Psychiatrists and psychologists would be likely to identify agoraphobia

Diagnosis

Agoraphobia is diagnosed based on:

Signs and symptoms
In-depth interview with your doctor or a mental health professional
Physical exam to rule out other conditions that could be causing your symptoms
Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Psychotherapy

Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

You can learn:

What factors may trigger a panic attack or panic-like symptoms and what makes them worse
How to cope with and tolerate symptoms of anxiety
Ways to directly challenge your worries, such as the likelihood of bad things happening in social situations
That your anxiety gradually decreases if you remain in situations and that you can manage these symptoms until they do
How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist’s office. Therapists who treat agoraphobia are well aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. He or she may offer to see you first in your home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

Medications

Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications in the treatment of agoraphobia.

Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants may also effectively treat agoraphobia.
Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, your doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren’t a good choice if you’ve had long-term problems with anxiety or problems with alcohol or drug abuse.

It may take weeks for medication to relieve symptoms. And you may have to try several different medications before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your doctor likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you’re ready to stop taking medication.

Alternative medicine

Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your doctor. Although these supplements are available without a prescription, they still pose possible health risks.

For example, the herbal supplement kava, also called kava kava, appeared to be a promising treatment for anxiety, but there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using any product that contains kava until more-rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.

Coping and support

Living with agoraphobia can make life difficult. Professional treatment can help you overcome this disorder or manage it effectively so that you don’t become a prisoner to your fears.

You can also take these steps to cope and care for yourself when you have agoraphobia:

Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Communicate regularly with your therapist. Consistency can make a big difference, especially when it comes to practicing skills and taking your medication.
Try not to avoid feared situations. It’s hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places can make them less frightening and anxiety provoking. Family, friends and your therapist can help you work on this.
Learn calming skills. Working with your therapist, you can learn how to calm and soothe yourself. Meditation, yoga, massage and visualization are simple relaxation techniques that also may help. Practice these techniques when you aren’t anxious or worried, and then put them into action during stressful situations.
Avoid alcohol and recreational drugs. Also limit or avoid caffeine. These substances can worsen your panic or anxiety symptoms.
Take care of yourself. Get enough sleep, be physically active every day, and eat a healthy diet, including lots of vegetables and fruits.
Join a support group. Support groups for people with anxiety disorders can help you connect to others facing similar challenges and share experiences.

Preparing for your appointment

If you have agoraphobia, you may be too afraid or embarrassed to go to your doctor’s office. Consider starting with a phone call to your doctor or a mental health professional, or ask a trusted family member or friend to go with you to your appointment.

What you can do

To prepare for your appointment, make a list of:

Any symptoms you’ve been experiencing, and for how long
Things you have stopped doing or are avoiding because of your stress
Key personal information, especially any significant stress or life changes that you experienced around the time your symptoms first developed
Medical information, including other physical or mental health conditions that you have
All medications, vitamins, herbs or other supplements you’re taking, and the dosages
Questions to ask your doctor so that you can make the most of your appointment

Some basic questions to ask your doctor may include:

What do you believe is causing my symptoms?
Are there any other possible causes?
How will you determine my diagnosis?
Is my condition likely temporary or long term (chronic)?
What type of treatment do you recommend?
I have other health problems. How best can I manage these together?
What is the risk of side effects from the medication you’re recommending?
Are there options other than taking medications?
How soon do you expect my symptoms to improve?
Should I see a mental health professional?
Are there any printed materials that I can have? What websites do you recommend?

Don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

What symptoms do you have that concern you?
When did you first notice these symptoms?
When are your symptoms most likely to occur?
Does anything seem to make your symptoms better or worse?
Do you avoid any situations or places because you fear they’ll trigger your symptoms?
How are your symptoms affecting your life and the people closest to you?
Have you been diagnosed with any medical conditions?
Have you been treated for other mental health disorders in the past? If yes, what treatment was most helpful?
Have you ever thought about harming yourself?
Do you drink alcohol or use recreational drugs? How often?

Overview

What is agoraphobia?

Agoraphobia is an anxiety disorder that causes intense fear of becoming overwhelmed or unable to escape or get help. Because of fear and anxiety, people with agoraphobia often avoid new places and unfamiliar situations, such as:

Open or enclosed spaces.
Crowds.
Places outside your home.
Public transportation.

How many people have agoraphobia?

About 1% to 2% of adults in the United States have been diagnosed with agoraphobia. Roughly 2% of adolescents experience it. Agoraphobia is more common among women. It usually starts before age 35.

What are the risk factors for agoraphobia?

Risk factors for developing agoraphobia include:

Having panic attacks or other phobias.
Experiencing stressful life events, such as the death of a loved one, being attacked, or being abused.
Having a nervous or anxious nature.
Responding to panic attacks with excess fear and apprehension.
Having a relative with agoraphobia.

Symptoms and Causes

What causes agoraphobia?

It is not clear what causes agoraphobia. However, it is often associated with an existing panic disorder. Panic disorder causes short, intense attacks of fear for no particular reason. About a third of people who have panic disorder develop agoraphobia. But agoraphobia also can occur alone.

What does agoraphobia feel like?

Everyone experiences anxiety sometimes. But an anxiety disorder causes excessive worry that affects daily activities. Agoraphobia can make you feel extreme fear and stress, which may cause you to avoid situations.

The signs of agoraphobia are similar to a panic attack. You may experience:

Chest pain or rapid heart rate.
Fear or a shaky feeling.
Hyperventilation or trouble breathing.
Lightheadedness or dizziness.
Sudden chills or flushing (red, hot face).
Excessive sweating (hyperhidrosis).
Upset stomach.

Diagnosis and Tests

How is agoraphobia diagnosed?

If you think you have agoraphobia, and the anxiety is interfering with your daily life, you should talk to a primary care provider or psychiatrist. If you are afraid to visit a medical office in person, you may be able to schedule a telephone or video appointment.

The healthcare provider may ask you:

Do you get stressed about leaving your house?
Are there any places or situations you avoid because you’re afraid? Why are you afraid?
Do you rely on others to do your shopping and errands?

A healthcare provider can diagnose agoraphobia based on your symptoms, how often they happen and how severe they are. It is important to be open and honest with your healthcare providers. Your provider may diagnose agoraphobia if you meet specific standards developed by the American Psychiatric Association. To have a diagnosis of agoraphobia, a person must feel extreme fear or panic in at least two of the following situations:

Using public transportation.
Being in an open space.
Being in an enclosed space, such as a movie theater, meeting room or small store.
Standing in a line or being in a crowd.
Being out of your home alone.

Management and Treatment

How is agoraphobia treated?

Agoraphobia treatment usually involves a combination of treatment methods: therapy, medication and lifestyle changes.

A therapist can help you work through your fears. Using cognitive behavioral therapy (CBT), a mental healthcare provider can help you recognize thoughts that cause you anxiety. Then you’ll learn ways to react more productively.

Using relaxation and desensitization techniques, your provider may have you imagine a scary situation and manage the feelings. Eventually, you will be able to take part in activities that produce anxiety, and you will know how to manage your emotions. Over time, therapy can train the brain to think differently.

Your healthcare provider also may suggest medications called selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Those medications can treat depression and anxiety disorders.

You can manage agoraphobia with lifestyle changes:

Avoid alcohol, drugs and caffeine (coffee, tea and soda, for example).
Eat a healthy, well-balanced diet.
Exercise regularly.
Practice breathing exercises.

Prevention

How can I reduce my risk of agoraphobia?

There is no proven way to prevent agoraphobia. However, it is easier to manage in its earlier stages. The more you avoid situations, the more fearful you may become. Some people with severe agoraphobia are unable to leave their home at all and are totally dependent on others for help. Agoraphobia can also lead to other health problems if left untreated, including depression, alcohol or drug abuse and other mental health disorders. These are reasons why it’s important to seek mental health help early.

Outlook / Prognosis

What is the outlook (prognosis) for people with agoraphobia?

About a third of people with agoraphobia overcome the disorder and become symptom-free. Another half learn to manage their symptoms better but still have some anxiety.

You and your loved ones will need to have patience as you heal from agoraphobia. Many people need 12 to 20 weeks of CBT (talk therapy) if they also take medication. Without medication, therapy might take up to a year.

Living With

How can I learn to cope with agoraphobia?

Take good care of yourself, take your medications as prescribed and practice techniques you learn from your therapist. And don’t allow yourself to avoid situations and places that spark anxiety. The combination can help you do things you enjoy with less fear.

A note from Cleveland Clinic

Many people avoid talking about anxiety disorders. Agoraphobia can make you feel afraid and isolated. But with treatment, you can manage the symptoms and lead a full life. If agoraphobia or any anxiety disorder affects the way you live your life, call your healthcare provider. An open, honest conversation can lead to the help you need to live a full life.