What Is Agoraphobia? Symptoms, Causes And Treatments (2024)

Agoraphobia is defined by an individual’s fear of being trapped in an open or crowded place in which potential escape is difficult or help may not be readily available. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the diagnostic resource shared across the mental health profession in the U.S., only recently recognized agoraphobia as its own distinct diagnosis apart from panic disorder.

Individuals must experience intense anxiety in response to at least two of the following settings to be diagnosed with agoraphobia, according to the DSM-5:

• Public transit
• Open spaces
• Enclosed spaces (such as stores and movie theaters)
• Lines or crowds
• Being outside the home alone

Further, the diagnosis of agoraphobia also requires that this anxiety causes extreme avoidance behaviors that disrupts their relationships, career and overall lifestyle. For some, this may look like extreme difficulty leaving their home and retreating from the world.

“The fear of having a panic attack or feeling helpless or embarrassed usually becomes obsessive,” says Sam Zand, D.O., a clinical psychiatrist in Las Vegas and the chief medical officer for Better U. “Agoraphobic patients usually self-isolate, avoid social situations or modify their lives to accommodate for the anxiety.”

Just over 1% of U.S. adults experience agoraphobia at some point in their lives^[1]Agoraphobia. National Institute of Mental Health. Accessed 11/4/2021. . When left untreated, the DSM-5 categorizes this disorder as “persistent and chronic.” With treatment, however, some people can become symptom-free. Even more find temporary relief from their symptoms, although they may relapse in times of stress. However, some individuals continue to struggle with agoraphobia, despite treatment.

Agoraphobia is often confused with social anxiety, says Amanda Fialk, Ph.D, a licensed clinical social worker in New York City, and the chief of clinical services at The Dorm, a company that provides mental health treatment for young adults. “There are similar symptoms such as heart palpitations, feeling nauseous, feeling faint, sweating, trembling, dizziness, headache, shortness of breath and feeling as if one is dying,” she says.

The distinction, Fialk notes, is in the emotional response. Those with social anxiety may suffer from embarrassment, humiliation or a sense of rejection in social situations, she explains, whereas agoraphobic individuals experience intense fear in situations that cause them panic.

“If anybody has initial anxious feelings about leaving the house or being in a particular situation, they should seek help,” says Dr. Zand. “Red flags might include avoidance of certain situations, behavior modification to set up a lifestyle without triggers, substance use to mask the anxiety and isolation from others.” He adds that these symptoms can worsen over time if left untreated.

Some cases of agoraphobia result from a previously existing panic disorder. “Most of the time, we can draw a connection to a trauma or series of compound difficult experiences that led to this phobia,” says Dr. Zand.

Psychological risk factors for developing agoraphobia include the following:

• Childhood trauma
• A stressful life event
• History of mental health diagnoses
• Substance abuse
• Relationship issues

Additionally, unfounded and intense fears over the following may also trigger agoraphobia:

• Suffering harm from a violent crime or terrorist attack
• Being infected by disease from a crowd of people
• Public humiliation, shame or embarrassment

If agoraphobia is left untreated, individuals may become home-bound, retreating from society altogether. “We know humans need societal connection as a hardwired genetic necessity,” he explains. The isolation and loneliness brought on by agoraphobia may result in depression, physical illness and a shorter lifespan, he adds.

Untreated agoraphobia can also lead to substance abuse as people seek fast relief from their anxiety, making diagnosis and treatment all the more imperative.

Treatment options for agoraphobia most often include a combination of medications, therapy and lifestyle changes, Fialk says.

• Medications: Patients with agoraphobia may be prescribed antidepressants to manage their symptoms. These may include selective serotonin receptor inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and benzodiazepines.
• Therapy: Therapeutic approaches like cognitive behavioral therapy (CBT) and exposure therapy can be used to treat this disorder. “By purposely bringing on the feeling of anxiety when discussing the phobia or mildly introducing the fear-inducing situation, we can practice coping skills like breath work, thought replacement, distraction, grounding and meditation,” says Dr. Zand.
• Lifestyle changes: Adopting simple lifestyle changes like regular exercise, avoiding alcohol and drugs, and attending online or in-person support groups may offer some relief, suggests Fialk.
• Alternative treatments: There are alternative treatments available as well, like ketamine, to help enhance a patient’s progress, adds Dr. Zand. “Ketamine acts as a neurological reset, to decrease the rigidity of the brain and introduce alternative perspectives and healthier neural networks,” he explains.

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If you’re struggling with symptoms of agoraphobia, a mental health professional such as a psychologist or psychiatrist can help set you on the path to recovery.

“As a psychiatrist, I believe it’s never too early to reach out for help,” says Dr. Zand. “Preventative mental health care should be emphasized as much, if not more, than preventive physical care.”