Am I just a homebody? Or is this agoraphobia?

From Emily Dickinson to J.D. Salinger and through today, agoraphobia has been an enduring affliction. This panic disorder is more common than you might think.

Sep 24, 2021 UPDATED
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Colloquially known as the “fear of leaving the house,” agoraphobia is an anxiety disorder in which sufferers are paralyzed with fear in some unfamiliar situations. 

A diagnosis requires being fearful and anxious about two or more of the follow­ing situations:

  1. using public transportation; 

  2. being in open spaces; 

  3. being in enclosed places; 

  4. standing in line or being in a crowd; or 

  5. being outside of the home alone in other situations. 

It’s among the more disruptive anxiety disorders (on the other end of the spectrum from general anxiety disorder) as agoraphobic people avoid triggering situations and environments so staunchly, they may be unable to function outside the familiar safety of their homes. 

Is agoraphobia a mental illness?

Yes. According to the handbook physicians and psychologists rely on to diagnose mental illnesses, known as the DSM-5, phobia-related anxiety disorders are mental illnesses. An element of this classification is that people with agoraphobia often understand that the fear they feel isn’t rational.

Agoraphobia can be a disabling condition, but it doesn’t necessarily define those who have it.

When in a triggering setting or situation (such as a crowd, on public transportation, etc.), agoraphobic people experience panic attacks, distinct episodes of intense fear. 

Symptoms of panic attacks include:

  • Rapid heart rate

  • Trouble breathing or a feeling of choking

  • Chest pain or pressure

  • Lightheadedness or dizziness

  • Feeling shaky, numb or tingling

  • Excessive sweating

  • Sudden flushing or chills

  • Upset stomach or diarrhea

  • Feeling a loss of control

The dread of having a panic attack causes agoraphobic people to be paralyzed by triggering situations—even if the situation is a necessary one, like a trip to the grocery store.

That said, the fact that agoraphobia is classified as a mental illness does not mean agoraphobics are “crazy.” 

Historically, these folks have been labeled “hermits,” “recluses,” or even “shut-ins.” But we know that, far from being “weak” or “crazy,” agoraphobics have made huge contributions to the society that causes them so much dread. 

Emily Dickinson didn’t leave her house for over twenty years, interacting with those outside her household only via baked goods she let down from her window in a basket

Some say Marcel Proust became agoraphobic after the deaths of his parents. Howard Hughes famously became extremely agoraphobic after a near-fatal plane crash. 

Agoraphobia can be a disabling condition, but it doesn’t necessarily define those who have it.

What triggers agoraphobia?

While many people who experience panic attacks are struck by them seemingly out of nowhere, people with phobia-related disorders have their fear triggered in particular circumstances or by specific things. 

For instance, someone with acrophobia (extreme fear of heights) is likely to have a panic attack looking out the window of a penthouse apartment. 

Not only is depression common among those with agoraphobia, but the longer the agoraphobia is left untreated, the more likely the development of depression is.

Similarly, a person with agoraphobia can have a panic attack in situations that make them feel 

  • Exposed/vulnerable

  • Helpless

  • Trapped

  • Susceptible to bacteria or “pathogens”

According to the Mayo Clinic, common triggers of agoraphobia include:

  • Open spaces like parking lots

  • “Closed-in” spaces like elevators

  • Standing in line

  • Being somewhere where the exit isn’t visibleq2aaw

A Monarch by SimplePractice illustration of six different people walking in all different directions.

How does agoraphobia affect a person’s life?

At its most extreme, agoraphobia can affect a person’s life by essentially preventing them from living it. If left untreated, the fear of the world outside of one’s home can cause a complete withdrawal from society. As with many panic disorders, when agoraphobia goes unaddressed, it can feed itself, intensifying the existing fear of the outside world, and even causing new phobias.

What’s more, the rate of comorbidity between agoraphobia and depression is quite high. Not only is depression common among those with agoraphobia, but the longer the agoraphobia is left untreated, the more likely the development of depression is. Indeed, those with agoraphobia have an increased risk of suicide.

Who has agoraphobia?

People of all races and backgrounds can experience agoraphobia—though it is about four times more likely to be diagnosed in women than in men. According to the Mayo Clinic, it is also more likely to develop in adults younger than 35, though it can be diagnosed later in life. 

The National Institute of Mental Health (NIMH) estimates about 0.9% of U.S. adults had agoraphobia in 2016, and that 1.3% will experience an episode of agoraphobia at some point.

There is some research that suggests agoraphobia may run in families, either genetically or via learned behaviors and attitudes. There are also other risk factors, including the experience of psychological stress—agoraphobia has been linked to PTSD, for instance.

Does agoraphobia go away? Can it be treated?

Yes. Some people experience agoraphobia temporarily; it may be that a particularly stressful period may spark a bout of agoraphobia. For these people, the panic symptoms of agoraphobia may dissipate as the conditions that aroused it abate. 

But for everyone living with agoraphobia, be it acute or chronic, help is available. Panic disorders including agoraphobia are highly treatable, by talk therapy, medication, or a combination of the two. 

Cognitive-behavioral therapy (CBT) is a common treatment for agoraphobia, as it can help patients cope with fear they know to be irrational through mindfulness and desensitization exercises. 

Research suggests CBT is more effective in treating panic disorders than some other talk therapies. This may be in part due to the fact that people can receive CBT treatment and practice CBT exercises without having to leave the house, at least initially. In fact, some studies find that CBT delivered over the internet (or iCBT) is as effective for agoraphobia as more traditional in-person methods.

Some agoraphobes also benefit from medications like antidepressants and anti-anxiety medications, specifically serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), according to the Cleveland Institute

A Monarch by SimplePractice illustration of an iPad with the screen showing a virtual therapy session featuring a male therapist in an orange shirt talking to a male client in a gray shirt.

Article originally published May 18, 2021. Updated Sep 24, 2021.

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