Overview

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.

Symptoms

Typical agoraphobia symptoms include fear of:

• Leaving home alone
• Crowds or waiting in line
• Enclosed spaces, such as movie theaters, elevators or small stores
• Open spaces, such as parking lots, bridges or malls
• Using public transportation, such as a bus, plane or train

These situations cause anxiety because you fear you won't be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

In addition:

• Fear or anxiety almost always results from exposure to the situation
• Your fear or anxiety is out of proportion to the actual danger of the situation
• You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed
• You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance
• Your phobia and avoidance usually lasts six months or longer

Panic disorder and agoraphobia

Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you're totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Signs and symptoms of a panic attack can include:

• Rapid heart rate
• Trouble breathing or a feeling of choking
• Chest pain or pressure
• Lightheadedness or dizziness
• Feeling shaky, numb or tingling
• Excessive sweating
• Sudden flushing or chills
• Upset stomach or diarrhea
• Feeling a loss of control
• Fear of dying

When to see a doctor

Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.

Don't let agoraphobia make your world smaller. Call your doctor if you have signs or symptoms listed above.

Causes

Biology — including health conditions and genetics — temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.

Risk factors

Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors for agoraphobia include:

• Having panic disorder or other phobias
• Responding to panic attacks with excessive fear and avoidance
• Experiencing stressful life events, such as abuse, the death of a parent or being attacked
• Having an anxious or nervous temperament
• Having a blood relative with agoraphobia

Complications

Agoraphobia can greatly limit your life's activities. If your agoraphobia is severe, you may not even be able to leave your home. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, run errands, or take part in other normal daily activities. You may become dependent on others for help.

Agoraphobia can also lead to or be associated with:

• Depression
• Alcohol or drug abuse
• Other mental health disorders, including other anxiety disorders or personality disorders

Prevention

There's no sure way to prevent agoraphobia. However, anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places over and over again before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

Diagnosis

Agoraphobia is diagnosed based on:

• Signs and symptoms
• In-depth interview with your doctor or a mental health professional
• Physical exam to rule out other conditions that could be causing your symptoms
• Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Psychotherapy

Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

You can learn:

• What factors may trigger a panic attack or panic-like symptoms and what makes them worse
• How to cope with and tolerate symptoms of anxiety
• Ways to directly challenge your worries, such as the likelihood of bad things happening in social situations
• That your anxiety gradually decreases if you remain in situations and that you can manage these symptoms until they do
• How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia are well aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. He or she may offer to see you first in your home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

Medications

Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications in the treatment of agoraphobia.

• Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants may also effectively treat agoraphobia.
• Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, your doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren't a good choice if you've had long-term problems with anxiety or problems with alcohol or drug abuse.

It may take weeks for medication to relieve symptoms. And you may have to try several different medications before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your doctor likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication.

Alternative medicine

Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your doctor. Although these supplements are available without a prescription, they still pose possible health risks.

For example, the herbal supplement kava, also called kava kava, appeared to be a promising treatment for anxiety, but there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using any product that contains kava until more-rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.

Coping and support

Living with agoraphobia can make life difficult. Professional treatment can help you overcome this disorder or manage it effectively so that you don't become a prisoner to your fears.

You can also take these steps to cope and care for yourself when you have agoraphobia:

• Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Communicate regularly with your therapist. Consistency can make a big difference, especially when it comes to practicing skills and taking your medication.
• Try not to avoid feared situations. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places can make them less frightening and anxiety provoking. Family, friends and your therapist can help you work on this.
• Learn calming skills. Working with your therapist, you can learn how to calm and soothe yourself. Meditation, yoga, massage and visualization are simple relaxation techniques that also may help. Practice these techniques when you aren't anxious or worried, and then put them into action during stressful situations.
• Avoid alcohol and recreational drugs. Also limit or avoid caffeine. These substances can worsen your panic or anxiety symptoms.
• Take care of yourself. Get enough sleep, be physically active every day, and eat a healthy diet, including lots of vegetables and fruits.
• Join a support group. Support groups for people with anxiety disorders can help you connect to others facing similar challenges and share experiences.

Preparing for an appointment

If you have agoraphobia, you may be too afraid or embarrassed to go to your doctor's office. Consider starting with a phone call to your doctor or a mental health professional, or ask a trusted family member or friend to go with you to your appointment.

What you can do

To prepare for your appointment, make a list of:

• Any symptoms you've been experiencing, and for how long
• Things you have stopped doing or are avoiding because of your stress
• Key personal information, especially any significant stress or life changes that you experienced around the time your symptoms first developed
• Medical information, including other physical or mental health conditions that you have
• All medications, vitamins, herbs or other supplements you're taking, and the dosages
• Questions to ask your doctor so that you can make the most of your appointment

Some basic questions to ask your doctor may include:

• What do you believe is causing my symptoms?
• Are there any other possible causes?
• How will you determine my diagnosis?
• Is my condition likely temporary or long term (chronic)?
• What type of treatment do you recommend?
• I have other health problems. How best can I manage these together?
• What is the risk of side effects from the medication you're recommending?
• Are there options other than taking medications?
• How soon do you expect my symptoms to improve?
• Should I see a mental health professional?
• Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

• What symptoms do you have that concern you?
• When did you first notice these symptoms?
• When are your symptoms most likely to occur?
• Does anything seem to make your symptoms better or worse?
• Do you avoid any situations or places because you fear they'll trigger your symptoms?
• How are your symptoms affecting your life and the people closest to you?
• Have you been diagnosed with any medical conditions?
• Have you been treated for other mental health disorders in the past? If yes, what treatment was most helpful?
• Have you ever thought about harming yourself?
• Do you drink alcohol or use recreational drugs? How often?