The Relationship Between Agoraphobia and Social Anxiety

Agoraphobia and Social Anxiety Often Go Together

People with agoraphobia fear leaving their home.
Getty / E+ / Don Bayley

You may have heard that agoraphobia and social anxiety disorder are closely connected and that's true. What have we learned about the similarities and differences between these disorders as well as how often they occur together?

The Relationship of Agoraphobia and Social Anxiety Disorder

Agorphobia and social anxiety disorder are interrelated in many ways. In order to understand this, it's helpful to talk about the definition of these disorders, how the two may differ, and how to tell them apart.

That said, many people have both agoraphobia and social anxiety disorder, a phenomenon referred to in medicine as "comorbidity."

Let's take a look at what we've learned about the interaction of these two conditions.

Agoraphobia and It's 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.

Agoraphobia most often occurs in conjunction with panic disorder. Although agoraphobia can be diagnosed without panic disorder, over 95 percent of people diagnosed 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. 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.

Comorbidity of Agoraphobia and Social Anxiety Disorder

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.

Other 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 with Agoraphobia and/or Social Anxiety Disorder

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 pscyhotherapist with who you feel comfortable.

Bottom Line on the Relationship Between Agoraphobia and Social Anxiety Disorder

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 of having a panic attack when exposed to those circumstances. In contrast, with social anxiety disorder, it is the exposure to people 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.

That said, 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 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 persons life.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, DC. 2013. Print.

Gerez, M., Suarez, E., Serrano, C., Castanedo, L., and A. Tello. The Crossroads of Anxiety: Distinct Neurophysiological Maps for Different Symptomatic Groups. Neuropsychiatric Disease and Treatment. 2016. 12:159-75.

Kogan, C., Stein, D., Maj. M. et al. The Classification of Anxiety and Fear-Related Disorders in the ICD-11. Depression and Anxiety. 2016. 1141-1154.

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