Agoraphobia

Overview
Clinicians
Clinicians

Agoraphobia is a type of anxiety disorder in which you feel extremely scared of situations or places that would be difficult to get away from or get help in.

On this page, you can find the following information:

Who develops agoraphobia?
What causes agoraphobia?
What are the symptoms of agoraphobia?
How is agoraphobia diagnosed?
What is the treatment for agoraphobia?
What support is available for agoraphobia?

Although agoraphobia is often thought of as a fear of open spaces, it’s about:

a fear of feeling panic when you think about being in a situation that would be hard or embarrassing to leave or to get help in, and
the panic you feel when you are in that situation.

These fears can make you scared about leaving your home, using public transport or being in a public place. Those who suffer the most change their behaviour so much that they can’t leave the house.

Key points

Agoraphobia varies from day to day. You don’t panic every time you go to the supermarket or into a situation you have felt scared about before. But sometimes you do.
As agoraphobia is a severe type of anxiety, many people with agoraphobia have panic attacks.
Agoraphobia is considered the most severe of the phobias.This means agoraphobia is a serious mental illness that can affect your life a lot, so it’s important that you get help.
Although agoraphobia won’t get better on its own, there are treatments that can make a difference.

Who develops agoraphobia?

Agoraphobia affects between 1.5 per cent and 3.5 per cent of the population in its fully developed form; in a less severe form, up to 1 in 8 people experience it.Agoraphobia usually develops between the ages of 25 and 35, and is usually a lifelong condition unless treated.Like all phobias, it is more common in women.

What causes agoraphobia?

While the cause can be hard to pin down, agoraphobia is more common in people who tend to be anxious or nervous. About two-thirds of people with panic disorder develop agoraphobia.Other factors that make it more likely you will develop agoraphobia include:

trauma
severe stress
other mental illness, such as depression or eating disorders
drug or alcohol misuse
a family history of anxiety or depression.

What are the symptoms of agoraphobia?

Your symptoms may be mild or severe. They can affect your body (physical), your mind (cognitive) and your behaviour.

Physical symptoms are like those of a panic attack, such as:

breathing quickly and shallowly
your heart beating quickly
feeling sick in your stomach
breaking out in a sweat
pain in your chest.

Cognitive symptoms include the fear that if you had a panic attack, it would:

make you look stupid
make you feel embarrassed
threaten your life by your heart stopping or you not being able to breathe
you wouldn’t be able to escape.

You may also have other fears, such as:

not being able to cope without help
being left alone at home
a general feeling of anxiety or dread.

These symptoms can affect your behaviour, so that you, for example,

avoid situations that could lead to panic attacks, such as crowded places, public transport and queues
become unable to leave the house for long periods of time
need to be with someone you trust when you go out
avoid being far away from home.

How is agoraphobia diagnosed?

It’s important to contact your doctor if you think you have the symptoms of agoraphobia. If you can’t manage to get to your doctor, arrange to have a phone consultation. Your doctor will ask you to describe your symptoms, how often they occur and in what situations. Tell them as much as possible about what you are feeling and thinking and how that limits what you do. Your doctor may do a physical check up to make sure your symptoms do not have a physical cause.

What is the treatment for agoraphobia?

Things that can make a difference include:

learning about agoraphobia and the self-care techniques you can use to manage it
psychological therapy
medication.

For most people, a combination of these will work best.

What self-care is there for agoraphobia?

There is a lot that you can do to care for yourself and reduce your symptoms.

Tell the people you trust about your agoraphobia and stay in touch with them.
If your agoraphobia is mild, it’s important that you face your fear by going out often, so that the fear doesn’t grow. The more often we let a fear stop us from doing something, the harder it is to do it the next time. The key is to feel the fear and do it anyway.
If your agoraphobia is stronger, you can ask family/whānau and friends to come with you when you go out. Let them know in advance that you might have to wait for a panic attack to pass, or even go home so that you feel less pressured or embarrassed if that happens.
Learn how to reduce panic and anxiety through relaxation techniques and mindfulness.
Learn more about managing and improving your condition with the self-help books and online tools listed below.
Exercise can help. If you can go outside, walk each day, especially in a natural environment. If you are housebound, it’s still important to move as much as possible.
A healthy diet supports you to manage your stress well.

Psychological therapy

There are trained professionals who know about agoraphobia and how to help someone who is affected by it. They can provide you with support and help for working through any distressing thoughts and feelings you have and support you to make positive changes in your life. For some people, it might be helpful to understand why your agoraphobia developed, and this may involve processing earlier trauma. For others, this is not important or useful, and instead, the key is to focus on changing your thinking and behaviour.

Cognitive-behavioural therapy (CBT), a psychological therapy that largely focuses on overcoming unhelpful beliefs, has been shown to work well with agoraphobia. Sometimes, therapy will also involve desensitisation which is a gradual exposure to your fear of situations or places that would be difficult to get away from or get help in. This can be a very effective step in getting over your phobia. Don’t worry though – this only happens when you are ready and at a pace that is right for you.

Ask your doctor for a referral or find a counsellor or therapist or find a psychologist yourself. If you can’t get out to see a counsellor or therapist, some people offer phone counselling. Phone Anxiety NZ 0800 ANXIETY (0800 269 4389) for a recommendation.

Medication

Medications such as selective serotonin reuptake inhibitors (SSRIs), or benzodiazepines may be used together with relaxation techniques and psychological therapy. The choice of medication will depend on your preference, response to previous medication and consideration of possible side effects.

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that has been found to be effective in treating mood disorders such as anxiety, panic attacks and obsessional thoughts. An SSRI called sertraline is usually recommended for people with agoraphobia. Side effects associated with sertraline include feeling sick, problems with eyesight and vision, diarrhoea or constipation, feeling agitated or shaky and excessive sweating. These side effects usually go away with time. Read more about sertraline.

Benzodiazepines have a calming, relaxing effect and a short course may be prescribed for severe flare-ups of panic-related symptoms. Benzodiazepines must be used for a short time only. Ongoing use for longer than two to four weeks is not recommended. Read more about benzodiazepines.

What support is available for agoraphobia?

24/7 phone helpline 0800 ANXIETY (0800 269 4389).

If you can manage it, join a support group in your area. Ask your doctor, phone Healthline 0800 611 116 or Anxiety NZ 0800 ANXIETY (0800 269 4389) to see if there is one in your area. If you can’t go out to a group, check out the online forums and find one that works for you.

Learn more

Phobias Mental Health Foundation, NZ
Find out how to tell if someone is struggling with their mental health BBC, UK, 2021
Panic disorder and agoraphobia RANZCP
Agoraphobia NHS Choices
Agoraphobia Patient Info, UK
Agoraphobia, the disease of the digital age NZ Herald
Panic course (online course), This Way Up, Australia
Overcoming panic and agoraphobia Online course, UK
Togetherall UK

References

Living with anxiety – understanding the role and impact of anxiety in our lives Mental Health Foundation, UK, 2014
Phobias Mental Health Foundation, New Zealand, 2014
Agoraphobia Patient Info, UK, 2016
Generalised anxiety disorder in adults Best Practice Journal, 2009 Dec; 25.
Agoraphobia NHS Choices, UK, 2016
Panic disorder and agoraphobia RANZCP, March 2005

Credits: Health Navigator Editorial Team. Reviewed By: Dr Bev Haarhoff Last reviewed: 28 Sep 2017 Page last updated: 20 Aug 2022

Information for healthcare providers on agoraphobia

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Diagnosing agoraphobia

In an updated diagnosis, DSM-V separates agoraphobia from panic disorder, and characterises agoraphobia as having:

a marked fear or anxiety about actual or anticipated exposure of public spaces, with the symptoms of fear or anxiety occurring most of the time in at least two of five different situations (i.e., using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside of the home alone);
these situations are feared and avoided because the person believes that escape might be difficult or help might not be available if the person develops panic-like symptoms or other distressing signs or symptoms (e.g., incontinence);
the individual must actively make attempts to avoid the situation; avoidance can be behavioural (e.g., finding employment that no longer requires using public transportation) or cognitive (e.g., using distraction when in a feared situation);
the feared situations should not be realistically threatening (e.g., walking alone at night in a high-crime area) or due to sociocultural context (e.g., not leaving home if an orthodox Muslim woman living in Syria);
consistent with other phobias, DSM-V suggests that symptoms must last for at least six months; however, it is noted that this criterion is flexible and meant to guide clinical judgment in ruling out transient fears.¹

Conditions that cause similar symptoms to anxiety should be considered. This includes hyper- and hypothyroidism, angina, asthma, depression and substance misuse e.g. caffeine, amphetamines, cannabis, cocaine. Some medications also cause symptoms of anxiety e.g. anticholinergics and toxicity from digoxin.²

Treating agoraphobia

Most patients show a positive response to either drugs or CBT.³

Clinical pathways

Clinical practice guidelines for the treatment of panic disorder and agoraphobia. Royal Australian and New Zealand College of Psychiatrists Australian and New Zealand, 2003
Agoraphobia Patient Info Professional References, UK, 2016

References

Asmundson GJG, Taylor S, Smits JA. Panic disorder and agoraphobia – an overview and commentary on DSM-5 changes. Depression & Anxiety. 2014 June; 31 (6): doi: 10.1002/da.22277.
Generalised anxiety disorder in adults. Best Practice Journal, 2009 Dec; 25.
Clinical practice guidelines for the treatment of panic disorder and agoraphobia. Royal Australian and New Zealand College of Psychiatrists Australian and New Zealand, 2003

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: