Is an intense fear about being in places from which escape might be difficult?

Definition

Agoraphobia is an intense fear and anxiety of being in places where it is hard to escape, or where help might not be available. Agoraphobia usually involves fear of crowds, bridges, or of being outside alone.

Alternative Names

Anxiety disorder - agoraphobia

Causes

Agoraphobia is a type of anxiety disorder. The exact cause of agoraphobia is unknown. Agoraphobia sometimes occurs when a person has had a panic attack and begins to fear situations that might lead to another panic attack.

Symptoms

With agoraphobia, you avoid places or situations because you do not feel safe in public places. The fear is worse when the place is crowded.

Symptoms of agoraphobia include:

• Being afraid of spending time alone
• Being afraid of places where escape might be hard
• Being afraid of losing control in a public place
• Depending on others
• Feeling detached or separated from others
• Feeling helpless
• Feeling that the body is not real
• Feeling that the environment is not real
• Having an unusual temper or agitation
• Staying in the house for long periods

Physical symptoms can include:

• Chest pain or discomfort
• Choking
• Dizziness or fainting
• Nausea or other stomach distress
• Racing heart
• Short of breath
• Sweating
• Trembling

Exams and Tests

The health care provider will look at your history of agoraphobia and will get a description of the behavior from you, your family, or friends.

Treatment

The goal of treatment is to help you feel and function better. The success of treatment usually depends in part on how severe the agoraphobia is. Treatment most often combines talk therapy with a medicine. Certain medicines usually used to treat depression may be helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. DO NOT stop taking them or change the dosage without talking with your provider.

• Selective serotonin reuptake inhibitors (SSRIs) are most often the first choice of antidepressant.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice.

Other medicines used to treat depression or medicines used to treat seizures may also be tried.

Medicines called sedatives or hypnotics may also be prescribed.

• These medicines should only be taken under a doctor's direction.
• Your doctor will prescribe a limited amount of these drugs. They should not to be used every day.
• They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.

Cognitive-behavioral therapy (CBT) is a type of talk therapy. It involves 10 to 20 visits with a mental health professional over several weeks. CBT helps you change the thoughts that cause your condition. It may involve:

• Understanding and controlling distorted feelings or views of stressful events or situations
• Learning stress management and relaxation techniques
• Relaxing, then imagining the things that cause the anxiety, working from the least fearful to the most fearful (called systematic desensitization and exposure therapy)

You may also be slowly exposed to the real-life situation that causes the fear to help you overcome it.

A healthy lifestyle that includes exercise, getting enough rest, and good nutrition can also be helpful.

Support Groups

You can ease the stress of having agoraphobia by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.

See below for more information and support for people with agoraphobia:

Anxiety and Depression Association of America -- adaa.org/supportgroups

Outlook (Prognosis)

Most people can get better with medicines and CBT. Without early and effective help, the disorder may become harder to treat.

Possible Complications

Some people with agoraphobia may:

• Use alcohol or other drugs while trying to self-medicate.
• Be unable to function at work or in social situations.
• Feel isolated, lonely, depressed, or suicidal.

When to Contact a Medical Professional

Call for an appointment with your provider if you have symptoms of agoraphobia.

Prevention

Early treatment of panic disorder can often prevent agoraphobia.

Images

References

American Psychiatric Association. Anxiety disorders. In: American Psychiatric Association, ed. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:189-234.

Calkins AW, Bui E, Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 32.

Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 369.

National Institute of Mental Health website. Anxiety disorders. www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Updated July 2018. Accessed June 17, 2020.

Reviewed By: 

Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What is intense fear called?

Is an intense fear of being in a situation from which escape is difficult or impossible?

What is it called when you are scared of tight places?

What causes intense fear?