The primary characteristic of agoraphobia is severe anxiety and fear about being in or anticipating certain situations. These situations include things like being in a place where escape might be difficult or impossible (such as in a restaurant), or in which help may not be available in the event of having a panic attack (or panic-like symptoms).
Oftentimes, when in this situation, an individual may have the vague thought that something dreadful may happen. Such concerns must persist for at least 6 months and occur virtually every time an individual encounters the place or situation.
Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
More specifically, the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) requires that an individual experiences intense fear in response to (or when anticipating entering) at least 2 of the following five situations:
- using public transportation, such as automobiles, buses, trains, ships, or planes
- being in open spaces, such as parking lots, marketplaces, or bridges
- being in enclosed spaces, such as shops, theaters, or cinemas
- standing in line or being in a crowd
- being outside of the home alone
A person who experiences agoraphobia actively avoids such situations — travel is restricted or the person changes daily routines — or else the situations are endured with significant distress. For example, people with agoraphobia often require the presence of a companion, such as a family member, partner, or friend, to confront the situation.
In addition for agoraphobia to be diagnosed, the fear or anxiety must be out of proportion to the actual danger posed by the situations that are feared. For instance, there’s little actual danger waiting in line at the bank. Millions of people do this every day without incident. But a person suffering from agoraphobia imagines the bank being robbed, then having a panic attack, and then dying because of a cardiac event where a paramedic could not get to the person in time.
These feelings of anxiety, fear, and avoidance must persist for at least six months and cause significant distress and impairment in the person’s life, making it difficult (or nearly impossible) to hold down a job, attend school, go out to social engagements, or maintain friendships or relationships.
The most common result of agoraphobia is a person who declines or refuses to leave their house, because of the kinds of intense, irrational fears the person experiences. Trying to reason with a person with agoraphobia about the likelihood of any of their fears coming true usually does not result in any change of their behavior, since the fears are irrational to start with. Often times, a person with agoraphobia is intellectually aware the fears are irrational — but can’t stop believing them no matter what.
Women are twice as likely to experience agoraphobia than men. Agoraphobia appears to exist in approximately 1.7 percent of the population every year.
In order for an agoraphobia diagnosis to be made, the anxiety or phobic avoidance in agoraphobia can not be better accounted for by another mental disorder, such as social phobia (e.g., avoidance limited to social situations because of fear of embarrassment), specific phobia (e.g., avoidance limited to a single situation like elevators), obsessive-compulsive disorder (e.g., avoidance of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), or separation anxiety disorder (e.g., avoidance of leaving home or relatives). As with all mental disorders, the symptoms listed above are not due to the direct physiological effects of a use or abuse of a substance (e.g., alcohol, drugs, medications) or a general medical condition.
Prior to 2013, agoraphobia required the diagnosis of panic disorder to also be made. Now, if an individual meets criteria for panic disorder and for agoraphobia, both diagnoses can be assigned. But if a person has agoraphobia without panic attacks, then just a diagnosis of agoraphobia is appropriate.
Learn more: Treatment of Agoraphobia
This entry has been adapted for 2013 DSM-5 criteria; diagnostic code: 300.22.