Agoraphobia guide: Symptoms, triggers, and treatment

Agoraphobia Definition: What Are People With Agoraphobia Afraid of?

Agoraphobia is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as the “marked fear or anxiety about two (or more) of the following: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, and/or being outside of the home alone.”

These fears can inhibit someone’s ability to participate in many normal activities required to move through life. It can prevent someone from wanting to drive, get on public transportation, or go to places to see friends or meet new people, effectively cutting them off from life outside their homes.

Individuals with agoraphobia severely fear and avoid situations of the like out of worry that they won’t be able to escape or get help if they start to panic – they go to drastic measures to avoid losing control. Their panic can sometimes lead to panic attacks, instances of extremely intense fear and anxiety that can make someone think they may be having a heart attack or that they are in danger of dying.

What Does Agoraphobia Feel Like?

Agoraphobia can come with a range of emotions: above all, it can make one feel extremely fearful and anxious when confronted with the situations (or even thoughts about the situations) that scare them. It can also make one feel really frustrated, disappointed, and hopeless. 

It can also cause one to feel embarrassed if they’re unable to leave their home and have to rely on others for basic necessities like food and household supplies. Further, severe cases of agoraphobia can cause one to develop depression and other mental health conditions.

Is Agoraphobia Just Anxiety?

Agoraphobia isn’t “just” anxiety. Many of us encounter day-to-day anxiety or anxiety about specific situations, events, outcomes, etc. However, agoraphobia is characterized by extreme fear and anxiety that causes the individual significant distress. The anxiety it causes also must be severe enough to impede daily functioning, such as causing someone to avoid certain places or situations.

What Are Symptoms of Agoraphobia?

Again, the primary characteristics of agoraphobia are intense fear and anxiety of the select situations listed earlier. If the individual isn’t able to avoid these fear- and anxiety-inducing situations, then they might experience the following symptoms of anxiety:

• Quickened heartbeat
• Sweating
• Shaking or trembling
• Chest pain
• Breathing issues
• Dizziness or nausea
• Difficulty swallowing
• Fear of dying
• Panic attacks

What Is an Example of Agoraphobia?

Jonathan has a crippling fear of riding in a taxi… and on the bus, as well as on the subway. Fortunately for him, he’s able to avoid public transportation with ease, as his work is remote and there’s a grocery store just around the corner that he walks to. But he also has severe anxiety in crowded spaces and long lines – which aren’t always easy to avoid at the grocery store or even on the way to the grocery store.

Jonathan avoids the crowds and long lines as best he can, going to the store first thing in the morning and just before close. When this tactic doesn’t work, he leaves and returns the next day. But, inevitably, he sometimes gets stuck in crowds on the sidewalk. This always incites panic, and Jonathan breaks into a run to get home as quickly as possible. 

This is an example of agoraphobia. As you can see, the fear and anxiety that come with these scenarios are debilitating. Jonathan structures his life around avoiding these fears, and experiences distress when he doesn’t succeed in doing so. Fortunately, with treatment, Jonathan and others with agoraphobia can learn to face their fears and better manage their agoraphobia.

What Are the Stages of Agoraphobia?

Often, mental health professionals will measure stages of agoraphobia on a scale in terms of severity using a scale similar to the following:

• 0 – No symptoms
• 1 – Mild
• 2 – Moderate
• 3 – Severe
• 4 – Acute or extreme

Often, it is noticeable that symptoms of agoraphobia may start small and be infrequent, but may grow to be more serious or frequent if agoraphobia is left untreated. However, through treatment, these symptoms can be reduced, allowing people with agoraphobia to go about their lives largely unaffected.

What Is the Main Cause of Agoraphobia?

Agoraphobia is believed to be a form of misplaced or forecasted fear of an environment that is a result of one’s inner feelings that have been suppressed unconsciously, such as hostility or sexuality. However, there are also other factors that can contribute to the development of agoraphobia. These can be categorized as:

• Temperamental: Those with an anxiety sensitivity (or who believe anxiety symptoms are harmful) are at a higher risk of developing agoraphobia as well as other anxiety disorders. 
• Environmental: Experiencing negative or stressful events, especially in childhood, can also contribute to the development of agoraphobia — such events include parents’ divorce or the death of a close family member. Overprotective or, on the opposite side of the spectrum, neglectful parents can also serve as contributors.
• Genetic and physiological: Finally, if one’s parents or other close relative has agoraphobia, they’re much more likely to develop it. In fact, according to the DSM-5, heritability for agoraphobia is 61% — it has the strongest association with the genetic factor out of all of the phobias.

Agoraphobia vs. Another Mental Health Disorder

The tricky thing is that sometimes fear and anxiety can be better attributed to another disorder. The following are common conditions that can either accompany agoraphobia or be the true cause of your symptoms, instead:

• Situational Specific Phobia: This might be diagnosed if the fear and avoidance is allocated to just one of the agoraphobic situations previously discussed. 
• Separation Anxiety Disorder: A major difference between agoraphobia and separation anxiety disorder is that, with the latter, fearful thoughts are about detachment from significant others or family members.
• Social Anxiety Disorder: This disorder is rooted in the fear of interacting with others and being negatively judged or perceived.
• Panic Disorder: This condition includes frequent and unexpected panic attacks, while those that come with agoraphobia occur in or because of the specific situations the individual fears.
• Major Depressive Disorder: This disorder may cause an individual to avoid leaving home because of feelings of apathy, low self-esteem, and loss of energy; avoidance is unrelated to fears of the situations listed earlier.

Is Agoraphobia the Same as Social Anxiety?

As explained above, social anxiety disorder is actually different from social anxiety. The major difference between agoraphobia and social anxiety is that a person with agoraphobia fears having anxiety attacks, panic symptoms or losing control in certain situations, while social anxiety occurs when a person worries about feeling judged, humiliated or embarrassed in social situations. 

Although both agoraphobia and social anxiety have avoidance, the fears accompanying social anxiety are more specifically focused on what people think of them, while agoraphobia’s fears are about situations that make that person uncomfortable, though not always for a specific reason.

What Not to Say to an Agoraphobic

It would be inappropriate to tell them to, “just get over it”, or to “just face your fears.” This would be discounting how debilitating agoraphobia is for people. Though you may not understand their fear, it’s important to still validate the fact that these situations feel terrifying for them, whether it seems “reasonable” or not.

The best thing to do is treat any person’s fears or anxieties with kindness and with compassion. If you want to support someone with agoraphobia, do not belittle them, and encourage them to seek out help from a therapist who is well-versed in working with anxiety disorders.

How Is Agoraphobia Treated? Can Agoraphobia Be Cured?

If you’re someone who suffers from agoraphobia, you might be wondering, “How do I cope with agoraphobia?” Fortunately, agoraphobia is a treatable condition. However, the goal of treatment is largely to reduce and mitigate symptoms, as “curing” one’s agoraphobia is not necessarily possible. 

The symptoms of this condition can be relieved through psychotherapy or medication or, often, a combination of the two. Psychotherapy helps the individual set goals and learn skills to reduce anxiety symptoms.

The most effective form of therapy for anxiety disorders like agoraphobia is cognitive behavioral therapy (CBT), which focuses on teaching a person with specific skills to better tolerate feelings like anxiety, directly challenge fears, and gradually return to the activities they have avoided because of intense anxiety.

Therapists focus on how to determine what triggers anxiety, fear, and panic-like symptoms in given situations. Then, on directly confronting and challenging one’s worries, and eventually changing unwanted behaviors. 

Certain forms of antidepressants and anti-anxiety medications can also prove effective in lessening one’s anxiety. However, therapy is ultimately the tool that will help the individual get to the root of their problem and better manage it.