The Link Between Agoraphobia and PTSD

Agoraphobia and post-traumatic stress disorder (PTSD) are both mental health disorders that can seriously negatively impact a person’s ability to function on a day-to-day basis. Learn about the connection here.

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The world today can feel like an overwhelming place. For people who have experienced trauma or developed post-traumatic stress disorder, the stress of the world can feel even stronger, and they may actively avoid engaging with the world for fear of reliving their initial trauma.

In other cases, individuals may develop symptoms related to agoraphobia, a type of anxiety disorder in which they are afraid to leave environments they consider safe. Learn more about the connection between PTSD and agoraphobia here. 

How are PTSD and agoraphobia related?

Most of us will experience at least one traumatic event that puts us at risk of developing PTSD. While the word “trauma” can be used to describe many different types of experiences that are stressful, not all stressful events are necessarily traumatic. 

On the other hand, people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, a terror attack, or similar traumatic experiences are at risk for PTSD. 

In some cases, even having a close relationship with someone that has experienced events such as those listed above can lead to the development of PTSD. 

According to a study by the National Center for PTSD, about 5% of the U.S. population has PTSD in any given year.

The symptoms of PTSD are varied and present differently in different people. These symptoms are grouped into four categories:

• Intrusive 
• Avoidance
• Cognitive/mood symptoms
• Arousal/reactivity symptoms

In all cases of PTSD, though, symptoms can make everyday functioning incredibly difficult. 

Agoraphobia, on the other hand, is an anxiety disorder characterized by intense fear and anxiety of being in places where it is hard to escape or where help might not be available. Agoraphobia usually involves fear of crowds, bridges, or being outside alone. An estimated 0.9% of U.S. adults had agoraphobia in the past year. 

The relationship between agoraphobia and PTSD is best exemplified through the shared avoidant symptoms of both disorders. Avoiding or trying to avoid internal (thoughts or memories) and external reminders (places, people, situations) of a particular event can create intense fear and anxiety about any place or situation that feels uncomfortable or unsafe. This idea of safety is the key to understanding the relationship between agoraphobia and PTSD. 

Both PTSD and agoraphobia are disorders in which there is dysregulation in the person’s fight-or-flight response, and without treatment, individuals can continue to isolate themselves to maintain a feeling of safety and security in the face of fear. 

What causes PTSD and agoraphobia?

The DSM-5 outlines specific diagnostic criteria for PTSD. Life-threatening events can send your body into a heightened state of arousal and stress. Ideally, the emotional and physical response to these events subside over time, but if they do not, a trauma-related disorder such as PTSD may be present. To be diagnosed, you must have a certain number of symptoms for more than one month, and the symptoms must be significantly affecting your life. 

To meet the official diagnostic criteria for agoraphobia, an individual must fear both going out in public places and must also make active attempts to avoid the outside world. For it to be considered “diagnosable” agoraphobia, their fears cannot be related to a realistic threat, explainable by sociocultural context, occur in the context of substance use or withdrawal, or be caused by another mental health disorder.  The symptoms must also be persistent, typically lasting for 6 months or longer.

The root cause of agoraphobia is incredibly nuanced and can stem from different sources. 

The most common source of agoraphobia can be attributed to an underlying panic disorder. Individuals with agoraphobia often experience panic attacks when they are faced with going out into public spaces. Thus, the individual's continuous isolation can be seen as an attempt to mitigate the risk of experiencing another panic attack. The physical symptoms of a panic attack can be incredibly overwhelming and uncomfortable, and the fear of experiencing one can lead to the development of agoraphobia. 

Physical symptoms of a panic attack include:

• Pounding or racing heart
• Sweating
• Chills
• Trembling
• Difficulty breathing
• Weakness or dizziness
• Tingly or numb hands
• Chest pain
• Stomach pain, nausea, or vomiting

There are other reasons someone develops agoraphobia. For example, individuals who have agoraphobia without panic disorder tend to fear having incapacitating or embarrassing situations in public spaces. An example of this would be an elderly person’s fear of falling over and hurting themselves or an individual’s fear of losing control of their bowels in public. The fear and embarrassment in these types of situations can lead the individual to avoid any situation in which they may experience this type of embarrassment. 

The difference between agoraphobia and PTSD

The difference between agoraphobia and PTSD can be understood by considering the source of the symptoms. Plainly stated, if your continuous hypervigilance and avoidance are based on a fear of reliving or reexperiencing a traumatic event from your past, you are likely experiencing symptoms of PTSD. 

Conversely, if your avoidance and isolation are based on a fear or anxiety of experiencing a panic attack in a place where you have experienced one before or in a place you are unfamiliar with, it is more likely that you are experiencing agoraphobia related to panic disorder. 

If it feels difficult to engage with the world and you’re continuously isolating yourself from others, it is important to reach out to a mental health professional. You should never try to diagnose yourself with a mental health disorder; it is best to leave the assessment, diagnosis, and treatment of mental health disorders such as PTSD and agoraphobia to trained professionals. 

Furthermore, agoraphobia can oftentimes be misdiagnosed if a proper assessment is not obtained. Specific phobia, separation anxiety disorder, social anxiety disorder, panic disorder, acute stress disorder or post-traumatic stress disorder, and major depressive disorder are all examples of diagnoses that can, in certain scenarios, better account for symptoms than an agoraphobia diagnosis.  

Additionally, it is important to note that approximately 80 percent of individuals with PTSD also have at least one other psychiatric disorder. The most common disorders to occur alongside PTSD include depression, alcohol and drug abuse, and other anxiety disorders. For this reason, it is imperative to reach out to a mental health professional, such as the clinicians at Charlie Health, so that you can receive a proper diagnosis and begin your journey to recovery. 

Hypervigilance in PTSD and agoraphobia with panic disorder

Hypervigilance is a state of heightened awareness and sensitivity to potential danger. In PTSD, hypervigilance develops as a result of experiencing or witnessing a traumatic event. People with PTSD may feel constantly on guard, easily startled, and have a heightened sense of danger, even in situations that are not actually threatening. This can lead to avoidance of certain situations or people, as well as a persistent sense of anxiety and fear.

In agoraphobia with panic disorder, hypervigilance may stem from the fear of experiencing another panic attack. People with panic disorder may become hyper-focused on physical sensations in their bodies, constantly monitoring themselves for signs of an impending attack.

In summary, hypervigilance and avoidance are common symptoms that can occur in both PTSD and agoraphobia with panic disorder. At the same time, it’s important to recognize the difference between the two disorders because of their shared symptomatology.

Treatment for agoraphobia and PTSD

Psychotherapy (talk therapy) is one of the most effective treatments for both PTSD and agoraphobia. 

During psychotherapy, you'll develop healthy stress management skills so you can better handle situations that could potentially increase your symptoms. Ultimately, psychotherapy can help you gain control over your fear and improve your quality of life. Some common treatment modalities that are employed in the treatment of both disorders are:

Cognitive behavioral therapy (CBT) and exposure therapy 

CBT helps people identify and challenge negative thoughts and beliefs that contribute to their fears. It also involves gradual exposure to the feared situation in a controlled and supportive environment to help reduce anxiety and desensitize the person to their triggers.

Medications

Certain medications, such as antidepressant medications, may be prescribed by a healthcare provider to help manage symptoms of PTSD and agoraphobia. These medications can help reduce symptoms and allow for a better quality of life. Medication is best used in tandem with talk therapy. 

Mindfulness and relaxation techniques

Techniques such as mindfulness, meditation, and relaxation exercises can help reduce anxiety and improve overall well-being. 

For the treatment of trauma-based disorders such as PTSD, working with a therapist that specializes in trauma-informed care is critical. Certain psychotherapy modalities, such as eye movement desensitization reprocessing (EMDR) therapy, in which the therapist will use eye movement techniques to help the brain process traumatic memories, are specifically helpful for trauma-based disorders. 

How Charlie Health can help 

The isolation and loneliness that can arise from living with PTSD or agoraphobia can make it feel like you are alone in your struggle. Just know that help is available. No matter what the root cause of your fear and isolation is, a personalized treatment plan can help you start to better understand your mental health and offer actionable steps toward improving your symptoms. 

Charlie Health’s virtual Intensive Outpatient Program (IOP) is an accessible, evidence-based, and comprehensive solution for teens and young adults struggling with mental health issues such as agoraphobia and PTSD. Click here to start today.