Fear of Leaving the House Versus Agoraphobia
Part of the difficulty in treating a fear of leaving the house is that it can be a challenge to define. Agoraphobia is the condition most commonly associated with a fear of leaving the home, and is the primary iteration of the phobia discussed here.
However, the two do not overlap completely. Agoraphobia may involve a severe panic attack typically triggered at the thought of suffering a panic attack or other serious psychological or physical issue if the status quo of your current situation is broken.
Franklin Delano Roosevelt famously declared “We have nothing to fear but fear itself,” and it’s precisely that fear of fear itself which helps characterize agoraphobia. It’s the sensation of being so afraid of that situation triggering terror and a panic attack as to trigger one that propels agoraphobia.
In theory, this panic attack can be triggered by any situation in which escaping or asking for help seems impossibly dangerous or humiliating. However, it is true that the most common and well-known form of this panic attack-driven phobia does involve a fear of leaving the house. The fear becomes so intense people suffering from agoraphobia refuse to leave their “safe zones.”
Fear of large crowds is a common cause of agoraphobia. Sufferers often fear spaces such as subways, malls, or other areas where large crowds are common. This links the disorder closer with the fear of leaving home, as after all, the easiest way to avoid large crowds and the panic attacks they may trigger is to stay home.
What’s more, while it doesn’t cover all cases, agoraphobic panic attacks over leaving one’s home link the phobia to the home more closely than other forms of this fear. For example, staying inside for fear of being shot or getting into an accident may cause you to be afraid to leave your home, but it’s ultimately a fear of guns or cars that is at the root of your fear. With agoraphobia, your fear is directly linked to leaving your “safe zone”—the most common manifestation of which is the home.
As such, while the two aren’t a perfect match, agoraphobia is nevertheless one of the most closely linked and popularly understood forms of an otherwise more generalized fear of leaving the house.
Rarity and Statistics
Afraid of leaving the house? Yes it is a notoriously rare condition, with less than 1 percent of Americans suffering from it. Making it even more difficult is that roughly 1.8 American adults may suffer from some form of agoraphobia despite not having any previous history of panic attack disorders. The median age range for the onset of agoraphobia is between 20 and 30. While generalizations across gender lines are difficult, studies have shown women are more likely to report suffering from agoraphobia than men.
The National Health Service estimates that roughly 1 in 50 people in the UK have some form of panic disorder, with around a third of those people going on to develop some form of agoraphobia. That said, agoraphobia does not only manifest as a fear of leaving the house, so it remains unclear how many people suffer from that specific form of the condition.
Upon seeking treatment, the NHS estimates that a third of people are eventually cured and remain symptom-free, one in five continue to struggle, and half experience improvement, but have periods where their condition is more serious, and may relapse if triggered by stressors.
Causes and Symptoms
Part of what makes agoraphobia so difficult to treat is that its causes are notoriously difficult to pin down. Instead of specific symptoms, doctors often refer to a series of questions that, given certain answers, may paint a picture of a possible case of agoraphobia. Some of these questions include:
- Do you find the idea of leaving the house to be stressful?
- Are there certain situations or places you feel you need to avoid, and if so, which?
- What avoidance strategies, if any, do you use to cope with this stress?
One cause consistently linked with agoraphobia is a tendency toward panic attacks. While most people suffering from panic attacks are not agoraphobic, agoraphobia nevertheless typically manifests with and is triggered by panic attacks.
In addition to these questions and panic attacks, there are a wide range of potential symptoms that can be associated with fear of leaving the house, especially in its agoraphobic form, including:
- Rapid heartbeat
- Hot or cold spells
- Trouble swallowing
- Chest pain
- Trouble breathing
Many of these symptoms are triggered and exacerbated by the extreme stress that can accompany agoraphobia. This stress is also characterized by extreme feelings of fear and shame, as well as the fear of and shame at the idea of these feelings manifesting should the subject leave their home. Examples include:
- Fear of dying
- Fear of humiliation
- Fear of a loss of control
- Fear of losing others
- Fear of a panic attack
Therapy, Medicine, and Treatments
Severe cases of a fear of leaving the house, especially in the form of agoraphobia, nearly always require professional assistance in the form of therapy and psychological and psychiatric care. Doctors can ask you the aforementioned questions about your stress, triggering stressors, and the form your stress takes, along with queries about your personal and medical history. Based on that information, they can suggest one or more treatment possibilities.
In many cases, one-on-one therapy with an accredited professional is an important step. These sessions can help get at the root of your triggering stress factors in a safe, calm, controlled environment.
Other therapy program options include:
- Cognitive Behavioral Therapy (CBT): This involves changing patients’ thought processes so they are able to think in a more positive way. In the case of a fear of leaving home, it can help address the specific problematic chains of thought patients may have connected to the subject. In the case of agoraphobia, it can address the issue of panic attacks and the chains of thought that may trigger them.
- Interpersonal Therapy (IPT): This form of therapy focuses on interpersonal and cultural relationships and how they may impact your psyche, in this case, agoraphobic fears of leaving home.
- Dialectical Behavioral Therapy (DBT): This combines CBT and IPT, making use of stress management and mindfulness techniques.
- Acceptance and Commitment Therapy (ACT): This involves behavior change by way of acceptance and mindfulness. This means developing mental flexibility and the ability to change the way you view certain things, such as the nature of the world outside your home.
Support groups are another common form of treatment that can help treat the fear of leaving your home, especially in its agoraphobic form. Many of the issues stemming from agoraphobia involve fear, shame, and the associations of these factors with the outside world. By engaging in support groups that serve as a “safe zone,” patients can share their feelings with others with similar conditions. This can help them feel as though they are not alone, assuage some of the fears they have, and, thus, help them confront their agoraphobic fears, including the fear of leaving home.
Some types of antidepressants and anti-anxiety medications that are used to combat agoraphobia and other conditions that can cause a fear of leaving your home include:
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Alprazolam (Xanax)
- Andclonazepam (Klonopin)
- Diazepam (Valium)
Please NOTE this website does not recommend any medication, we are simply listing options that may be prescribed by your health professional.