Agoraphobia is fear of and anxiety about being in situations or places without a way to escape easily or in which help might not be available if intense anxiety develops.
(See also Overview of Anxiety Disorders.)
The situations are avoided, or they may be endured but with substantial anxiety. About 30 to 50% of people with agoraphobia also have panic disorder.
Agoraphobia without panic disorder affects about 2% of women and 1% of men during any 12-month period. Peak age at onset is the early 20s; first appearance after age 40 is unusual.
Symptoms and Signs of Agoraphobia
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 a panic attack in a typical agoraphobic situation. Others simply feel uncomfortable in such a situation and may never or only later have panic attacks there. Agoraphobia often interferes with function and, if severe enough, can cause people to become housebound.
Diagnosis of Agoraphobia
- Clinical criteria
Diagnosis is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
To meet the DSM-5 criteria for diagnosis, patients must have marked, persistent (≥ 6 months) fear of or anxiety about ≥ 2 of the following situations:
- Using public transportation
- Being in open spaces (eg, parking lot, marketplace)
- Being in an enclosed place (eg, shop, theater)
- Standing in line or being in a crowd
- Being alone outside the home
Fear must involve thoughts that escape from the situation might be difficult or that patients would receive no help if they became incapacitated by fear or a panic attack. In addition, all of the following should be present:
- The same situations nearly always trigger fear or anxiety.
- Patients actively avoid the situation and/or require the presence of a companion.
- The fear or anxiety is out of proportion to the actual threat (taking into account sociocultural norms).
- The fear, anxiety, and/or avoidance cause significant distress or significantly impair social or occupational functioning.
Treatment of Agoraphobia
- Cognitive-behavioral therapy
- Sometimes a selective serotonin reuptake inhibitor (SSRI)
If untreated, agoraphobia usually waxes and wanes in severity. Agoraphobia may disappear without formal treatment, possibly because some affected people conduct their own form of exposure therapy. But if agoraphobia interferes with functioning, treatment is needed.
Cognitive-behavioral therapy is effective for agoraphobia. Cognitive-behavioral therapy involves teaching patients to recognize and control their distorted thinking and false beliefs as well as instructing them on exposure therapy.
Many patients with agoraphobia benefit from drug therapy with an SSRI.