Agoraphobia: Fear of Open Spaces & Situations — Symptoms & Treatment

Agoraphobia is an anxiety disorder marked by intense fear/anxiety about situations where escape might be difficult or help unavailable if panic-like symptoms occur.

Feared Situations (DSM-5: ≥2 required)

• Public transportation (buses, trains, planes)
• Open spaces (parking lots, bridges, fields)
• Enclosed spaces (shops, theaters, elevators)
• Crowds/standing in line
• Being alone outside home

Core Features

• Fear is disproportionate to actual danger.
• Situations avoided, endured with distress, or require a companion.
• ≥6 months duration; causes significant impairment.
• Often comorbid with panic disorder (but can exist independently).

Treatment (Evidence-Based)

• CBT with exposure: Gradual, systematic in vivo exposure to feared situations + cognitive restructuring. Gold standard.
• SSRIs/SNRIs: Sertraline, escitalopram, paroxetine, venlafaxine — first-line pharmacotherapy.
• Combined CBT + medication: Superior for moderate-severe cases.
• Virtual reality exposure therapy (VRET): Emerging, effective for access-limited patients.

Outlook

Highly treatable. Without treatment, tends to worsen → housebound. Early intervention prevents disability.