Agoraphobia: what it is, symptoms, causes and treatment

The NHS describes agoraphobia as a fear of being in situations where escape might be difficult or that help would not be available if things go wrong. Many people assume agoraphobia is simply a fear of open spaces, but it is actually a more complex condition.

Someone with agoraphobia may be scared of travelling on public transport, visiting a shopping centre or leaving home. If they find themselves in a stressful situation they usually experience the symptoms of a panic attack, such as rapid heartbeat, rapid breathing, feeling hot and sweaty and feeling sick. They avoid situations that cause anxiety and may only leave the house with a friend or partner, or order groceries online rather than going to the supermarket. The NHS calls this change in behaviour avoidance.

The NHS stresses that the severity of agoraphobia can vary significantly between individuals. Some people can force themselves to confront uncomfortable situations but feel considerable fear and anxiety while doing so.

The NHS classifies the symptoms into three types: physical, cognitive and behavioural. Physical symptoms usually only occur when you find yourself in a situation that causes anxiety, and many people rarely experience them because they deliberately avoid those situations.

The NHS says a stepped approach is usually recommended for treating agoraphobia and any underlying panic disorder. The steps are: find out more about the condition, the lifestyle changes you can make and self-help techniques; enrol yourself on a guided self-help programme; then undertake more intensive treatments such as cognitive behavioural therapy (CBT) or see if symptoms can be controlled using medicine.

If your symptoms do not respond to self-help and lifestyle changes, the NHS says your GP may suggest trying a talking therapy. If you prefer, you can refer yourself directly for talking therapies, such as CBT, without seeing your GP. If you are under 18, or want to get help for someone under 18, the NHS points to mental health support for children and young people.

The NHS says agoraphobia can sometimes develop if a person has a panic attack in a specific situation or environment. They begin to worry so much about having another panic attack that they feel the symptoms returning in a similar situation, and so they avoid that situation.

During a panic attack, the NHS suggests staying where you are and resisting the urge to run to a place of safety (if driving, pull over where it is safe); focusing on something non-threatening and visible; breathing slowly and deeply while counting slowly to 3 on each breath in and out; challenging your fear; and using creative visualisation. It adds that trying to fight the symptoms can often make things worse, and that although a panic attack may be embarrassing and difficult it is not life threatening.

The NHS says agoraphobia can develop as a complication of panic disorder. The exact cause of panic disorder is not fully understood, but most experts think a combination of biological and psychological factors may be involved. Biologically, panic disorder is closely associated with the body's natural fight or flight response, which is thought to be more intense in people with the condition.

Occasionally a person develops agoraphobia without a history of panic disorder or panic attacks. The NHS says this type can be triggered by other fears, such as being a victim of violent crime or a terrorist attack if you leave your house, becoming infected by a serious illness if you visit crowded places, or doing something by accident that will embarrass or humiliate you in front of others.

• A traumatic childhood experience, such as the death of a parent or being sexually abused.

• A stressful event, such as bereavement, divorce or losing your job.

• A previous history of mental illness, such as depression, anorexia nervosa or bulimia.

• Alcohol-use disorder or drug misuse.

• Being in an unhappy relationship, or one where your partner is very controlling.

The NHS says to speak to your GP if you think you have agoraphobia. Your GP will ask you to describe your symptoms, how often they occur and in what situations. They may ask whether you find it stressful leaving the house, whether there are places or situations you have to avoid and whether you rely on others to shop for you. The NHS says it is very important to tell your GP how you have been feeling.

Your GP may want to do a physical examination and sometimes blood tests, because an overactive thyroid can cause symptoms similar to a panic attack. The NHS says a diagnosis of agoraphobia can usually be made if you are anxious about being in a place or situation where escape or help may be difficult, you avoid those situations or endure them with extreme anxiety or the help of a companion, and no other underlying condition may explain your symptoms. If there is any doubt you may be referred to a psychiatrist for a more detailed assessment.

The NHS directs anyone under 18, or anyone wanting to get help for someone under 18, to its page on mental health support for children and young people rather than to adult talking therapies. The NICE guideline CG113 covers care for adults aged 18 and over with generalised anxiety disorder or panic disorder, with or without agoraphobia.

Speak to your GP if you think you have symptoms of agoraphobia. If you feel unable to attend in person, the NHS says a telephone consultation should be possible. You can also refer yourself for NHS talking therapies for anxiety and depression.

The NHS names Mind and Anxiety Care UK as charities that are useful resources for information and advice about managing anxiety and phobias and can put you in touch with other people who have had similar experiences. If you feel hopeless or are thinking about harming yourself, contact your GP or NHS 111, and call 999 if you are in immediate danger.

On the NHS the usual route is your GP or self-referral to your local NHS talking therapies service, which offers guided self-help and CBT. Medicine, if recommended, is prescribed by your GP.

Private CBT or psychiatric assessment is also available if you prefer. The therapy techniques are the same in principle. Check that a private therapist is registered with a recognised professional body, and tell your GP so that your care stays coordinated.