Reviewed by Lauren Guilbeault
A common misunderstanding about agoraphobia is that it’s always a fear of leaving home. In fact, certain movies have presented this disorder in just that way. While becoming homebound is one possibility, the picture of agoraphobia sometimes looks quite different.
So, what is agoraphobia? There’s an old saying among psychologists that agoraphobia is the fear of fear. That description is easy enough to understand, but it doesn’t tell the whole story. What agoraphobia looks like depends on its many possible symptoms and the severity of your condition.
Agoraphobia Signs And Symptoms
The word “agoraphobia” comes from the Greek word “agora,” which can be translated as “a place of assembly” or “marketplace.” A German neurologist named Westphal coined the term in 1871, using this Greek root word along with “phobia” to refer to a fear of large, open spaces.
But psychologists’ understanding of the condition has changed over time. Now, they recognize many other signs of this disorder. Perhaps the best way to explore the symptoms and warning signs of agoraphobia is to learn about how experts diagnose this disorder.
It’s one thing to look at a brief description of agoraphobia and say to yourself, “Yep, I think I have this condition.” A thorough assessment of symptoms and circumstances is entirely different. If you go to a mental health professional to find out if you have agoraphobia, they will follow a systematic process to determine if that is indeed the problem you’re experiencing.
Recognizing There’s A Problem
Of course, before you even go to a counselor or psychiatrist, you have to realize that something isn’t right with the way you feel, think, and behave. The fear and anguish may be enough to let you know you have a mental health problem.
Ruling Out Other Conditions - Is it Agoraphobia?
Several medical conditions can have symptoms similar to the panic attacks that sometimes go along with agoraphobia. You may need to check with a physician first to make sure the problem isn’t purely physical if you have any of the following symptoms:
- Rapid heart rate
- Trouble breathing
- Feeling of choking
- Chest pain
- Excessive sweating
- Sudden flushing or chills
- Upset stomach
Once you know that your signs aren’t a result of a medical condition, you can see a mental health professional find out if they’re due to agoraphobia. At that time, they will rule out other mental disorders, such as other anxiety disorders.
Whether you talk to a psychologist or therapist online, at a clinic, or in a private office, they might also give you tests to check for mental conditions, including agoraphobia. During your first session, they’ll get information about your family, personal, and medical history. Then, they’ll likely proceed with a diagnostic interview.
The purpose of this interview is to find out about the symptoms you’re having, where and when they’re happening, and how you are dealing with them. Your therapist will ask you questions and listen carefully to your answers. They’ll observe your reactions as you discuss your fears. With all this information in mind, they’ll compare your condition with the Diagnostic and Statistical Manual, the DSM-5, which is the standard used in the mental health profession to identify mental disorders.
DSM-5 Criteria for Agoraphobia
The DSM-5 outlines both the fears and other factors that a therapist needs to look for when diagnosing agoraphobia. This information makes the diagnosis more accurate and reliable. Your doctor or therapist refers to this outline as they consider the information they’ve gleaned from your interview.
First, the DSM-5 includes a list of the types of fears that define agoraphobia. To receive this diagnosis, you must have at least two of the following fears:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd.
- Being outside your home alone
Agoraphobia is more than just an occasional fear. To receive this diagnosis, you must have these fears almost every time you’re in the situations that provoke them. For example, if you’re afraid of using public transportation, you have this fear nearly every time you have to take a plane, bus, or train.
Degree Of Distress
Mild fears don’t count when it comes to this diagnosis. If you have agoraphobia, your distress is completely out of proportion to the actual danger you’re in, based on both the nature and context of the threat.
Here’s an example of how that might look: You’re in a crowded movie theater. You’re feeling anxious, and you’re terrified you’ll have a panic attack if the anxiety gets any worse. You aren’t in any physical danger, but the fear seems just as distressing. In agoraphobia, the fear is far more extreme than the situation calls for. It continues to intensify until you leave the theater and go home.
An agoraphobia diagnosis requires that you have these fears, anxiety, or avoid these situations persistently for six months or more.
Diagnosis also considers the effects your fears, anxiety, and avoidance have on your life. If you’re experiencing extreme psychological distress due to your symptoms, you may have this condition. On the other hand, if the fears are infrequent or mild, they have less effect on your life.
Agoraphobia can also affect the way you function on a day-to-day basis. If you can’t do the errands, you need to do to take care of your daily needs, that’s a significant impairment. If your fears prevent you from attending work meetings, going on outings with friends, or enjoying a quiet day alone, your therapist may diagnose agoraphobia.
Reasons For The Fear
The DSM-5 lists another criterion for people with agoraphobia who don’t have a history of panic disorder. This added ingredient is about the reasons you fear or avoid agoraphobic situations. You fear the situation because you have thoughts that you can’t escape it or get help if you have symptoms of panic or other embarrassing symptoms.
Is The Diagnosis Necessary?
If you meet all the criteria, a doctor or therapist can give you a diagnosis of agoraphobia. Insurance companies usually require some diagnosis before they will pay their share of the treatment cost. However, a mental health professional may be able to help you, even if you don’t have a diagnosis. They can often provide therapy without getting the insurance company involved, especially if they offer services at prices you can afford without relying on insurance.
But why would you not want to have a diagnosis? There could be several reasons. First, you might want to take care of the problem privately, without having a diagnosis on your medical record. Many people are concerned about the stigma of having a diagnosis or fear that it will affect how they see themselves.
Finally, you might not meet all the criteria of an agoraphobia diagnosis but still have problems you want to overcome. In that case, therapy can help you with your current symptoms and early signs of agoraphobia. In fact, counseling may prevent your condition from ever reaching a diagnosable level.
Assessing Severity of Your Agoraphobia
Now, for the big question: How bad is your agoraphobia? There are a few questions you and your therapist need to answer before you’ll know to distinguish between mild agoraphobia and severe agoraphobia.
In the early stages of agoraphobia, you might feel afraid now and then, but not very often. You might have a pang of fear when you leave your home, but you don’t feel the intensity of terror. Maybe you’ve only had these symptoms for a few weeks. And, you might be able to do all your everyday activities without avoiding anything important.
But the real question is: Would you benefit from agoraphobia treatment? If your life has become very limited, sheltered, or empty, therapy can help you get back to the things you want and need to do. You can not only learn relaxation techniques and coping skills to deal with your anxiety, but you can also address the root of the problem. And, even if your symptoms are mild or just beginning, therapy may benefit you. It offers you ways to manage your early symptoms. And, improving your mental health may make you less vulnerable to this disorder.
Treatment for Agoraphobia
There are three main types of treatment for agoraphobia. First, there are cognitive therapies. Cognitive Behavioral Therapy and exposure therapy are the most used types of psychotherapy for agoraphobia.
The second type of treatment is taking medications, such a benzodiazepine, for quick relief of severe symptoms or an SSRI antidepressant for longer-term improvement.
The third type of agoraphobia treatment is a combination of cognitive therapies and medications. Of these three types of treatment, cognitive therapies have proven most effective over the long haul.
You might suspect you have agoraphobia, but how do you know for sure? You can start by taking an agoraphobia test to screen yourself for this mental disorder. If your answers reveal that agoraphobia is a strong possibility, you can talk to a mental health professional to discuss it further.
Conclusion - There is Help for Agoraphobia
Thinking you might have a mental disorder can bring feelings ranging from mild interest to nagging worries to overwhelming concern. But knowing the truth and understanding the severity of your condition has an entirely different effect. It allows you to face the real problem squarely, take positive actions, and overcome it. If you think you might have agoraphobia, consider taking a screening test or talking to a mental health professional as soon as possible. When you know what you’re dealing with, you’ll be ready to take the next steps to better mental health.