Reviewed by: HU Medical Review Board | Last reviewed: January 2012 | Last updated: May 2020
Agoraphobia, which is an anxiety disorder, literally means “fear of the marketplace” and is often thought of as “fear of open spaces,” but it’s actually more complicated than that. A person with agoraphobia may fear being in places like parking lots, taking a bus, train or other public transportation (even a cruise ship!), leaving the house alone, going shopping or to the movies, or just standing in line somewhere. In a crowded store, the patient may feel trapped.
The condition can be crippling. People with agoraphobia may have enormous difficulty completing routine tasks such as getting groceries, picking up prescriptions, and taking clothing to the dry cleaners or, even worse, a laundromat where waiting is required. At the worst, an agoraphobic patient may be entirely unable to leave his or her home.
For agoraphobia to be diagnosed, a patient has to have had consistent fear and/or anxiety of situations like those mentioned above for at least six months. There’s fear that escape from these situations could be difficult, or that there might be no one to help, if something happened like a panic attack. The circumstances simply cannot be endured without intense fear/anxiety, or without a companion. As time passes, situations and places where the fear has occurred are avoided more and more. There must significant impairment of the patient’s daily life.
Agoraphobia most frequently occurs with panic disorder, and both the fear and the occurrence of panic attacks can often be inextricably linked to the agoraphobia. However, this is not always the case. There can be, for example, a terrible fear of being embarrassed if the patient becomes overwhelmed and needs to escape immediately.
Many patients with agoraphobia are also depressed. And some physical conditions such as asthma, Crohn’s disease and Irritable Bowel Syndrome can be linked with agoraphobia.
Symptoms of Agoraphobia
In addition to intense fear, anxiety and avoidance, symptoms may include:
- Difficulty breathing or hyperventilation
- Rapid or pounding heartbeat
- Trembling or shaking
Treatment of Agoraphobia
Treatment usually involves both medications, generally antidepressants and anti-anxiety drugs, and therapy. Cognitive behavioral therapy has been shown to be very helpful. In this, patients learn about the condition and, in most cases, undergo desensitization therapy, which accustoms them gradually to the idea and the experience of facing the anxiety-causing situations.
A person with severe agoraphobia may require home visits from a therapist, meetings in a place where the patient feels safe, or therapy by phone or email, until the condition improves enough for office visits. The patient may, for example, be asked to imagine circumstances that provoke a fearful or anxious response while practicing relaxation techniques. Real-life exposure to such situations in small doses that increase in duration is also often used, and these techniques have been found to be very effective.
Agoraphobia and Migraine
Agoraphobia has not been studied separately for its relationship to migraine. However, several studies looking at migraine and anxiety disorders (and sometimes including the affective disorders of bipolar and depression) have confirmed that migraines are associated with agoraphobia without panic disorder. In addition, a strong link has been found between migraine and panic disorder with and without agoraphobia.
What little data there is suggests that symptoms of agoraphobia tend to precede migraines, rather than migraine leading to the onset of agoraphobic episodes.