Agoraphobia

Agoraphobia is the fear and avoidance of being in places or situations from which escape might be difficult or embarrassing (eg public transport, queues, theatre), or in which help might not be available if the person suddenly develops a symptom that could be incapacitating or embarrassing (eg dizziness, derealisation, loss of bladder or bowel control, a panic attack). As a result of this fear, the person restricts activities, requires the presence of a companion, or endures agoraphobic situations despite intense anxiety.

Assess patients who have agoraphobia for other psychiatric disorders because agoraphobia is a common symptom of other anxiety disorders, and can also occur in major depression and psychotic disorders. For example:

• a patient with social anxiety disorder may fear going out in public, due to concerns of social embarrassment
• a patient with major depression may lack the motivation to leave the home regularly
• a patient with a psychotic disorder may restrict leaving the house because of delusional concerns of risk.

Most people with agoraphobia develop it as a response to recurrent panic attacks. These panic attacks can also be a symptom of an underlying psychiatric disorder.

Treatment involves managing the underlying condition and treating panic attacks, if they are a feature. Once anxiety is sufficiently reduced, use behavioural therapy with graded exposure to overcome the phobic avoidance.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders such as agoraphobia during the perinatal period, see here or for considerations in partners, see here.