Agoraphobia: Symptoms, causes, diagnosis, and outlook

Agoraphobia is an anxiety disorder that manifests as a fear of situations where escape could be difficult, or in which help would not be available if something bad were to happen.

The word comes from the ancient Greek word “agora,” referring to a place of assembly or market place.

The condition is often misunderstood as a fear of open spaces but is, in reality, more complex.

Agoraphobia may involve a fear of crowds, bridges or of being outside alone

About 1.8 million Americans aged over 18 years, or about 0.8 percent of adults, have agoraphobia without a history of panic disorder.

The median onset age is 20 years.

Fast facts on agoraphobia

Here are some key points about agoraphobia. More detail is in the main article.

Agoraphobia often develops after having one or more panic attacks.

It can lead to various fears, such as the fear of open spaces and the fear of places where escape is difficult, such as elevators.

Agoraphobia can make it difficult for a person to leave their house.

Physical symptoms include chest pains, dizziness, and shortness of breath.

Agoraphobia is often treated medically with antidepressants or anxiety-reducing medicine.

Most people with agoraphobia can get better through treatment.

What is agoraphobia?

Agoraphobia is an extreme avoidance of situations that could cause panic.

Agoraphobia is listed in the Diagnostic and Statistical Manual of Mental Disorder 5 (DSM-5) as an anxiety disorder.

An anxiety disorder is when a feeling of anxiety does not go away and tends to grow worse over time.

One type of anxiety disorder is a panic disorder, where panic attacks and sudden feelings of terror can occur without warning.

Agoraphobia is one such panic disorder. Agoraphobic panic attacks are linked to a fear of places where it is hard to escape or where help may not be available.

Places that can induce agoraphobia include those that can make a person feel embarrassed, helpless, or trapped, such as crowded areas, bridges, public transport and remote areas.

Most people develop agoraphobia after having had one or more panic attacks. These attacks cause them to fear further attacks, so they try to avoid the situation in which the attack occurred.

People with agoraphobia may need help from a companion to go to public places, and may at times feel unable to leave home.

Recent changes in diagnostic criteria

The terms of diagnosis have recently changed. Since 2013, DSM-5 states that people with agoraphobia no longer need to acknowledge the excessiveness of their anxiety in relation to the cause of the phobia.

In DSM-4, a person aged under 18 years had to have the condition for at least 6 months to receive a diagnosis.

In DSM-5, the 6-months duration has been extended to all patients. This is to avoid the overdiagnosis of transient, or fleeting, unrelated fears.

DSM-4 also linked the diagnoses for panic disorder and agoraphobia, but this changed in DSM-5 because a considerable number of patients with agoraphobia do not experience panic symptoms.

Panic disorder and agoraphobia are now two separate diagnoses, and the labeling of “agoraphobia with or without panic disorder” no longer applies.

Agoraphobia psychotherapy
Agoraphobia will be often be treated with psychotherapy

Psychotherapy involves working with a therapist to reduce symptoms of anxiety so that the person will feel safer and able to function better.

Cognitive-behavioral therapy (CBT) focuses on changing the thoughts that cause the condition.

The person may learn:

that it is unlikely that fears will come true

that anxiety decreases over time, and that symptoms can be managed until it does

how to cope with the symptoms

how to understand and control a distorted view of stress-inducing situations

how to recognize and replace thoughts that cause panic

how to manage stress

One task might be to imagine the situations that cause anxiety, working from the least to the most fearful.

Therapists who treat agoraphobia may offer initial treatment without the patient needing to visit the therapist’s office.

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