Panic Disorder Symptoms What Is Agoraphobia? An anxiety disorder that causes symptoms of fear and prompts avoidance behaviors By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. Learn about our editorial process Updated on August 18, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Martin Dimitrov / E+ / Getty Images Table of Contents View All Table of Contents Definition Symptoms Types Causes Diagnosis Treatment Coping Frequently Asked Questions What Is Agoraphobia? Agoraphobia Agoraphobia is an anxiety disorder that involves an extreme and irrational fear of being unable to escape a difficult or embarrassing situation. People fear they will experience panic or other incapacitating symptoms when trapped in a public and inescapable setting. Agoraphobia is sometimes mistaken as a fear of leaving the house, but it is more complex. The disorder is marked by anxiety that causes people to avoid situations where they might feel panicked, trapped, helpless, or embarrassed. It can occur on its own or alongside another mental health condition, such as panic disorder. This fear often leads to persistent avoidance behaviors, in which the person begins to stay away from the places and situations in which they fear panic may occur. For example, a person with agoraphobia may avoid driving a car, leaving the comfort of home, shopping in a mall, traveling by airplane, or simply being in a crowded area. Due to these avoidance behaviors, the life of a person with agoraphobia can become very restrictive and isolated—greatly affecting their personal and professional life. For example, heightened fears and avoidance behaviors can make it difficult for a person with agoraphobia to travel for work or to visit with family and friends. Even small tasks, such as going to the store, can become extremely difficult. Fear and avoidance can become so severe with agoraphobia that the person with the phobia becomes confined to their home. Fortunately, agoraphobic symptoms can be treated. Agoraphobia and Fear of Leaving the House Symptoms of Agoraphobia Symptoms of agoraphobia may include: Being afraid of leaving homeBeing afraid of open spaces, bridges, or shopping centersFear of enclosed spaces or buildingsFear of leaving home or being in social situations aloneFear of losing control in a public placeFear of places where escape might be difficultFear of public transportation These situations almost always trigger an anxiety response that is out of proportion to the actual danger presented by the situation. Panic attacks often precede the onset of agoraphobia. When forced to endure a feared situation, a person may experience a panic attack that causes symptoms including: Chest painChillsDiarrheaDizzinessFeelings of chokingFeelings of unrealityNauseaNumbnessRapid heartbeatShortness of breathSweatingTrembling The Symptoms of Agoraphobia Types of Agoraphobia Although many people with agoraphobia will also have panic disorder, it is possible to be diagnosed with agoraphobia without having a history of panic disorder. When this occurs, the person still has a fear of being stuck in a situation where escape would be difficult or humiliating. However, they generally do not fear having full-blown panic attacks. Rather, they may be afraid of having some other type of distressing anxiety symptom or other intense physical issues, such as vomiting or having a severe migraine. For instance, the person may be afraid that they will lose control of their bladder in public or faint without any help being available. Approximately one-third to half of those diagnosed with panic disorder will also develop agoraphobia. The National Institute of Mental Health (NIMH) reports that agoraphobia occurs to approximately 0.9% of adults in the U.S. population in any given year. This condition typically develops in adulthood, though it can emerge earlier in adolescence. Agoraphobia vs. Other Phobias The avoidance behaviors present in agoraphobia differ from the diagnostic criteria of a specific phobia. For instance: A person with agoraphobia may avoid traveling by airplane due to a fear of having a panic attack on a plane and not necessarily due to aerophobia, or the fear of flying. A person with agoraphobia may avoid crowds, fearing the embarrassment of having a panic attack in front of a lot of people. Such a fear is not the same as social anxiety disorder, which is a separate mental health condition that involves anxiety about being negatively evaluated by others. Causes of Agoraphobia The exact causes of agoraphobia are not known, but there are a number of risk factors that may increase your risk of developing this condition. These include: Having another anxiety disorder, such as generalized anxiety disorder or social anxiety disorder Another phobia A family history of agoraphobia A history of abuse or trauma Brain chemistry Low self-esteem or depression Learned associations can also play a role in the development of agoraphobia. Experiencing a panic attack in a certain situation or setting can lead to a fear that such a reaction will occur again in the future. In some cases, post-traumatic stress disorder (PTSD) can contribute to the development of agoraphobia. PTSD can occur following a traumatic event and lead to hypervigilance and anxiety symptoms, which can lead to the onset of agoraphobia. Extended periods of isolation may increase the risk of developing agoraphobia. For example, fear caused by the COVID-19 pandemic combined with isolation caused by social distancing and quarantines has increased anxiety for many Americans. Mental health experts believe that the repercussions of these events may have a lasting effect on the well-being of adults and children for years to come. Diagnosis of Agoraphobia To receive a diagnosis of agoraphobia, a healthcare provider will assess your symptoms and check for any underlying medical conditions that might be causing those symptoms. You may be asked about your medical history and you will be asked about the nature, duration, and severity of your anxiety symptoms. Mental health conditions such as agoraphobia are diagnosed using criteria in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR). The book categorizes different mental disorders and is published by the American Psychiatric Association. In order to be diagnosed with agoraphobia, you must: Have marked fear in at least two different situations, such as open spaces, crowded areas, or public transportationHave the agoraphobic situation almost always provoke an anxiety responseHave fear that is out of proportion to the threatExhibit avoidance behaviors or distress that disrupts your normal routines, work, school, and relationshipsExperience these symptoms for at least six months The symptoms must also not be better explained by another medical or mental condition. Treatment for Agoraphobia If a person does develop agoraphobia with panic disorder, symptoms typically begin to occur within the first year that the person starts having recurring and persistent panic attacks. Agoraphobia can get worse if left untreated. For the best outcomes in managing agoraphobia and panic symptoms, it is important to seek treatment as soon as symptoms arise. Treatment options typically include a combination of both medication and psychotherapy. Psychotherapy The therapeutic approach may include some systematic desensitization, in which the person gradually confronts avoided situations with the support and guidance of their therapist. Some research has shown that integrating exposure therapy with psychodynamic treatment has been beneficial in panic disorder with agoraphobia. Many times, the person will fare better in facing their fears if accompanied by a trusted friend. Medications Medications may also be prescribed to help manage certain symptoms of agoraphobia. These medications include: Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and Zoloft (sertraline); selective serotonin-norepinephrine inhibitors (SNRIs) such as Effexor (venlafaxine); and tricyclic antidepressants (TCAs) such as Tofranil (imipramine) and Anafranil (clomipramine) Anti-anxiety medications, such as Klonopin (clonazepam) and Xanax (alprazolam) Coping With Agoraphobia In addition to seeking help from a mental health professional, there are also lifestyle changes that can help you to better manage the symptoms of agoraphobia. These include: Practicing stress management techniques, such as deep breathing, visualization, and progressive muscle relaxation to help reduce anxiety Eating a healthy and nutritious diet Getting regular physical exercise Avoiding drugs and alcohol Limiting caffeine intake Through the support of family and friends and professional help, a person with agoraphobia can manage their condition. With medication and psychotherapy, a person with agoraphobia can expect to eventually experience fewer panic attacks, fewer avoidance behaviors, and a return to a more independent and active life. If you or a loved one are struggling with agoraphobia, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. How to Cope With Agoraphobia Frequently Asked Questions How common is agoraphobia? The National Institutes of Health (NIH) found that less than 1% of the population reports having agoraphobia during the past 12 months. Additionally, males and females appear to have agoraphobia at near-equal rates at 0.8% and 0.9% respectively. Though, other health institutions suggest that the prevalence may be a bit higher, or somewhere between 1% and 2%. What causes agoraphobia? The cause of agoraphobia is unclear, though this condition often exists along with panic disorder. In fact, roughly one in three people with a panic disorder also develop agoraphobia. A family history of agoraphobia or a history of trauma may also contribute to the development of agoraphobia. What are the best treatment options for agoraphobia? Generally, a combination of psychotherapy and medication provides the best treatment outcome for people with agoraphobia. That said, the most effective treatment depends on the severity of the condition. Lifestyle changes can help reduce agoraphobic symptoms as well. 11 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Mental Health. Agoraphobia. Cleveland Clinic. Agoraphobia. 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Cognit Ther Res. 2012;36(5):427-440. doi:10.1007%2Fs10608-012-9476-1 Wechsler T, Kumpers F, Muhlberger A. Inferiority or even superiority of virtual reality exposure therapy in phobias? – A systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia. Front Psychol. 2019;10:1758. doi:10.3389/fpsyg.2019.01758 Batelaan N, Van Balkom A, Stein D. Evidence-based pharmacotherapy of panic disorder: An update. Int J Neuropsychopharmacol. 2012;15(3):403-15. doi:10.1017/S1461145711000800 University of Florida Health. Agoraphobia. Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013. By Katharina Star, PhD Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Panic Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.