The Relationship Between Agoraphobia and Social Anxiety

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It's not too surprising that agoraphobia and social anxiety disorder are closely connected. When you're afraid of going outside it makes sense it would include a fear of interacting with other humans.

Still, they aren't the same thing and it's important to understand the similarities and differences between the two as you seek diagnosis and treatment for your symptoms.

At a Glance

Agoraphobia and social anxiety disorder frequently occur together, and this is thought to occur more than half the time. When this happens, the symptoms appear to be more severe than if one of these conditions were present. Fortunately, treatments are available for both disorders, which can help to get to the base of the problem and restore a person's life.

What's the Connection?

Agoraphobia and social anxiety are closely related conditions but have some important differences in the causes of the symptoms.

With agoraphobia, it is the fear of enclosed places, transportation, and leaving home that leads to isolation, but the primary fear is that escape may not be possible and/or the embarrassment of a panic attack. Agoraphobia isn't exclusively anxiety about being around people.

In contrast, with social anxiety disorder, it is the exposure to people and the chance of being judged that leads to emotional and sometimes physical distress. Whereas a person with agoraphobia often welcomes a companion, this is not the case with social anxiety disorder.

So essentially, if you're agoraphobic you probably have social anxiety disorder, but if you have social anxiety disorder you aren't necessarily agoraphobic (maybe you just live in a small town without a ton of people!)

Association With Panic Attacks and Panic Disorder

Agoraphobia is typically thought of as the fear of leaving your home. While it is true that many people with agoraphobia are housebound, agoraphobia actually refers to the fear of being in situations or places from which escape would be difficult or embarrassing in the event of a panic attack. In a sense, it can be thought of as having a fear of having a panic attack.

Agoraphobia usually leads to the avoidance of specific places such as crowds, automobiles, buses, trains, elevators, and bridges. In addition, people with agoraphobia may fear leaving the house alone. Most people with agoraphobia are better able to cope if in the company of a trusted companion.

Although agoraphobia can be diagnosed without panic disorder, over 95 percent of people diagnosed with agoraphobia also have a diagnosis of panic disorder.

Agoraphobia most often occurs in conjunction with panic disorder. When agoraphobia is diagnosed without panic disorder, severe anxiety is experienced but not to the degree that it constitutes a panic attack.

How They Differ

Although both agoraphobia and social anxiety disorder (SAD) can involve the fear of public places, people with SAD feel anxiety only in situations where scrutiny by others may occur. For example, being on an elevator alone or in a car alone would not be uncomfortable.

While people with agoraphobia usually feel better in the company of a trusted companion, people with social anxiety disorder may feel worse because of potential scrutiny by the companion as well.

Agoraphobia
  • Fear of leaving house

  • Fear of having a panic attack in public places

  • Fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong

  • Feel better with trusted companion

SAD
  • Fear of public places

  • Fear of situations where scrutiny by others may occur

  • Fear of being in a position of being negatively judged

  • Feel worse with trusted companion due to fear of scrutiny

Comorbidity

When it is difficult to distinguish between the anxiety of agoraphobia and SAD, it may be that both diagnoses apply.

Results of an older National Comorbidity Survey conducted in the United States showed a correlation of .68 between diagnoses of agoraphobia and social anxiety disorder, meaning that the two disorders occurred together around 68 percent of the time. More recent studies have found that major depression is often a comorbidity as well.

Some studies suggest that having both disorders together is more common in women than in men and that when both disorders are present, the course tends to be more severe.

Studies comparing the particular neurophysiological pathways in the brain with different anxiety disorders have found a close correlation between pathways in agoraphobia and social anxiety disorder, though these differ somewhat from those involved in other anxiety disorders such as obsessive-compulsive disorder.

Coping

There are effective treatments that can help with symptoms of agoraphobia and social anxiety disorder and there is considerable overlap.

Ways of managing agoraphobia and treatments for social anxiety disorder can often help with the other condition as well, although treatments such as systemic desensitization and others are used primarily with agoraphobia.

This underlines the importance of an accurate diagnosis and the care of a psychotherapist with whom you feel comfortable.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Arlin Cuncic, MA
Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.