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What is the Relationship Between Agoraphobia and Social Anxiety Disorder?

Agoraphobia and Social Anxiety

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Agoraphobia is typically thought of as the fear of leaving your home. While it is true that many agoraphobics 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.

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

Agoraphobia most often occurs in conjunction with panic disorder. Although agoraphobia can be diagnosed without panic disorder, in clinical settings over 95% of people with agoraphobia also have a diagnosis of 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 do Agoraphobia and Social Anxiety Disorder 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. While people with agoraphobia usually feel better in the company of a trusted companion, people with SAD may feel worse because of potential scrutiny by the companion as well.

Comorbidity of Agoraphobia and SAD

When it is difficult to distinguish between the anxiety of agoraphobia and SAD, it may be that both diagnoses apply. Results of the National Comorbidity Survey conducted in the United States in 1996 showed a correlation of .68 between diagnoses of agoraphobia and SAD, meaning that the two disorders frequently occur together.

In addition, a 1993 study of the overlap between SAD and agoraphobia revealed that the disorders are more likely to co-occur in women, and that when both disorders are present, the course tends to be more severe.

Sources:

Degonda M, Angst J. The Zurich study: XX. Social phobia and agoraphobia. European Archives of Psychiatry and Clinical Neuroscience. 1993;243(2):95-102.

Magee WJ, Eaton WW, Wittchen H-U, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry. 1996;53(2):159-168.

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