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Agoraphobia

By

John W. Barnhill

, MD, Weill Cornell Medical College and New York Presbyterian Hospital

Last full review/revision October 2018 by John W. Barnhill, MD

Agoraphobia is fear or anxiety about being in situations or places with no way to escape easily or in which help might not be available if intense anxiety develops. These situations or places are often avoided or endured with much distress.

Agoraphobia is a type of anxiety disorder. About 30 to 50% of people with agoraphobia also have panic disorder. About 2% of women and 1% of men have agoraphobia during any 12-month period. Most people with agoraphobia develop it by the age of 35.

Common examples of situations or places that create fear and anxiety include standing in line at a bank or at a supermarket checkout, sitting in the middle of a long row in a theater or classroom, and using public transportation, such as a bus or an airplane. Some people develop agoraphobia after experiencing a panic attack in one of these situations. Other people simply feel uncomfortable in these settings and may never, or only later, have panic attacks there. Agoraphobia often interferes with daily living, sometimes so drastically that it makes people housebound.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors diagnose agoraphobia when the fear, anxiety, or avoidance lasts 6 months or more and involves at least two of the following situations:

  • Using public transportation
  • Being in a open space, such as a parking lot or marketplace
  • Being in an enclosed space, such as a shop or theater
  • Standing in line or being in a crowd
  • Being alone outside the home

The fears must involve concerns that escape might be difficult or that help will be unavailable if people panic or become incapacitated.

In addition, all of the following must be present:

  • Symptoms are almost always triggered by the same situations
  • People change their behavior to avoid the situation or need a companion to help them tolerate it
  • Symptoms are out of proportion to the actual danger
  • Symptoms cause significant distress or significantly impair functioning
  • Symptoms are not caused by another mental disorder such as social phobia, or a general medical condition such as inflammatory bowel disease

Treatment

  • Exposure therapy
  • Cognitive-behavioral therapy
  • Sometimes antidepressants called selective serotonin reuptake inhibitors

If agoraphobia is not treated, it usually waxes and wanes in severity and may even disappear without formal treatment, possibly because people have used their own form of exposure therapy, exposing themselves repeatedly to the situation that triggers their fears until the fears subside. Others no longer complain about agoraphobia symptoms because they have learned to avoid situations (such as airplanes or crowds) that trigger their anxiety. However, simply avoiding situations may significantly restrict people's life. Because treatments often increase anxiety at first, treatment of agoraphobia (and other anxiety disorders) often involves learning relaxation strategies.

Exposure therapy helps more than 90% of people who practice it faithfully.

Cognitive-behavioral therapy may also help. With this therapy, people learn to do the following:

  • Recognize when their thinking is distorted
  • Control the distorted thinking
  • Modify their behavior accordingly

People with agoraphobia may benefit from taking a selective serotonin reuptake inhibitor (SSRI). Although SSRIs are considered to be antidepressants, they may also work well for anxiety disorders.

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