Key takeaways:
Agoraphobia is an anxiety disorder that causes people to fear public spaces and situations where they believe they can’t escape or get help.
Factors like genetics, environment, stress, and history may all play a role in developing agoraphobia.
Treatment for agoraphobia usually involves a combination of psychotherapy, medication, and healthy life habits.
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Most of us get frustrated when the checkout line at the grocery store is 11 people long. And who hasn’t felt closed in when they just caught the elevator only to find it packed beyond capacity? Though these situations might feel uncomfortable, you can usually still get through them.
But for people who have agoraphobia, the fear of being in a crowded, public, or enclosed space is terrifying and overwhelming. This fear may cause them to avoid people and activities they used to enjoy.
Let’s take a closer look at what agoraphobia is and how it’s treated.
What is agoraphobia?
Agoraphobia is an anxiety disorder. It leads to excessive fear and avoidance of places or situations that may cause you to feel panicked or trapped.
People who have agoraphobia fear situations where they believe they will be unable to escape or get help if their anxiety gets worse. Sometimes just imagining the situation can cause overwhelming anxiety.
Because of this intense fear, people with agoraphobia often restrict their lives. They might avoid situations like parking lots, crowds, elevators, or driving alone across a bridge.
The fear can be worse when places are crowded. At its most severe, agoraphobia can make you too scared to leave your house at all.
What causes agoraphobia?
Experts believe that several factors play a role in whether you develop agoraphobia. Some of these factors include:
Biology, such as an imbalance of neurotransmitters in the brain
Other health conditions, such as thyroid problems or heart arrhythmias
Family or personal history of anxiety disorders
Childhood trauma
Ongoing stress
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Often, a history of anxiety or panic is present before someone is diagnosed with agoraphobia. Low self-esteem and depression have also been linked to anxiety disorders.
What are the symptoms of agoraphobia?
Agoraphobia causes several symptoms. First, it leads to overwhelming fear in at least two of the following situations:
Crowds
Waiting in line
Leaving home alone
Using public transportation (for example, buses, trains, and airplanes)
Enclosed spaces such as elevators and theaters
Open spaces such as parking lots and malls
The symptoms of agoraphobia are both physical and emotional. Many physical symptoms are similar to what you experience when you have a panic attack.
Physical symptoms of agoraphobia can include:
Chest pain or discomfort
Shortness of breath
Feeling dizzy, lightheaded, unsteady, or faint
Fainting
Feeling like you’re choking
Nausea and stomach distress
Fluttering or pounding heart or fast heart rate
Sweating
Trembling
Chills or heat sensations
Your healthcare provider will also look for the following characteristics to diagnose agoraphobia:
The fear or anxiety is much greater than the actual danger of your situation.
Fear or anxiety almost always happens in situations where you’re in a public place.
You avoid places where you know you’ll feel anxious.
You need a trusted companion to go out with you.
You endure a feared situation but feel highly distressed the whole time.
Your agoraphobia symptoms get in the way of your relationships, work, or other areas of your life.
Your symptoms aren’t due to another mental health or medical condition.
How do you treat agoraphobia?
Agoraphobia treatment often includes a combination of psychotherapy, medication, and lifestyle changes.
Psychotherapy for agoraphobia
Cognitive behavioral therapy (CBT) is often recommended for anxiety disorders like agoraphobia. CBT generally takes place over a limited number of structured sessions.
CBT helps you recognize how your thoughts, feelings, and actions affect each other. This type of therapy is effective in treating agoraphobia. CBT focuses on your specific fears and teaches you skills to challenge and tolerate the anxiety.
Your provider may also suggest that you try CBT with exposure therapy. With exposure therapy, you practice putting yourself in situations that you fear. At the same time, you’ll use new skills to cope with the anxiety you feel. The goal is to learn that you can tolerate feeling afraid — and you don’t have to let agoraphobia control your life.
Other types of therapy — such as acceptance and commitment therapy (ACT) — may also help. A mental health provider can help you determine what will work best for you.
Medications for agoraphobia
Medication is often prescribed along with psychotherapy to treat agoraphobia. The first-choice medications for agoraphobia are selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRIs), two types of antidepressants.
Examples of specific medications that your provider may recommend are:
Fluoxetine (Prozac)
Citalopram (Celexa)
Escitalopram (Lexapro)
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
If you have severe agoraphobia, your provider may recommend faster-acting medications like benzodiazepines or beta blockers. You typically use these only as needed right before a situation that makes you highly anxious.
Your provider may also suggest other medications. This will depend on any other mental health conditions you may have, such as depression.
Lifestyle changes for agoraphobia
You can also try certain lifestyle habits to help manage your agoraphobia symptoms. Activities such as meditation and mindfulness may help lower your anxiety levels.
Here are a few ideas to consider:
Eat a healthy, well-balanced diet.
Schedule regular exercise into your daily routine.
Avoid coffee, soda, and other drinks with caffeine.
Avoid drugs and alcohol.
The relationship between agoraphobia and panic disorder
You can have both agoraphobia and panic disorder. However, they are separate conditions. Agoraphobia is a fear of being in certain types of spaces. Panic disorder causes repeated panic attacks that may happen without warning.
Over time, people with panic disorder can develop agoraphobia. This occurs when you try to avoid additional panic attacks. You may stop going anywhere where you’ve had a panic attack in the past. This often means avoiding public places — a hallmark sign of agoraphobia.
The bottom line
Why trust our experts?
Agoraphobia is an anxiety disorder. It causes overwhelming fear of situations or locations where you can’t easily escape or get help if panic sets in. If you think you may have agoraphobia, talk with your healthcare provider. Help is available, and with treatment, your chance for recovery is very good. You can search for a mental health professional in your area by calling SAMHSA’s National Helpline at 1-800-662-4357.
