Agoraphobia: Causes, Symptoms, Diagnosis, and Treatment

Agoraphobia is a condition in which the person has a fear of open places as well as the places where the crowd is present and finds it difficult to escape to a safe place, usually it is home. It is a type of anxiety disorder. Most commonly seen among females. People having agoraphobia may be having depression, or obsessive-compulsive disorder or may suffer from social phobias too.

Several theories have been suggested for the cause of this condition. Some of the theories are the cognitive hypothesis, the psychoanalytic theory, the theory of spread and maintenance, the theory of learning, and personality and family influences.

The diagnosis of agoraphobia is done based on the criteria given by ICD-10 and DSM-V. This condition lasts long if not intervened on time and should be treated as it affects an individual mentally and make the person go through depression and suicidal attempts.

Agoraphobia: Causes

The exact cause of the development of agoraphobia is unknown. Several theories have been studied to explain the occurrence of agoraphobia.

  • The hypothesis is that it mainly occurs because of the response to repeated exposure to the anxiety-provoking situations

  • Mental health theory tells about how the person reacts to inner emotional conflicts

  • People leaving alone in a house for a long time tend to develop this

  • Some suggest that it may be because of chemical imbalances

Agoraphobia: Symptoms

The main symptoms of agoraphobia include −

  • Fear of being alone

  • Fear of losing control in a public place

  • Fear of being in places where one feels the difficulty of escape

  • Stays at home for a prolonged period

  • A feeling of detachment from others

  • Feeling of helplessness

  • Dependency on others

  • Feeling that the body is not real

  • Feeling that the environment is not real

  • Frequent panic attacks in this patient can present with sweating, hot flushes, palpitations, trembling, chills, nausea, loose motions, numbness, etc.

Agoraphobia: Risk Factors

There is no exact cause known to develop agoraphobia but several factors have been known to increase the risk of agoraphobia which includes −

  • Patient under depression

  • People have other phobias such as claustrophobia, social phobia

  • People having another type of anxiety disorder

  • An individual having a history of physical or sexual abuse

  • A person with substance abuse

  • Family history of agoraphobia

Agoraphobia: Diagnosis

The diagnosis of agoraphobia is done based on the criteria given by ICD-10 and DSM-V.

ICD- 10 Diagnostic Criteria

According to this criterion, all the following features should be present

  • The symptoms presented by the patient should be because of the anxiety

  • Should not be because of the other symptoms such as delusions or obsessional thoughts

The anxiety present should be restricted to either one of the following 2 situations

  • Crowdie places, public places, traveling away from home, and traveling alone

  • Avoiding the phobic situation should be a prominent feature

DSM-V Diagnostic Criteria

According to this criterion, the following features should be present −

  • Intense fear or anxiety about 2 or more of the following 5 situations.

    • Using public transport

    • Being in open spaces

    • Being in enclosed places

    • Standing in a line or a crowd

    • Living outside of the home alone

  • The person usually avoids these situations

  • These situations almost all provoke anxiety or fear

  • The anxiety is out of proportion to the actual danger the agoraphobic situation can cause

  • These kinds of situations are by taking the stress

  • The anxiety or avoiding the situations is persistent typically lasting for 6 months or more

  • The anxiety causes severe stress and affects social, occupational, and other areas of functioning

  • If the person is facing another medical condition the anxiety or fear is excessive

  • This anxiety is not better explained by symptoms of any other mental disorder.

Agoraphobia: Treatment

Agoraphobic patients should be treated effectively as it interferes with one's normal functioning. The effect of treatment depends on the severity of the condition.

  • Systematic desensitization − In this technique, the person is made to relax and imagine the situations that can cause anxiety from least fearful to extremely fearful situations. Some of the real-life experiences are also been used.

  • Pharmacological therapy − In this, the patients are treated by giving anti-anxiety and anti-depressant medicines to reduce the symptoms associated with the phobias.

  • Behavior therapy − In this, modification of the patient's behavior by a well-trained therapist is been done.

  • Cognitive techniques − In this, the finding of the irrational thoughts that the patient is thinking and focusing on them, and helping the patient to come out of those thoughts is done.

  • Relaxation techniques− the patient is thought to be relaxed by doing some of the breathing techniques.

Hypnotherapy can also be tried as a treatment procedure.

Agoraphobia: Prevention

There are no preventive measures as such to prevent the occurrence of agoraphobia. But timely diagnosis and intervening in the condition can help the person to come out of the situation and to lead a normal life.


Agoraphobia is a mental issue in which the individual has a fear of open places, crowded places, or enclosed places where escape is difficult. The patient prefers to stay home for a longer duration. It more commonly affects women.

The exact cause is not known but some theories have been suggested to explain to cause of the condition. People staying away from being alone, people with substance abuse, and people having a history of sexual or physical abuse are more prone to develop agoraphobia. This affects the individual's daily functioning and hence should be intervened at the early stage as it can get chronic with frequent attacks.

The diagnosis is done based on the criteria given by ICD-10 and DSM-5. This condition is treated by systematic desensitization in which the patient is made to imagine things from least to extreme fear-causing situations. The patient is also thought to handle the situations through behavior therapy. Medications like anti-depressants and anti-anxiety drugs are also given.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha