Agoraphobia is fear of being in situations where escape might be difficult, or where help would not be available if things went wrong. It is not simply fear of open spaces or of leaving the house. That is why crowds, public transport, queues, bridges and being far from home all qualify: each is hard to leave quickly.
Key points
- Agoraphobia is fear of situations where escape would be hard or help unavailable, not fear of open spaces.
- Crowds, public transport, queues, bridges and being far from home are triggers: none can be left quickly.
- It occurs with or without panic disorder, and ICD-11 and DSM-5-TR treat it as its own diagnosis.
- Severity ranges from short trips only to being housebound for long periods.
- NICE recommends self-help first, then CBT with graded exposure or an antidepressant.
Symptoms
- Rapid heartbeat, rapid breathing, chest pain; feeling hot, sweaty, sick or faint, trembling, dizziness.
- Fear of being unable to escape from a place or situation, or of losing control or sanity in public.
- Avoiding crowded places, public transport and queues; needing a companion to go anywhere; avoiding being far from home.
Causes and risk factors
- Panic disorder, or previous panic attacks in a particular place, most often.
- Traumatic childhood experiences; stressful life events such as bereavement, divorce or job loss.
- Depression, an eating disorder, alcohol dependence, drug misuse, or a controlling relationship.
Treatment
- Steps 1-2: recognition, then CBT-based self-help. Step 3: CBT (7 to 14 hours) or an antidepressant, paired with graded exposure.
- Steps 4-5: referral to specialist services, which should consider home-based CBT if attending a clinic is difficult.
- Benzodiazepines are linked to a less good long-term outcome and should not be prescribed.
When to speak to a professional
- Anxiety about escape or help is changing where you go or how you travel.
- You have stopped going to places you used to, or order online to avoid shops.
- You have been housebound, even briefly.
- Self-help has not worked, or you use alcohol or drugs to get through trips out.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.