What Is Agoraphobia?

Agoraphobia: What is agoraphobia? Definition, signs, symptoms of agoraphobia plus examples of agoraphobia.

Agoraphobia is the fear of going out into public places. Agoraphobia can occur with or without panic attacks. (more on panic disorder with agoraphobia)

Mary's problems started one day when she was pumping gas. Some rough young men came over and made rude remarks. She was frightened and began avoiding gas stations. The fear increased, and she became unable to do the grocery shopping without her husband. She spent much of her day worrying about anticipated trips out of the house. Within two years, she was housebound.

Her husband consulted a psychiatrist who gave him advice on how to persuade Mary to come in for a consultation. The psychiatrist saw them together, educated them about agoraphobia, and prescribed medication. At Mary's next session, she was calm enough to begin the therapeutic work of enlarging her "perimeter of safety." Her husband attended all of the sessions. Between sessions, he helped her with her homework. He would accompany her as she gradually went further from home. When she began to go places on her own, he was coach and cheerleader. She was eventually able to deal with her fears on her own. Mary elected to remain on her medications for a year after her symptoms had gone away. *

Criteria for Agoraphobia:

• Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. Note: Consider the diagnosis of Specific Phobia if the avoidance is limited to one or only a few specific situations, or social phobia if the avoidance is limited to social situations.
• The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.
• The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (e.g., avoidance limited to social situations because of fear of embarrassment), specific phobia (e.g., avoidance limited to a single situation like elevators), obsessive-compulsive disorder (e.g., avoidance of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), or separation anxiety disorder (e.g., avoidance of leaving home or relatives).

Treatment for Agoraphobia

In milder forms, agoraphobia may cause an individual to avoid certain situations and jobs. However, in some cases, the fear increases until the individual becomes depressed and housebound. Occasionally one may be too fearful to come in for treatment. This may be a reason for resurrecting the old concept of the physician's house call.

Individuals with severe agoraphobia should usually start both medication and therapy as soon as possible. Without the medication, such an individual might not be able to make full use of the therapeutic process. People with mild to moderate symptoms might choose a combination approach or therapy alone. Homework between situations and coaching from family members or therapists help one gradually face feared situations.

*vignettes are fictional examples

For information on agoraphobia and other anxiety disorders, visit comprehensive anxiety articles.

Source: American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association.