Agoraphobia is an intense fear about being in public places where you feel escape might be difficult. So you tend to avoid public places, and may not even venture out from home. It can greatly affect your life. Treatment can work well in many cases. Treatment options include cognitive behavioural therapy and medication, usually with a selective serotonin reuptake inhibitor (SSRI) antidepressant.
This leaflet is part of our series on anxiety and phobias
Many people think that agoraphobia means a fear of public places and open spaces. But this is just part of it. If you have agoraphobia you tend to have a number of fears of various places and situations. So, for example, you may have a fear of:
But, they all stem from one underlying fear. That is, a fear of being in a place where help will not be available, or where you feel it may be difficult to escape to a safe place (usually to your home).
When you are in a feared place you become very anxious and distressed, and have an intense desire to get out. The anxiety usually causes physical symptoms such as: a fast heart rate, palpitations, shaking (tremor), sweating, dry mouth, feeling sick, chest pain, headaches, stomach pains, a 'knot in the stomach', fast breathing. You may even have a panic attack (see separate leaflet called Panic Attack). Even thinking about going to such places can make you anxious. To avoid this anxiety, you tend to avoid feared places.
The severity of agoraphobia can vary greatly. Some people with agoraphobia can cope quite well outside their home by sticking to familiar areas and routines. Some people with agoraphobia can go out from their home and travel on buses, trains, etc, without getting anxious if they go with a friend or family member. There may be times when you have good spells where you cope better than at other times.
However, to prevent anxiety, many people with agoraphobia stay inside their home for most or all of the time. But, by avoiding the feared situations, this can often cause the fear to grow stronger and the problem may get worse. So, agoraphobia can be disabling and greatly affect your life.
Agoraphobia typically develops between the ages of 25 and 35 and is usually a lifelong problem unless treated. However, it can sometimes develop at a younger or older age than this.Twice as many women are affected than men.
Many, but not all, people with agoraphobia also have a condition called panic disorder. See separate leaflet called Panic Disorder which discusses this. Briefly, people with panic disorder have panic attacks that occur suddenly, often without warning. A panic attack is like a sudden and severe attack of anxiety and fear.
If you have panic disorder you may worry about having a panic attack in a public place, which is embarrassing, difficult to get out of, or where help may not be available. Therefore, you may develop agoraphobia - a fear of being in such places - because you have panic disorder.
You are likely to have agoraphobia if:
CBT helps you to change certain ways that you think, feel and behave. It is a useful treatment for various mental health problems, including phobias.
CBT is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part, and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious.
Note: unlike other forms of psychotherapy, CBT does not look into the events of the past. CBT aims to deal with, and to change where appropriate, your current thought processes and/or behaviours.
CBT usually works well to treat most phobias, but does not suit everyone. However, it may not be available on the NHS in all areas.
These are commonly used to treat depression, but also help to reduce the symptoms of phobias, even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms.
A combination of CBT and an SSRI antidepressant may work better in some cases than either treatment alone.
These medicines are sometimes called minor tranquillisers. They work well to ease symptoms of anxiety. The problem is, they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not a usual long-term treatment. However, a short course may be prescribed from time to time for a particularly bad spell of anxiety.