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:
using public transportation;
being in open spaces;
being in enclosed places;
standing in line or being in a crowd; or
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
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
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 visible
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.
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.
Agoraphobia Management and Treatment | Cleveland Clinic. (2020). Retrieved December 1, 2020, from Cleveland Clinic website: https://my.clevelandclinic.org/health/diseases/15769-agoraphobia/management-and-treatment
Agoraphobia - Symptoms and causes. (2017). Retrieved December 1, 2020, from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987
Aslam, N. (2012). Management of Panic Anxiety with Agoraphobia by Using Cognitive Behavior Therapy. Indian Journal of Psychological Medicine, 34(1), 79–81. https://doi.org/10.4103/0253-7176.96166
Batinic, B., Opacic, G., Ignjatov, T., & S. Baldwin, D. (2017). COMORBIDITY AND SUICIDALITY IN PATIENTS DIAGNOSED WITH PANIC DISORDER/AGORAPHOBIA AND MAJOR DEPRESSION. Psychiatria Danubina, 29(2), 186–194. https://doi.org/10.24869/psyd.2017.186
Bekker, M. H. J. (1996). Agoraphobia and gender: A review. Clinical Psychology Review, 16(2), 129–146. https://doi.org/10.1016/0272-7358(96)00012-8
Causes - Agoraphobia. (2020.) NHS. Retrieved December 1, 2020, from https://www.nhs.uk/conditions/agoraphobia/causes/
Crowe RR. (2012). The genetics of panic disorder and agoraphobia. Psychiatric Developments, 3(2). Retrieved from https://pubmed.ncbi.nlm.nih.gov/2864687/
Emily Dickinson: Poet in the Kitchen | The History Kitchen (2012, October 4). PBS Food. Retrieved December 1, 2020, from PBS Food website: https://www.pbs.org/food/the-history-kitchen/emily-dickinson-poet-kitchen-cooking/
Grace, J. (2019, October 18). PTSD and Agoraphobia: When Your Fear Response Is Triggered, It Doesn’t Feel Safe to Leave Your House. Retrieved December 1, 2020, from Psych Central.com website: https://blogs.psychcentral.com/neurodivergent/2019/10/ptsd-and-agoraphobia-when-your-fear-response-is-triggered-it-doesnt-feel-safe-to-leave-your-house/
Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis. (2020). Retrieved December 1, 2020, from Cognitive Behaviour Therapy website: https://www.tandfonline.com/doi/full/10.1080/16506073.2019.1628808
Kivi, R. (2012, July 16). Agoraphobia. Retrieved December 1, 2020, from Healthline website: https://www.healthline.com/health/agoraphobia#diagnosis
McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006
Milrod, B., Chambless, D. L., Gallop, R., Busch, F. N., Schwalberg, M., McCarthy, K. S., … Barber, J. P. (2015). Psychotherapies for Panic Disorder. The Journal of Clinical Psychiatry, 77(07), 927–935. https://doi.org/10.4088/jcp.14m09507
NIMH » Agoraphobia. (2017, November). Retrieved December 1, 2020, from Nih.gov website: https://www.nimh.nih.gov/health/statistics/agoraphobia.shtml
NIMH » Panic Disorder: When Fear Overwhelms. (2020, December). Retrieved December 1, 2020, from Nih.gov website: https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml#
Phobias. (2020). Retrieved December 1, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias
Phobias | MentalHealth.gov. (2017). Retrieved December 1, 2020, from Mentalhealth.gov website: https://www.mentalhealth.gov/what-to-look-for/anxiety-disorders/phobias
Substance Abuse and Mental Health Services Administration. (2016, June). Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/
Top 10 Most Reclusive Celebrities - TIME. (2009, June 3). Retrieved December 1, 2020, from TIME.com website: http://content.time.com/time/specials/packages/article/0,28804,1902376_1902378_1902446,00.html
Table 2. 12-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort 1 (n=9282). (n.d.). Retrieved from https://www.hcp.med.harvard.edu/ncs/ftpdir/table_ncsr_12monthprevgenderxage.pdf
Telman, L. G. E., van Steensel, F. J. A., Maric, M., & Bögels, S. M. (2017). What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers, fathers, and siblings of children with anxiety disorders. European Child & Adolescent Psychiatry, 27(5), 615–624. https://doi.org/10.1007/s00787-017-1076-x
Mcleod, S. (2020). Systematic Desensitization - A Treatment for Phobias | Simply Psychology. Retrieved December 1, 2020, from Simplypsychology.org website: https://www.simplypsychology.org/Systematic-Desensitisation.html#:~:text=Systematic%20desensitization%20is%20a%20type,stimulus%20gradually%20using%20counter%20conditioning.