproportionate level of fear around a situation in which an individual believes they may be exposed, uncomfortable, or unable to leave easily. It’s not uncommon for someone with a phobia to avoid potentially triggering situations, which is why some people with agoraphobia rarely or never leave the house. Those who do leave home may experience moderate to extreme distress while doing typically mundane activities such as going to work, sitting in traffic, or going grocery shopping. Typically, symptoms must last at least six months and represent a disruption to one’s life to qualify as clinical agoraphobia. This phobia usually manifests in adolescence or early adulthood, before age 35.
Since panic disorder is often comorbid with this phobia, it may also be helpful to learn about the common signs of this condition. Symptoms of a panic attack can include:
- A wave of fear or a sense of losing control
- Feelings of impending doom
- Rapid heart rate
- Shaking or trembling
- Trouble breathing
- Upset stomach
- Numbness or tingling in the hands
- Sweating
- Fear regarding the potential for a future panic attack
Panic attacks usually last between a few minutes and a half hour. They can produce strong mental and physical symptoms, so much so that they are often confused with heart attacks. Because they can be scary and even debilitating, the fear of having another one can cause an individual to do everything possible to avoid them. For example, if someone experiences a panic attack at a grocery store, they may start to avoid that and similar environments—which illustrates how panic disorder and agoraphobia can be linked.
Causes of agoraphobia
Genetics are thought to play a significant role in the development of agoraphobia. Environmental factors may also cause or contribute, such as overprotective parents, abuse or other trauma during childhood, fears experienced at a young age, being in a relationship with a controlling partner, and excess stress. A previous history of certain mental illnesses, such as depression, anorexia nervosa, bulimia, or issues with substance use may also increase the likelihood of developing this condition. Women may also be more likely to present with symptoms of agoraphobia.
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Again, having panic disorder may also put a person at higher risk for developing agoraphobia. As mentioned above, this is because even the experience of a single panic attack may cause someone to avoid situations where they could experience another. 87% of individuals with agoraphobia will experience other concurrent mental health conditions—usually either panic disorder, other phobias, social anxiety, or substance use issues. (Mental health research is constantly evolving, so older sources may contain information or theories that have been reevaluated since their original publication date.)
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Treatment for agoraphobia
Treatment for agoraphobia typically involves psychotherapy. Cognitive behavioral therapy (CBT) in particular is a widely accepted modality for treating this and other phobias. With this methodology, a qualified provider can help the individual learn to shift thought patterns around their triggers and develop healthy, effective coping mechanisms for dealing with symptoms that do arise. They may also work with the individual to slowly work up to facing their trigger(s) directly through some form of exposure therapy.
Medication is sometimes suggested in tandem with therapy for agoraphobia—typically antidepressants and/or medication for anti-anxiety. Always consult a qualified medical professional before starting or stopping any medication.
How online therapy can help
Since some people with agoraphobia find it difficult to leave the house, seeking treatment in the form of in-person therapy sessions may not be comfortable or possible. In cases like these, online therapy may be a more viable treatment option. With an online therapy platform like BetterHelp, you can get matched with a licensed therapist who you can meet with via phone, video call, and/or online chat to address the challenges you may be facing. See below for client reviews of BetterHelp counselors.
Research suggests that online therapy can be an effective treatment method for those who experience agoraphobia and panic attacks. The results of a systematic review and meta-analysis of 27 different studies show that online cognitive behavioral therapy can reduce symptoms of combined agoraphobia and panic disorder. Researchers also found that online CBT can be as effective as in-person therapy, and participants reported experiencing sustained improvements as a result of online treatment.
Counselor reviews
“It’s amazing how beneficial therapy is. The EMDR sessions with Keith have enabled me to reclaim my power and control over my own life. As a result of my work with Keith I went from too scared and anxious to leave the house with crippling panic, to being able to enjoy walks with my husband in the park, garden and we have even traveled by plane, and train. I’ve been able to leave some toxic relationships that weren’t serving me, and now feel equipped to not only face life but to enjoy the richness and fullness of it. I highly recommend Keith as a counselor and the EMDR sessions”.
“I want to say a Big Thank You to betterhelp.com for assigning Noami Kim to me…I don’t know if I’d have gotten a better session like hers. My 2 weeks alone with her has recorded some noticeable progress on coping with my frequent panic attacks/disorder. My experience so far with her has been very relaxing and conversational even when at times it was difficult for me to express myself. I feel very positive that’ll come out better and more focused in fighting this PAD. Thank You Noami Kim”.
Takeaway
Is it normal to be scared to leave your house?
While there may be situations where it could be considered “normal” to be scared to leave the house, a persistent fear of leaving your home may indicate that you are experiencing agoraphobia. Classified as a type of anxiety disorder, agoraphobia typically involves a sense of fear or anxiety when a person thinks about or tries to leave environments like their home. When people living with agoraphobia do enter public places, they may have feelings of nervousness or experience symptoms like panic attacks. In some cases, these feelings can increase to the point where a person is afraid to leave their house for weeks, months, or even years.
What are 4 causes of agoraphobia?
According to the UK National Health Service (NHS), agoraphobia may develop as a complication of panic disorder. There are a variety of psychological factors that may increase your risk of developing panic disorders, which may result in agoraphobia. These risk factors include:
- Trauma, often occurring in childhood.
- Stress, which may result from academic struggles, pressure at work, conflict in relationships, or various other sources.
- Substance misuse, a coping method that may increase symptom frequency and severity.
- History of mental illness, including conditions like depression, anxiety, or eating disorders.
How rare is agoraphobia?
According to estimates by the National Institute of Mental Health, 1.3% of adults in the United States will experience agoraphobia at some time in their lives. The annual incidence rate (or the number of U.S. adults who experienced agoraphobia in the past year) is 0.9%, with yearly prevalence rates being 0.9% for females and 0.8% for males. In addition, 2.4% of adolescents were estimated to have agoraphobia resulting in severe impairment during their lifetime, with the prevalence being 3.4% for females and 1.4% for males.
Will I have agoraphobia forever?
Without diagnosis and treatment, agoraphobia may persist for months or even years. In some severe cases, it's possible for agoraphobia to last for the rest of a person’s life. That being said, it's also possible for agoraphobia to improve with treatment. In order to get treatment, a person will need to talk to their primary care physician or a mental health professional. Due to the extreme fear that a person with agoraphobia can experience when leaving their home, it may be helpful to seek this treatment through online therapy platforms.
Can agoraphobia be cured?
While agoraphobia may not have a cure, there are treatments that may be effective at managing the condition and its symptoms. These treatments may include cognitive behavioral therapy (CBT), coping techniques, and in some cases, antidepressant or anti-anxiety medications. CBT sessions may involve learning ways to avoid feeling afraid when leaving your home or finding lifestyle changes that may help someone manage their symptoms. These changes can vary but may include exercising, eating a healthier diet, or eliminating substance use.
How do you fix agoraphobia?
One of the most effective ways to manage agoraphobia is through cognitive behavioral therapy or CBT. These CBT sessions may revolve around identifying what triggers your panic attacks and what thought patterns may be harmful, as well as ways to cope with symptoms of your condition. In addition, CBT may include techniques like exposure therapy, which can help a person gradually acclimate to the stimuli that triggers the symptoms of their agoraphobia in a safe and controlled environment. Without treatment, however, symptoms may get worse.
How long does agoraphobia last?
While the panic attacks that affect those living with agoraphobia can last anywhere from a few minutes to an hour (or in some cases longer), agoraphobia itself can last for days, months, or even years. How long a complex condition like agoraphobia lasts and the severity of one’s symptoms may be affected by whether or not they seek treatment. Treatment options for agoraphobia can vary, but may include cognitive behavioral therapy, exposure therapy, changes to one’s lifestyle, and medications like selective serotonin reuptake inhibitors (SSRIs).
Who is most at risk for agoraphobia?
There are several demographics that may experience a higher risk of agoraphobia. For example, most cases of agoraphobia present in individuals under the age of 35. Women may also be at a higher risk of developing agoraphobia, as the yearly prevalence rates are 0.8% for males and 0.9% for females. While people assume agoraphobia can only affect adults, it's also possible for children or teens to develop this condition as well. In addition, those in their late adolescence and early adulthood may be at a higher risk of developing agoraphobia, with the overall average age at onset being 17 years.
How hard is it to overcome agoraphobia?
Coping with agoraphobia can be challenging, especially for individuals who do not seek treatment. Because agoraphobia can make it difficult or uncomfortable to leave one’s home, it may be harder to maintain a job or interpersonal relationships. While seeking treatment by a medical professional is often the best course of action, there are several techniques one may use to cope with their symptoms. These can vary but may include relaxation techniques like meditation and yoga, exercise, breathing techniques, and progressive muscle relaxation.
Does agoraphobia get worse over time?
Without treatment, it's possible for the symptoms of anxiety disorders like agoraphobia to get worse as time passes. For example, according to the American Psychiatric Association, a person who doesn’t seek treatment for agoraphobia may become unable to leave their house entirely. In many cases, the reason this happens is to avoid potentially negative stimuli. When a situation causes anxiety symptoms or a panic attack, a person with agoraphobia may choose to avoid that situation in the future. As their panic attacks increase, they may find more and more reasons to avoid these negative stimuli. As a result, individuals may spend more and more time in their “safe” environments, which may reduce a person’s quality of life as their symptom severity increases over weeks, months, or years.
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