What Are the Symptoms of a Person with Agoraphobia?

The cause of agoraphobia is unknown, but it is thought to be due to a complex interaction of biological, psychological, and environmental factors.
Risk factors that can predispose a person to develop agoraphobia include: 

• Genetic
  • The disorder tends to runs in families
• Neurobiological
  • Certain brain changes may occur in people with agoraphobia 
• Personality
  • Extreme introversion 
  • Anxiety sensitivity (a belief that physical symptoms of anxiety are dangerous)
  • Avoidant, dependent, and related personality traits 
  • Other
    • Lack of perceived control 
    • Lack of assertiveness
    • Belief a person will be unable to cope in a feared situation
• Cognitive
  • Fear of having panic attacks or panic symptoms combined with expectations of the harm of a panic attack 
  • Other types of fear-related beliefs 
    • Fear of having an illness
    • Bodily preoccupation
    • Fear of being trapped or unable to cope due to a physical limitation 
• Social/environmental
  • Avoidance behaviors have been learned and reinforced because they reduce anxiety and stressful emotional states

Agoraphobia is diagnosed with a comprehensive psychiatric assessment.

The DSM-5 criteria for a diagnosis of agoraphobia include: 

• Marked fear or anxiety 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
  • Being outside the home alone
• Fear or avoidance of these situations because of thoughts that escape might be difficult or help might not be available if they develop panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly or fear of incontinence). 
• The situations almost always provoke fear or anxiety. 
• The situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. 
• The fear or anxiety is out of proportion to the actual danger posed by the situations and the sociocultural context. 
• The fear, anxiety, or avoidance is persistent, lasting six months or more. 
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
• If another medical condition (e.g., inflammatory bowel disease, Parkinson's disease) is present, the fear, anxiety, or avoidance is clearly excessive.
• The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder and are not related exclusively to:
  • A specific situation, as in specific phobia, situational type
  • Social situations, as in social anxiety disorder
  • Obsessions, as in obsessive-compulsive disorder (OCD)
  • Perceived defects or flaws in physical appearance, as in body dysmorphic disorder
  • Reminders of traumatic events, as in posttraumatic stress disorder (PTSD)
  • Fear of separation, as in separation anxiety disorder

Agoraphobia is a separate diagnosis from panic disorder. If a patient meets the criteria for panic disorder and agoraphobia, they would be diagnosed with both conditions.

Treatment for agoraphobia usually involves desensitization (also called exposure therapy). The patient is supervised by a therapist and is gradually exposed to feared situations to learn that the outcomes they fear do not happen. 

Techniques used to treat agoraphobia include: 

• Graded real-life exposure 
  • Involves exposure to real situations that progressing from less to more extreme aversion
  • The patient works with a therapist to develop coping strategies 
• Cognitive behavioral therapy (CBT) 
  • Helps patients change or eliminate negative thought patterns that influence their symptoms and help them change behavior
  • Takes at least 8 to 12 weeks, or more
  • Can also reduce anticipatory anxiety and avoidance of feared situations 
• Self-help or support groups 
• Stress management techniques 
• Relaxation
• Biofeedback
• Hypnosis
• Meditation
• Couples therapy 
• Aerobic exercise 
• Avoiding caffeine, certain over-the-counter cold medications, and some illegal drugs, that can aggravate symptoms of anxiety disorders

Patients who experience panic attacks along with their agoraphobia may be prescribed medication such as: 

• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors (SSRIs) antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa)
  • Often used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression
• High-potency benzodiazepines, such as alprazolam, clonazepam, and lorazepam
• Monoamine oxidase inhibitors (MAOIs)