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Agoraphobia: Symptoms, Causes & Treatment

How to overcome agoraphobia
Written by:

Wafaa Amjad Dar

Pharm-D

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The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs. Read more

According to agoraphobia definition, it is the excessive fear of crowded or open spaces where one thinks escape would be difficult. It may occur in places that can potentially make you feel trapped, helpless, or extremely embarrassed if you have a panic attack.

In the 11th version of the International Classification of Diseases (ICD [1*] ), agoraphobia falls under anxiety or phobic disorders. In this article, let’s learn more about the major symptoms of this condition and treatment options.

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What Is Agoraphobia?

A staggering 1.3% of US adults [2*] grapple with agoraphobia at some point during their lives. Typically, its symptoms manifest between the ages of 21 and 35 [3*] . According to the American Psychiatric Association (APA [4*] ), agoraphobia in psychology is recognized as a debilitating anxiety disorder.

Whenever a person with agoraphobia is in crowded or enclosed places, they feel trapped, and their anxiety levels rise. Their thoughts spiral as they focus on how hard it would be to escape if something bad happened. As they visualize the helplessness of their situation, they begin to panic. Consequently, the more thoughts of fear of being trapped accumulate, the more they stimulate the development of agoraphobia.

Since agoraphobia is the fear of going outside or being in crowded places, agoraphobic people prefer staying in environments where they feel safe confining them to their homes. In severe cases, patients stay housebound for years, which impacts their social life.

Symptoms

Symptoms may vary from person to person displaying a range of psychological and physical symptoms. However, there are also common signs and symptoms, such as the following:

  • Severe anxiety when exposed to trigger situations
  • Social isolation
  • Intense worry about enclosed or crowded places
  • Fear of losing control in a public place
  • Persistent worry about feared situations
  • Feeling trapped when in a feared situation

When placed in a stressful environment, patients with agoraphobia may also experience panic attacks and other associated panic symptoms such as:

Types of Agoraphobia

Agoraphobia presents in mainly two patterns [5*] , on the basis of which it is classified as:

  1. Agoraphobia with panic disorder: Individuals experience unexpected and recurrent panic attacks, which are sudden episodes of extreme worry or discomfort. Because of the fear of having a panic attack in specific situations, a person develops agoraphobic behavior. 
  2. Agoraphobia without a history of panic disorder: In such cases, agoraphobia develops independently of panic attacks. The marked fear may be related to a general sense of anxiety about being in certain environments with risky escapes rather than a specific concern about experiencing a panic attack.

Examples

Here are some common ways in which agoraphobia may manifest in daily life:

  • Fear of crowded places like malls, theaters, or public transportation. One may avoid such places due to concerns about feeling trapped or overwhelmed.
  • Anxiety about open spaces, such as parks or large plazas, where individuals may feel exposed and vulnerable.
  • Reluctance or refusal to travel far from home, whether by car, plane, or other means, due to the fear of being unable to escape or get help.
  • Fear of being alone or in situations where support is not readily available, leading to avoidance of solitary activities.
Discuss your symptoms and get support in a safe environment. Reach out to qualified medical professionals at MEDvidi.

Agoraphobia Causes and Risk Factors

Agoraphobia can develop due to various risk factors and reasons, sometimes a combination of these:

  • A family history of anxiety disorders (genetic predisposition [6*] ).
  • A history of prior panic attacks, where the fear of encountering another attack in public places triggers avoidance actions and anxiety.
  • Traumatic experiences.
  • Stressful life events, major life changes, or chronic stress can contribute to triggering the onset of agoraphobia.
  • Imbalances in mood-regulating neurotransmitters serotonin and norepinephrine may play a role in agoraphobia.
  • People with specific personality traits, like heightened anxiety or a propensity to avoid risks, are more prone to the condition.
  • Other mental health conditions like panic disorder and post-traumatic stress disorder increase the likelihood of developing agoraphobia [7*] .
  • Certain medical conditions, especially those affecting the cardiovascular or respiratory systems, may increase the risk for agoraphobia.
  • Substance abuse can raise the possibility of developing a condition.

Diagnosis of Agoraphobia

Individuals who notice disturbing symptoms should seek help for agoraphobia from a healthcare professional, such as a psychiatrist, psychologist, or licensed therapist.

Diagnostic Criteria

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 [8*] ), agoraphobia diagnosis requires that the patient has:

  • Marked and irrational fear for more than six months when presented with any two situations they fear, be it crowded places, public transportation, etc.
  • Avoidance behavior and fear of coming outside.
  • Fear that is disproportionate to the actual situation.
  • Anxiety or panic attacks upon exposure to the phobic stimulus.
  • Social or occupational dysfunction due to their fear and anxiety.
  • No underlying medical illnesses or mental health conditions may explain these symptoms.

Diagnostic Process

A qualified healthcare professional conducts a comprehensive assessment of the individual’s symptoms, medical history, and any relevant psychological or social factors. Following this evaluation, if the individual meets the diagnostic criteria for agoraphobia, the mental health professional confirms the diagnosis and proceeds to a personalized treatment plan to address their specific needs effectively.

Ask a medical professional about suitable treatment options for anxiety disorders.

Treatment

After conducting diagnostics, a clinician develops a treatment plan based on individual factors. Treatment for agoraphobia typically involves a combination of medication, therapy, and self-help strategies, depending on the severity of the condition.

Medication

A healthcare professional prescribes medication based on individual factors including medical history, severity of symptoms, presence of comorbid conditions, and response to treatment. Antidepressants and anti-anxiety medications are the most commonly used medicines [9*] to alleviate symptoms of anxiety, depression, and panic associated with agoraphobia. 

The list of medication for agoraphobia can include:

  • Selective serotonin reuptake inhibitors (SSRIs): sertraline (Zoloft), fluoxetine (Prozac).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): venlafaxine (Effexor XR).
  • Tricyclic antidepressants: imipramine (Tofranil), nortriptyline (Pamelor).
  • Benzodiazepines: alprazolam (Xanax), clonazepam (Klonopin).
  • Beta-blockers: propranolol [10*] (Inderal).

Psychotherapy

Psychotherapy (talk therapy) is a crucial component in the management of agoraphobia. Several types of therapy are effective in managing this condition, some of which are reviewed below.

Cognitive-behavioral Therapy (CBT)

CBT can be useful for the treatment of anxiety [11*] as it teaches patients to adopt positive thinking to break a cycle of negative thoughts. The therapist studies the patient’s psychology to understand the cause of fear and trains the patient to overcome agoraphobia when exposed to phobic stimuli. It is feasible for agoraphobic individuals to attend online sessions, with a gradual transition to in-person sessions as their comfort increases.

One type of CBT is exposure therapy which helps gradually expose a person to feared situations in a safe and controlled environment. This can help to get over agoraphobia by desensitizing the fear over time under professional supervision.

Dialectical Behavior Therapy (DBT)

Mental health professionals also use dialectical behavior therapy (DBT) for agoraphobia treatment. DBT trains patients to accept their conditions and cope with them better. It works well for individuals who feel fear, depression, or anxiety intensely.

Treating agoraphobia through DBT [12*] requires a patient’s active involvement and has four stages:

  • Distress tolerance: The patient deals with destructive behaviors caused by intense emotions. For example, the patient leaves the house to face their fears.
  • Emotional regulation: The patient learns to recognize the onset of fear and label it fear or anxiety. After this, the patient starts to work on adjusting their emotions. A good example is learning to replace negative thoughts with positive ones to ease the disproportionate fear of feeling trapped.
  • Mindfulness: Patients learn to live in the present, being aware of themselves and others. The therapist will help patients improve their self-esteem and their social life.
  • Interpersonal effectiveness: The patient learns to face conflict and interact with people without fear. The patient is no longer afraid of being around people in crowded or enclosed places. They can now handle their emotions and thoughts.

Coping Tips

While professional treatment is crucial to manage agoraphobia, incorporating self-help strategies and coping tips into daily life can help supplement treatment:

  • Practice stress management techniques, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation. 
  • Celebrate each accomplishment, no matter how small, to build self-confidence in facing challenging situations.
  • Challenge negative thoughts and replace them with more positive and realistic ones when exposed to situations you worry about.
  • Maintain a support system of friends and family or join support groups.
  • Have a designated safe space or comfort zone that can provide a sense of security when you need it.
  • Practice grounding exercises to stay focused on the present moment by paying attention to your senses and diverting your mind from anxious thoughts.
  • Engage in regular physical activity to reduce anxiety and improve mood.
  • Maintain a healthy diet, incorporating mood-boosting foods like fruits, vegetables, and whole grains to support your mental well-being.

In Conclusion

Agoraphobia can be managed. Once your healthcare provider has diagnosed agoraphobia, they will prescribe a suitable treatment. Medications, cognitive-behavioral therapy, or dialectical behavior therapy can be the best treatment solutions. Psychotherapy encourages active participation and interaction between the doctor and patient toward recovery, while medicines help reduce the symptoms. Contact the MEDvidi team if you want to receive personalized help and support.

FAQ

Agoraphobia can be triggered by a history of panic attacks, trauma, genetics, high stress levels, or certain personality traits.
If you find yourself avoiding certain situations or places due to intense anxiety, a persistent fear that escape might be difficult, or feeling stressed about leaving your comfort zone, it’s advisable to consult with a mental health professional to assess whether you may be developing agoraphobia.
While agoraphobia may not have a guaranteed cure, it can be managed through a combination of therapy, medication, and lifestyle changes, allowing individuals to lead fulfilling lives.
If agoraphobia is left untreated, it can lead to increased isolation, limitations in daily activities, and a significant decline in overall mental health and well-being.
Light exercises like walking, yoga, and deep breathing can be helpful for agoraphobia since they promote relaxation and help in the gradual expansion of comfort zones.

Sources

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  5. Agoraphobia With and Without Panic Disorder: A 20-Year Follow-up of Integrated Exposure and Psychodynamic Therapy
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  6. Genetic and environmental influences on the comorbidity between depression, panic disorder, agoraphobia and social phobia: A twin study
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  7. The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy
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  11. Cognitive Behavioral Therapy for Anxiety and Related Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials
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  12. The Structure of Standard DBT: The Four Skill Modules
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Written by:

Wafaa Amjad Dar

Pharm-D
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in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.