Last Updated on March 12, 2023 by Mike Robinson

Some people get scared when they have to leave their homes. Agoraphobia, which in Greek means “fear of the marketplace,” is a fear of any place where it might be hard to get away. This includes large open spaces, crowded places, and different travel methods. People with agoraphobia might not want to be alone outside the house, ride in a car, bus, or plane, be in a crowded place, be in a small space like a store or movie theater, or be on a bridge.
People with agoraphobia are afraid of these situations because they worry that they won’t be able to get out in an emergency or won’t be able to get help if they start to panic or have other embarrassing symptoms. They feel much pain and stress and may need someone to talk to.

Diagnosis for Agoraphobia

For agoraphobia to be considered a diagnosis, the agoraphobic situations must almost always cause fear and anxiety disproportionate to the actual danger. This distress usually lasts for at least six months. In its worst form, agoraphobia makes people unable to leave their homes. Fearful and anxious thoughts tend to change as people get older. Children often worry about getting lost, while adults may worry about having panic attacks or falling. Agoraphobia often accompanies other anxiety disorders and mood disorders, like panic disorder or a specific phobia.

In panic disorder, the person has repeated panic attacks and becomes terrified of having another one. This fear, called anticipatory anxiety or the fear of fear, is present most of the time and can seriously affect a person’s life even when a panic attack is not happening. Before they had panic disorder, most people with panic disorder showed signs of agoraphobia and anxiety.

Most of the time, people with agoraphobia don’t leave their safe zone, which may be their home or their immediate neighborhood. Any movement outside of this zone makes anxiety grow.

People with agoraphobia might not leave their homes for years, which hurts their relationships. More than one-third of people with agoraphobia don’t leave their homes and can’t work, according to estimates.

 Symptoms of Agoraphobia

According to the DSM-5, agoraphobia involves:

Fear or worry regarding: 

• being alone outside of the house 
• using a bus or train 
• being confined to spaces (stores, movie theaters) 
• being surrounded by people or in a line 
• residing in open areas (markets, parking lots) 
• being in situations where escaping might be challenging
• active avoidance of all situations that make one feel fearful or 
• anxiously staying home for an extended period 
• a sense of estrangement or detachment from others 
• a sense of hopelessness 
• reliance on others 
• Panic or anxiety attack (acute, severe anxiety) 

A person may be diagnosed with agoraphobia if other mental illnesses or physical ailments cannot explain their symptoms. Additionally, alcohol and sedative drug abuse are frequent among those who have agoraphobia as a way to cope with their distress.

Is agoraphobia a disabling disorder?

Agoraphobia can severely impair a person’s ability to function. Some cannot work and may depend heavily on other family members to take care of their shopping and household chores and go on rare excursions outside the safety zone with the affected person.

What percentage of people have agoraphobia?

The National Institute of Mental Health estimates that 1.3 percent of people have agoraphobia, with a 0.9 percent incidence rate. Compared to men, who experience a rate of 0.8 percent, women experience a rate of 0.9 percent. Agoraphobia typically manifests in late adolescence or early adulthood, though it can also happen in childhood.

Causes of Agoraphobia

Even though we don’t fully understand what causes most anxiety disorders, we know more about them now than we did ten years ago. In a broad sense, the chances of getting anxiety depend on a mix of life experiences, personality traits, or genetics. Agoraphobia is said to have a 61 percent heritability, making it the phobia most likely caused by a genetic predisposition to aversions. Some environmental factors have been linked to the development of agoraphobia. These include being exposed to stressful events (like the death of a parent or being attacked or mugged) and growing up in a home with little warmth and a lot of overprotection.

 Treatment Options for Agoraphobia

Treatment for phobias is frequently very effective. The purpose of therapy is to enable the agoraphobic individual to function normally, and the most successful strategy is systematic desensitization, also known as exposure therapy. It is a behavioral technique in which the patient is gradually exposed to the feared situation while being guided by a professional and learning that the feared outcomes do not occur.

The severity of the phobia typically determines how well a treatment plan works. The individual first learns relaxation methods before practicing them. When at ease, the person visualizes the elements of the phobia, going from the least frightening to the most terrifying. The use of graded real-life exposure has also been successful in helping people overcome their fears. 

Exposure Therapy

The method involves exposure to stressful situations, escalating from mild to severe ones. To overcome a fear of crowds, a person might first interact with a small group of people before gradually spending more time with bigger groups. With the help of a therapist, the person creates relaxation and breathing exercises as coping mechanisms to reduce anxiety.

While actual exposure in the real world is preferred, desensitization can also use imagined exposure. Exposure therapy for agoraphobia frequently reduces anxiety and boosts spirits and quality of life. Some patients benefit from other types of therapy, including biofeedback, hypnosis, meditation, relaxation techniques, and couples therapy.

Cognitive Behavior Therapy (CBT)

Patients receiving cognitive-behavioral therapy (CBT) can change their behavior and modify or eliminate thought patterns contributing to their symptoms. CBT typically takes 8–12 weeks to complete. Some patients might require more time in treatment to pick up and use their brand-new skills. This type of therapy is efficient in getting rid of panic attacks or cutting down on how often they occur and is said to have a low relapse rate. It also lessens worry about the future and prevents people from avoiding feared situations. 

Overcoming Treatment Obstacles

Treatment may become complicated when patients find it challenging to get to appointments due to their fears. Some therapists will conduct the initial sessions with an agoraphobic patient at home to deal with this issue. Therapists frequently accompany their clients on outings to stores and other locations they have avoided offering support and aid in overcoming their fears. 

The patient gradually enters a feared situation and tries to stay despite feeling increasingly anxious. In this way, the patient can understand that, despite how terrifying the feelings may be, they are not harmful and do pass. 

The patient experiences as much fear as they can handle during each attempt. With this step-by-step strategy, patients discover they can gradually conquer their fears and enter situations that previously seemed out of their reach with the therapist’s support and expert guidance. 

Many therapists give their clients “homework” to complete between appointments. Patients may only work with a therapist for a limited number of sessions before continuing to work independently with the help of a manual. 

Medicine Options

Administration of Medicines Prescription medication may be helpful for patients who experience panic attacks due to their agoraphobia to prevent them, lessen their frequency and severity, and lessen the associated anticipatory anxiety. 

Patients can gradually venture into situations that previously caused anxiety when they notice their panic attacks are less frequent and severe. Tricyclic antidepressants, high-potency benzodiazepines, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa), are the medication classes that are most frequently used (MAOIs). The patient’s needs, safety, and efficacy are considered when choosing the best medication. 

OCD and Social Phobias

When panic disorder coexists with OCD, social phobia, or depression, SSRIs can treat it. The patient first receives low doses of the medications, and then they are gradually increased until they see positive effects. Alprazolam, clonazepam, and lorazepam are examples of high-potency benzodiazepines. They act quickly and have few unwelcome side effects. However, some patients, particularly those who have struggled with alcohol or drug addiction, may develop benzodiazepine dependency.  

Benefits of Support Groups

After stopping the medication, panic attacks might start again. Getting involved in a self-help or support group and discussing their issues and successes with others is beneficial for many people with anxiety disorders. 

Frequently, the patient will join a support group for those battling agoraphobia. They will meet once a week to talk about their progress, offer each other words of encouragement, and get advice from the therapist. 

Final Thoughts

People with anxiety disorders can learn stress reduction strategies and meditation to help them relax, which may enhance the therapeutic effects. Exercise that is aerobically based can also be calming. Patients should avoid caffeine, illegal drugs, and over-the-counter cold remedies. These options can make the symptoms of anxiety disorders worse. 

Before taking any additional medications, consult your doctor or pharmacist. Can a person with agoraphobia benefit from a combination of therapies? Some patients with anxiety disorders may benefit from psychotherapy and pharmacotherapy together or in succession. According to claims, the combined approach provides quick relief, high effectiveness, and a low relapse rate. 

Also Read: Apeirophobia: Symptoms, Causes and Treatments