When Does Social Anxiety Become Agoraphobia?

When Does Social Anxiety Become Agoraphobia
Dr. Roseann Capanna-Hodge

Dr. Roseann Capanna-Hodge

Agoraphobia is an anxiety disorder involving fear and avoidance of situations or places that may be difficult to escape, such as crowds, public transportation, or open spaces. People with agoraphobia may feel trapped or helpless in these situations. 

On the other hand, social anxiety disorder involves intense fear and avoidance of social situations, such as meeting new people, speaking in public, or being observed by others. Social anxiety disorder and agoraphobia are different mental health conditions but can overlap and co-occur.

The development of agoraphobia from a social anxiety disorder or anxiety depends on the individual and their experiences and symptoms. If social anxiety significantly impacts a person's ability to leave their home or participate in normal daily activities, it may be a sign of agoraphobia.

For example, someone with a social anxiety disorder may develop agoraphobia if they avoid leaving their home due to fear of encountering social situations. Alternatively, someone with agoraphobia may develop social anxiety disorder if they fear being observed or judged outside their home.

What Does Phobic Mean?

The term “phobic” is commonly used to describe a person with extreme or irrational fear or aversion to a specific object, situation, or activity. This fear can be so intense that it can interfere with a person's daily life and activities, leading to avoidance behavior.

For instance, someone with a phobia of spiders may experience intense fear and anxiety when encountering bugs or even just thinking about bugs. This fear can be so severe that they may avoid going outside, avoid certain rooms in their home, or experience panic attacks when they come into contact with a bug.

What are Phobias, and How do They Develop?

Generally defined, phobias are anxiety disorders characterized by excessive and persistent fear and avoidance of a specific object, situation, or activity that is not inherently dangerous or threatening. This fear and avoidance may interfere with daily life and cause significant distress or impairment.

Once a phobia is established, it can be reinforced through avoidance behavior. Avoiding the feared object or situation may temporarily relieve anxiety but can also strengthen the phobia and make it more challenging to overcome. 

Phobias can develop through various factors, including genetics, learning, and life experiences. Research suggests some people may be genetically predisposed to developing phobias (Villafuerte & Burmeister, 2003). Traumatic life experiences and classical conditioning may cause phobias in many ways. 

Classical conditioning occurs when a neutral stimulus, such as an object or situation, becomes associated with a negative or traumatic event. For example, someone with a panic attack in an elevator may develop a phobia of elevators. Phobias caused by traumatic experiences are triggered by accidents, abuse, or natural disasters. In this case, a person attacked by a dog may develop a phobia of dogs.

I recall a teenager who became afraid to fly after bad turbulence on one of those little putter planes. Even though her rational brain knew she experienced turbulence because she flew on a little plane in bad weather, she couldn’t overcome her phobia of flying without exposure therapy and PEMF to calm and regulate her brain. 

One’s learning may also lead to developing phobia. Observational learning is when one learns to fear something by observing others. For instance, if a child sees their parent or sibling react fearfully to a spider, they may develop a fear of spiders themselves. I often see whole family “aversions” as a result of one person’s overreactions to stimuli. 

On the other hand, informational learning refers to learning to fear something based on the information received. If people read about the dangers of flying, they may develop a fear of flying.

Types of Phobias

There are numerous types of phobias, but they can be broadly categorized into three main groups, such as:

1. Specific phobias

Specific phobias involve fear or anxiety about specific objects, situations, or activities. Some common examples include fear of heights (acrophobia), fear of flying (aviophobia), fear of spiders (arachnophobia), and fear of enclosed spaces (claustrophobia). 

Other less common phobias include blood-injection-injury phobia, specific animal phobias, such as the fear of bugs, dogs, or snakes, and situational phobias, such as the fear of driving or climbing.

2. Social phobia

Social phobia, or social anxiety disorder, is characterized by a persistent fear of social situations where one may be exposed to scrutiny, judgment, or humiliation. Social phobia can significantly impair an individual's ability to function daily and negatively impact their relationships, career, and overall quality of life.

Research has shown that social phobia is a common disorder, affecting approximately 7-13% of the general population. It is more common among women than men and typically emerges in adolescence or early adulthood. Social phobia is often comorbid with other mental health disorders, such as depression or substance use disorder, which can complicate treatment (Hofmann et al., 2012).

3. Agoraphobia

Agoraphobia is an anxiety disorder involving fear and avoidance of situations or places where escape may be difficult or help may not be readily available. Common fears associated with agoraphobia include fear of public places, using public transportation, and being in open or closed spaces. Agoraphobia can significantly limit an individual's daily activities and affect their overall quality of life.

Research has shown that agoraphobia affects between 0.9% to 1.8% of the general population. It is more common among women than men and typically emerges in early adulthood. Individuals with agoraphobia may also have other mental health disorders, such as panic, social anxiety, or generalized anxiety (Kessler et al., 2005).

What are the Typical Symptoms of Agoraphobia?

What are the Typical Symptoms of Agoraphobia

Individuals with agoraphobia may experience various physical and psychological symptoms in response to these feared situations. Some typical symptoms of agoraphobia include:

1. Panic attacks

Individuals with agoraphobia may experience intense fear or panic in response to the thought of, or actual exposure to, a feared situation. I often tell parents it is the body’s response to stress, fear, and worry. Panic attacks are a common symptom of agoraphobia. These attacks are often sudden and intense episodes of fear or anxiety lasting several minutes. They can occur in children and adults. 

The experience of a panic attack can be distressing and lead to avoidance behavior in individuals with agoraphobia. This may result in individuals avoiding situations or places where they have previously experienced a panic attack, leading to social isolation and difficulty carrying out daily activities.

2. Avoidance behavior

Avoidance behavior is a common feature of agoraphobia, which can take many forms. For example, individuals with agoraphobia may avoid crowded places such as shopping malls, movie theaters, or public transportation, where they fear they may experience a panic attack or feel trapped. They may also avoid leaving their home altogether, which can lead to a condition called housebound agoraphobia.

The avoidance behavior in agoraphobia can be particularly challenging because it can limit an individual's ability to engage in daily activities, such as work, school, or social events. Over time, the avoidance behavior can reinforce the fear and anxiety associated with certain situations, making it even more difficult to overcome. Developing anxiety coping skills is an important part of the healing process. 

3. Physical symptoms 

The physical symptoms of agoraphobia can vary from person to person and may be similar to those experienced during a panic attack. These physical symptoms can be distressing and can interfere with an individual's ability to carry out daily activities. Symptoms are always uncomfortable but can vary in intensity. Some of the physical symptoms of agoraphobia, which are also associated with other medical conditions, include

  • Rapid heartbeat
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Chest pain or tightness
  • Nausea or stomach upset
  • Dizziness or lightheadedness
  • Feeling faint or like you might pass out
  • Chills or hot flashes

4. Fear of losing control

Individuals with agoraphobia may fear that they will lose control or embarrass themselves in a feared situation. Physical symptoms and a sense of impending doom often accompany the anxiety.

This symptom is particularly challenging because it can limit an individual's ability to engage in daily activities like work, school, or social events. Over time, the fear can intensify, leading to housebound agoraphobia, where an individual is afraid to leave home.

5. Hypervigilance

Individuals with agoraphobia may constantly be alert and vigilant for signs of danger in their environment. Hypervigilance is a symptom of agoraphobia because individuals with this disorder often have heightened awareness and anticipation of danger. They may constantly be scanning their environment for potential threats, which can be exhausting and can contribute to feelings of anxiety and fear.

Individuals with agoraphobia may feel like they need to be constantly on guard to protect themselves from harm. This hypervigilance can lead to avoidance behavior, as they may avoid situations or places they perceive as risky or threatening.

Social Anxiety vs. Agoraphobia

Social anxiety and agoraphobia share some similarities, but they are distinct disorders. Their similarity is that both involve avoidance behavior. People with social anxiety may avoid social situations, while people with agoraphobia may avoid situations where they fear panic-like symptoms. Both disorders can interfere with an individual's quality of life and daily functioning.

However, there are also significant differences between the two. While social anxiety is specific to social situations, agoraphobia is broader and encompasses a range of situations outside the home. Additionally, people with agoraphobia may experience panic attacks, which are not a necessary component of social anxiety.

An individual's social anxiety may be related to fear of negative evaluation, embarrassment, or rejection in social situations. This fear may lead to avoidance behavior, such as canceling plans, declining invitations, or finding excuses not to attend social events. Over time, this avoidance behavior may become more extensive, leading to avoidance of situations outside the home and developing agoraphobia.

The fear of leaving home or being in public may be related to the individual's social anxiety, as they may perceive these situations as threatening or embarrassing. The fear of having a panic attack or anxiety symptoms in public places may also contribute to the development of agoraphobia.

Social Anxiety vs. Agoraphobia Comparison Chart

Social Anxiety vs. Agoraphobia Comparison Chart

Social Anxiety

Agoraphobia

Social anxiety is characterized by fear or discomfort in social situations where children are expected to interact with others, such as making conversation, participating in group activities, or performing in front of others.

Agoraphobia is characterized by fear or avoidance of situations where escape may be difficult or help may not be readily available, such as crowded places or situations that may trigger panic attacks.

Social anxiety often leads to avoidance of social situations, which can interfere with a child's ability to form friendships, participate in extracurricular activities, and perform well in school.

Agoraphobia often leads to avoidance of certain places or situations, which can severely limit a child's ability to engage in age-appropriate activities and lead a normal life.

Children with social anxiety may experience physical symptoms such as sweating, trembling, blushing, or difficulty speaking when faced with social situations.

Children with agoraphobia may experience physical symptoms such as sweating, shaking, rapid heartbeat, or nausea when faced with situations that trigger their fear.

Social anxiety often develops in childhood or adolescence, and may be related to experiences of bullying, social rejection, or family conflict.

Agoraphobia can develop at any age, and may be related to experiences of trauma, panic attacks, or other anxiety disorders.

Treatment for social anxiety may involve cognitive-behavioral therapy, exposure therapy, or medication.

Treatment for agoraphobia may involve cognitive-behavioral therapy, exposure therapy, medication, or a combination of these approaches.

Social anxiety may improve over time, especially with early intervention and appropriate treatment.

Agoraphobia can be a chronic condition, but with appropriate treatment and support, many children are able to manage their symptoms and live normal, fulfilling lives.

OCD vs. Agoraphobia

Sometimes, individuals with OCD may develop obsessions related to agoraphobia. Because they fear leaving their homes or being in public places, they may engage in compulsive behaviors, such as repeatedly checking doors and windows, to ensure their safety. These behaviors may lead to further isolation and avoidance of situations outside the home, exacerbating agoraphobia symptoms. 

Furthermore, an individual with OCD may have an obsessive fear of contamination and engage in compulsive hand-washing behavior. This individual may also develop agoraphobia because they fear being in public places or touching objects outside their home that they perceive as contaminated.

In this case, the individual's OCD symptoms are related to contamination fears, and their compulsive hand-washing behavior is intended to alleviate the anxiety caused by these obsessions. 

However, this behavior may lead to isolation and avoidance of situations outside the home, worsening the agoraphobia symptoms. The fear of being in public places or touching contaminated objects outside their home may trigger a panic attack or anxiety symptoms, leading to further avoidance behavior and isolation.

OCD vs. Agoraphobia Comparison Chart

OCD

Agoraphobia

OCD is characterized by recurring, unwanted, and intrusive thoughts or obsessions that cause significant distress and anxiety.

Agoraphobia is characterized by fear or avoidance of situations where escape may be difficult or help may not be readily available, such as crowded places or situations that may trigger panic attacks.

Children with OCD often engage in compulsive behaviors or rituals, such as repetitive hand washing, checking, or counting, in an effort to reduce their anxiety or prevent harm.

Children with agoraphobia may experience physical symptoms such as sweating, shaking, rapid heartbeat, or nausea when faced with situations that trigger their fear.

OCD can interfere with a child's daily functioning, causing problems at school, in social relationships, or with family life.

Agoraphobia often leads to avoidance of certain places or situations, which can severely limit a child's ability to engage in age-appropriate activities and lead a normal life.

OCD may develop gradually over time, and may be related to genetic, environmental, or biological factors or have a sudden onset with PANS/PANDAS.

Agoraphobia can develop at any age, and may be related to experiences of trauma, panic attacks, or other anxiety disorders.

Treatment for OCD may involve cognitive-behavioral therapy, exposure and response prevention, or medication.

Treatment for agoraphobia may involve cognitive-behavioral therapy, exposure therapy, medication, or a combination of these approaches.

OCD can be a chronic condition, but with appropriate treatment and support, many children are able to manage their symptoms and live normal, fulfilling lives.

Agoraphobia can be a chronic condition, but with appropriate treatment and support, many children are able to manage their symptoms and live normal, fulfilling lives.

OCD may be accompanied by other mental health conditions, such as depression or anxiety disorders.

Agoraphobia may be accompanied by other anxiety disorders, such as panic disorder or social anxiety disorder.

How to Treat and Manage Agoraphobia 

Cognitive-behavioral therapy (CBT) is often used to treat agoraphobia. CBT can help individuals identify and challenge negative thought patterns and beliefs contributing to anxiety and avoidance. Exposure therapy, which involves gradually exposing individuals to feared situations in a safe and controlled manner, is also commonly used to treat agoraphobia (Choy et al., 2007).

Other types of therapy, such as psychodynamic therapy (Leichsenring et al., 2013) and Acceptance and Commitment Therapy (ACT) (Twohig et al., 2014), may also be helpful for some individuals with agoraphobia. Working with a mental health professional with experience in treating anxiety disorders and who can tailor treatment to meet your specific needs is important.

Since agoraphobia is often comorbid with other conditions, including anxiety, depression, and OCD, it is important to get a comprehensive picture of what is happening in the brain. We use a QEEG brain map is a great diagnostic tool that is the anchor for a detailed care plan in our BrainBehaviorReset™ Program. 

Citations

Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27(3), 266–286. https://doi.org/10.1016/j.cpr.2006.10.002

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1

Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617. https://doi.org/10.1001/archpsyc.62.6.617

Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., Huesing, J., Joraschky, P., Nolting, B., Poehlmann, K., Ritter, V., Stangier, U., Strauss, B., Stuhldreher, N., Tefikow, S., Teismann, T., Willutzki, U., Wiltink, J., & Leibing, E. (2013). Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder: A Multicenter Randomized Controlled Trial. American Journal of Psychiatry, 170(7), 759–767. https://doi.org/10.1176/appi.ajp.2013.12081125

Twohig, M., Morrison, K., & Bluet, E. (2014). Acceptance and Commitment Therapy for Obsessive Compulsive Disorder and Obsessive Compulsive Spectrum Disorders: A Review. Current Psychiatry Reviews, 10(4), 296–307. https://doi.org/10.2174/1573400510666140714172145

Villafuerte, S., & Burmeister, M. (2003). Untangling Genetic Networks of panic, phobia, Fear and Anxiety. Genome Biology, 4(8), 224. https://doi.org/10.1186/gb-2003-4-8-224

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She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach.  She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).

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Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.

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