Overview

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.

Symptoms

Typical agoraphobia symptoms include fear of:

Leaving home alone

Crowds or waiting in line

Enclosed spaces, such as movie theaters, elevators or small stores

Open spaces, such as parking lots, bridges or malls

Using public transportation, such as a bus, plane or train

These situations cause anxiety because you fear you won't be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

In addition:

Fear or anxiety almost always results from exposure to the situation

Your fear or anxiety is out of proportion to the actual danger of the situation

You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed

You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance

Your phobia and avoidance usually lasts six months or longer

Panic disorder and agoraphobia

Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you're totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Signs and symptoms of a panic attack can 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

Fear of dying

When to see a doctor

Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.

Don't let agoraphobia make your world smaller. Call your doctor if you have signs or symptoms listed above.

Causes

Biology — including health conditions and genetics — temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.

Risk factors

Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors for agoraphobia include:

Having panic disorder or other phobias

Responding to panic attacks with excessive fear and avoidance

Experiencing stressful life events, such as abuse, the death of a parent or being attacked

Having an anxious or nervous temperament

Having a blood relative with agoraphobia

Complications

Agoraphobia can greatly limit your life's activities. If your agoraphobia is severe, you may not even be able to leave your home. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, run errands, or take part in other normal daily activities. You may become dependent on others for help.

Agoraphobia can also lead to or be associated with:

Depression

Alcohol or drug abuse

Other mental health disorders, including other anxiety disorders or personality disorders

Prevention

There's no sure way to prevent agoraphobia. However, anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places over and over again before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.