​​Agoraphobia: Definition, Symptoms, & Examples​

By Charlie Huntington, M.A., Ph.D. Candidate
Agoraphobia is the fear of being in a public or crowded place and not being able to get out or get help. How do psychologists define and treat agoraphobia?
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I am fortunate to live in a U.S. state that is at the forefront of legalizing substances with psychedelic healing properties. I once took such a substance while at a huge concert. I must say that it truly augmented the experience for me—at least while the band was playing. As soon as they finished their set and decided to take a break, the house lights came up, and suddenly I was acutely aware of the tens of thousands of people around me. They were all very noisy and they were all moving a lot.
I don’t think I had ever been so overwhelmed in public. I was afraid that I would make a fool of myself or suddenly need help and be unable to get it. I had to sit very still and ask the friends I was with to help me stay focused on what was happening right around me. In doing this, I was able to avoid getting truly overwhelmed and maybe slipping into a panic attack. Pretty soon the band came back out, and I was again enthralled by their playing.

This story, for me, is a one-off, unusual situation; I promise I haven’t made a habit of getting too high at concerts. But the sensations I experienced in that moment—a sense of overwhelm and worry about how I’m going to react—are all too common for people who are diagnosed with agoraphobia.​
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What Is Agoraphobia? (A Definition)​

Agoraphobia can be defined as a certain kind of anxiety that some people experience when in public or in a crowd (American Psychiatric Association [APA], 2013). Specifically, it is the fear that something could go wrong and the fearful person will be unable to escape or get help, accompanied by the fear that being stuck in this way may lead to a panic attack. The symptoms of a panic attack which the person with agoraphobia is either experiencing or afraid to experience could include, alongside their fear, physical symptoms such as heart palpitations, nausea, chest pain, dizziness, and shortness of breath.​

To be diagnosed with agoraphobia, this kind of fear must arise for a person in at least two of five common situations, and they must have had experiences of fear like this for at least the last six months (APA, 2013). In other words, it cannot be a relatively new experience for the fearful person, nor can it be limited to just one context. Interestingly, a fearful response to simply imagining being in different public or crowded places counts for a diagnosis of agoraphobia as much as experiencing the anxiety in a real-life situation does.

People with agoraphobia not only fear these public situations; they usually actively avoid them, and they often turn to certain coping behaviors or thoughts to deal with the situations if they absolutely have to enter them.

Importantly, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is clear that this fear must be unrealistic or unfounded (APA, 2013). In other words, a teacher whose school received a bomb threat or shooting threat yesterday is not exhibiting signs of agoraphobia if they are afraid of going to school today. Cultural differences also need to be accounted for when considering an agoraphobia diagnosis: For example, a Black person in the United States might be reasonably expected to experience some distress at the thought of being in a crowded, rowdy, and mostly White public space.

A key aspect of agoraphobia is that the person is worried about how they will behave in public—in particular, that they may experience a panic attack while around other people. This may be because many, if not most, people with agoraphobia also meet criteria for panic disorder, a diagnosis characterized by persistent fear of experiencing a panic attack, worry about experiencing severe pain, and making changes to one’s lifestyle to avoid panic attacks (APA, 2013). For the many people with both diagnoses, life can be very challenging, as there are many life situations they strenuously avoid for fear of experiencing panic (Wittchen et al., 2010).

Opposite of Agoraphobia​

There is technically no opposite of agoraphobia, but we could say that the opposite experience to agoraphobia is that of being very comfortable, or even finding great enjoyment in, spending time in large crowds and public spaces. To take us back to that concert I was at, I’m sure many of the people there, if not most of them, were truly enjoying being surrounded by so many other people. The size and intensity of the crowd enhanced their experience rather than terrifying them.

Causes of Agoraphobia

Psychologists think that both panic disorder and agoraphobia begin with a person developing a fear of intense bodily sensations—the sort of symptoms that, if they become overwhelming, constitute a panic attack (APA, 2013). Some people are more aware of their bodies and changes in their experience than other people, and they are more likely to develop this kind of fear. Unfortunately, once this fear has taken shape, it can easily get reinforced. The fearful person is aware of their fear as they enter a public space, but they find relief when they depart early from the event they are attending. They have resolved their anxiety, but at a cost: They have reinforced their own behavior of avoiding the situation. When you combine this experience with the increasing sensitivity to symptoms of fear that comes from paying more attention to them, you have a recipe for developing deeper and deeper fear, and a stronger and stronger fear response, related to being in public.

Examples of Agoraphobia

Here is an example of a person with agoraphobia, taken from a recent study of agoraphobia (Shafran et al., 2021). The authors in this article describe Sally (not her real name) as a young woman with both agoraphobia and generalized anxiety disorder. Sally sought out treatment because she was having trouble engaging in any nonessential activities outside her home. She was living with her parents and working at a business just a few minutes from their home. Only after a significant round of treatment for her agoraphobia was she able to find a job farther from home and travel more than an hour away from home in a car.

Although Sally continued to have trouble with some public activities, her symptoms stayed mostly manageable until the onset of the COVID-19 pandemic. Initially, she was grateful for the excuse to stay home, but over time her anxiety about going outside at all grew substantially, and she became convinced that she could not possibly handle leaving home. At this point, she sought further treatment.

If you would like some more examples of how agoraphobia shows up in people’s lives, I recommend watching this video:​

Video: Agoraphobia: The Fear of Fear

Symptoms of Agoraphobia

For many people with agoraphobia, experiencing panic attack symptoms is a regular occurrence. Many people describe the experience of fearing or having a panic attack as feeling sure that they are about to die. They feel faint, struggle to breathe or have a choking sensation, break out in sweat, and feel that their heart is beating irregularly (Dwivedi & Kumar, 2015). If people with agoraphobia go to a doctor because they are worried about their physical symptoms, they are almost always told that there is no physiological cause for concern.​

People with agoraphobia are likely to come up with contingency plans. In other words, if they simply have to go out into the world, they may focus intensely on their exit strategies or even go so far as to keep close track of where the nearest hospital is in case they need treatment for panic symptoms (Dwivedi & Kumar, 2015).

All of the ways that agoraphobia can limit a person’s quality of life may also explain why there are high rates of psychological distress as well as symptoms of anxiety and depression among people with agoraphobia (APA, 2013). As symptoms worsen, many people with agoraphobia reduce their personal activities further and further, losing social connections and meaningful hobbies and jobs; this is a recipe for the onset of negative self-thoughts and possibly depression.

Treatment for Agoraphobia

Treatment for agoraphobia generally starts with learning about the condition itself. The therapist explains how panic and anxiety symptoms develop over time and how they are worsened by behaviors such as avoiding public places (Craske & Simos, 2013). The therapist aims to normalize these patterns and indicate how they are adaptive up to a point, so that clients realize they are not going to die and are not going crazy.

Next, people with agoraphobia build awareness of their physiological signs and learn relaxation techniques, with a focus on developing a strong practice of taking slow, deep breaths. Then, using the information gathered by self-monitoring and practicing breathing, clients learn to question their intensely held beliefs about what is happening in their bodies when in public and how safe they are. For example, they might identify, in collaboration with the therapist, how they have been overestimating the level of risk involved in certain public activities.
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Finally, the client will likely engage in two different forms of exposure therapy. First, during therapy sessions, they may practice inducing the physical sensations that they fear in order to also experience their physical symptoms as manageable and survivable. To do this, they might start with simple exercises like spinning and then building up to even causing themselves to hyperventilate.

At the same time, the client will practice in vivo exposures. This means getting out into exactly the public places and activities that trigger their agoraphobia. Again, they do it in a gradual way that is designed to slowly increase their tolerance for these situations.

Agoraphobia & Panic Attacks

It was once thought that agoraphobia could only occur in the context of a preexisting panic disorder (Wittchen et al., 2010), but psychiatrists and psychologists now consider it a separate, independent diagnosis (APA, 2013). It remains the case that people who receive both diagnoses have more intense panic symptoms, more depression and anxiety, and a worse prognosis for recovery (Shin et al., 2020).

Psychology of Agoraphobia

Agoraphobia has long been a slightly contentious diagnosis, not least because psychologists were divided about whether it should be classified as a subset of panic disorder (Asmundson et al., 2014). On the other hand, it has long been understood that cognitive behavioral therapy is the most standardized and effective treatment for agoraphobia (Craske & Barlow, 2008; Mitte, 2005), and it seems that this is because of its core components: exposure, relaxation training, and learning to manage one’s breath (Sánchez-Meca et al., 2010).

Overcoming Agoraphobia

Agoraphobia is treatable, and many people reach a point where their symptoms are manageable or they no longer meet criteria for the diagnosis. Whether they stay in that place is driven in large part by whether they continue to place themselves in situations that used to trigger their agoraphobia (Teismann et al., 2018). The more somebody’s agoraphobic avoidance returns, the less likely they are to maintain their newfound levels of functionality (Porter & Chambless, 2015).

Agoraphobia After COVID

It appears that people with agoraphobia, like the woman we met in the example above, initially responded positively to the restrictions necessitated by the COVID-19 pandemic (Plunkett et al., 2021), likely because they were being explicitly told not to do things in public that trigger their agoraphobic anxiety. Thankfully, even for people who might be housebound, there is hope: Recent studies indicate that effective cognitive behavioral therapy for agoraphobia can even be delivered fully online (Stech et al., 2020).

Articles Related to Agoraphobia​

​Want to learn more? Check out these articles:

Books Related to Agoraphobia​

If you’d like to keep learning more, here are a few books that you might be interested in.

Final Thoughts on Agoraphobia​

You probably know if you or somebody in your life has agoraphobia—it is not the kind of psychiatric disorder that can be fully hidden. I hope it is helpful to know, in general, that this condition is quite treatable and that many people, with serious effort in therapy, overcome or manage their symptoms enough to enjoy fulfilling lives out in the world. Although psychotherapy cannot resolve all of our mental health issues, it can certainly assist people with agoraphobia in improving their quality of life and reducing their psychological distress.

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