What is agoraphobia?
Agoraphobia is a fear of leaving your home. It is a type of anxiety disorder. People with agoraphobia feel scared of places that might make them feel trapped (like being unable to leave a classroom), on the spot or embarrassed (in conversation with others), or out of control (a party where they do not control the tone and timing).
Often these fears turn into anxiety attacks (panic attacks). Physical symptoms of a panic attack include shortness of breath, increased heart rate, and dizziness. When panic occurs, it reinforces your original belief that you should not have left your home.
You then start worrying about having another panic attack, especially in front of other people, which worsens the agoraphobia. About one third of people with agoraphobia never leave their home. People with agoraphobia can be treated with therapy and medications.
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Most common symptoms
Not all public experiences are created equal. Rate your fear of going out 0–10. (0=not fear inducing at all. 10 = high likelihood of a panic attack.) If you are trying to address the symptoms of agoraphobia yourself, push yourself to go out when your ratings of fear or anxiety are 0–4. If your anxiety is 5+, allow yourself to stay in until you have mastered the 0–4 experiences. —Dr. Wegner
A common symptom is intense fear of leaving your home. You may also have repetitive thoughts (ruminations) of all the reasons you should not leave, like "I can't go because I might get stuck there" or "I will have a panic attack if I go and that would be humiliating.
If a person with agoraphobia eventually pushes through and makes it out of the home, they might have a panic attack.
Symptoms usually start before age 35, often in the teenage years. In some cases, people who have panic disorder end up developing an intense fear of having an attack outside of the house and in front of someone. This may then become a secondary anxiety disorder, agoraphobia.
Other illnesses have similar symptoms. But there are some small differences:
- Post-traumatic stress disorder (PTSD) makes you want to stay out of certain situations. But it’s because you had a terrifying experience with that situation before.
- Specific phobias create fear or a certain situation, like a fear of flying.
- Social anxiety disorder makes you want to stay away from situations where you fear other people are going to judge you.
- Fear in two or more situations like:
- Public transportation—buses, planes, boats, trains
- Being in open spaces—wide boulevards, parking lots, bridges
- Being in closed spaces—movie theaters, stores, elevators
- Standing in a line
- Being in a crowd
- Being outside your home
- The fear of the situation is bigger than the actual danger.
- Overwhelming worry that if something bad happened, you would have trouble leaving. Or people could not reach you if you needed help—like if you fell or were lost.
- Not going to a specific place because of fear.
- Feared situations almost always cause anxiety, including thoughts that something terrible is going to happen. The anxiety may be set off during the situation—like while waiting to board an airplane. Or just by thinking about a situation—during the planning of a trip involving flying.
- Intense distress, fear, or avoidance of leaving your home for at least 6 months or more.
- Those with severe agoraphobia may never leave their house.
Other symptoms you may have
People with agoraphobia often have panic attacks. Symptoms of a panic attack include:
- Chest discomfort
- Trouble breathing
- Becoming dizzy or lightheaded
- Fast heartbeat
- Throat tightness
- Upset stomach
- Feeling detached from reality or from your body
- Fear of losing control
- Fear of dying
Risk factors for agoraphobia
It’s not known why agoraphobia happens. But certain factors make you more likely to have it.
- Family members with agoraphobia or other phobias.
- Certain personality traits like having a negative view toward life events.
- Experiencing stressful life events, like parents dying in childhood or being attacked.
- Growing up with overprotective parents or not feeling loved by your parents.
Can a child have agoraphobia?
While a child is not likely to develop agoraphobia, it is possible. Children may become extremely afraid of getting lost. Or of sitting in the middle of a long row of other people—like in a classroom or theater.
The fear makes them not want to go to places where this could happen. If you think your child may have agoraphobia—or some other kind of anxiety—talk to your pediatrician about making an appointment with a therapist.
Avoidance of the thing that creates anxiety (i.e., public spaces) makes the symptoms worse over time. Avoidance is a short-term solution with a long-term cost. Changing the way you think about going out also makes leaving home easier. A therapist can help with this—it is called cognitive reframing. —Dr. Wegner
Agoraphobia is treatable with a combination of therapy and medication.
Exposure and response prevention is a type of therapy that’s used to treat agoraphobia. With your therapist, you make a list of situations, from the least anxiety-provoking to the most. You will also be taught relaxation techniques. With the therapist, you will first imagine a mildly anxiety-provoking situation while practicing relaxation.
Once you master that, you move to the next situation that causes slightly more anxiety. You work your way to the end of the list, when you can either imagine a panic-inducing situation without panicking or can actually leave the house without panicking.
The therapy is safe and often effective, but it can make someone feel emotionally uncomfortable at times. Some people get better after only a few sessions, depending on the severity of the symptoms.
Medication can help, depending on your symptoms and if you have any other mental health conditions (like panic disorder, depression, or other anxiety disorders). The two main types of medications for treating agoraphobia are antidepressants and benzodiazepines for anxiety.
Depending on the person’s symptoms, it can take up to 6 weeks to have an effect.
Some lifestyle behaviors, like too much caffeine, lack of sleep, or alcohol use, can worsen symptoms of anxiety including agoraphobia.
- Don’t use alcohol or other drugs. It may seem like it is helping, but both can actually make symptoms worse.
- Get a good night’s sleep. Being tired increases anxious feelings and related symptoms.
- Exercise. Walking and running can lower anxiety, lessen stress, and boost your overall mood. Yoga offers similar benefits while also showing you how to calm your body.