Agoraphobia creeps up on you slowly, usually after you start having panic attacks; but unlike panic attacks that come out of the blue, there is chance to halt agoraphobia; if you can spot the early signs you are in a position to do something about it. This is what prompted me to write today’s article; I wanted to give you the benefit of 20 years of clinical knowledge to help you spot your own signs of agoraphobia before it takes hold.
If you’re reading this article as you think you might have agoraphobia, I recommend reading as much as possible about the subject, as it can take away some of the fear. You can start with my Guide to Agoraphobia and if you are wanting an assessment, you can reading my article on how to get agoraphobia diagnosed in Ireland.
I’ve been working as a psychologist for over 20 years and here are some of the most common changes that I heard from clients over the years.
- What feels safe gets shorter and shorter from home
- You feel fine close to home, but uncomfortable going further.
- A 20-minute drive that used to be nothing now feels “too far”.
- Shop more “online” than in-person
- Groceries move from the supermarket to online delivery.
- You avoid busy shops and tell yourself it’s “just more convenient”.
- You have a “safe person” that goes places with you
- Outings feel manageable only if a partner, friend or family member comes too.
- You turn down invitations if you’d have to go alone.
- Constant escape planning
- On the bus or in a café, you automatically clock the exits.
- You sit on the aisle, near the door or “just in case” spots.
- You feel a sense of relief when you know you can leave quickly.
- Subtle avoidance
- You start choosing the quietest times of day to go places.
- You skip certain routes, car parks, or particular shops because “they’re too busy” or “the parking is awkward”.
- You turn down events that involve crowds, queues, or long journeys.
- Anxiety about feeling trapped or far from help
- You feel uneasy in places where you worry you couldn’t get out or get help quickly: motorways, big shopping centres, trains, long queues.
At this stage, it may not look like classic “agoraphobia” from the outside but these are what I call the early warning signs of agoraphobia and it helps if you take note of them. There are subtle differences between just being nervous and experiencing early signs of agoraphobia and I shall help you differentiate between the two now.
Normal nerves vs agoraphobia
Everyone feels nervous sometimes — before a big exam, a talk at work, or visiting a new place. That’s part of being human. So what’s the difference between normal nerves and the early signs of agoraphobia?
Think in terms of pattern, intensity and impact.
Normal nerves
Normal nerves usually:
- Are tied to specific, understandable stressors (e.g. first day in a new job).
- Settle once you’re there and the situation proves safe.
- Don’t make you reorganise your whole life around avoiding the thing.
- Come and go – you’re not thinking about them most of the day.
Example:
You feel butterflies before giving a presentation, you’re a bit shaky at the start, then you settle and move on with your day.
The start of agoraphobia
Early agoraphobia tends to look more like:
- Persistent worry about certain places or situations, even days before.
- Fear centred on not being able to escape or get help if something goes wrong (often if you have a panic attack).
- Steady avoidance of more and more situations (public transport, crowds, being far from home).
- Safety behaviours, like only going out with someone, always sitting near exits, carrying “just in case” items (water, tablets, phone on 100% charge).
- A growing sense that your world is getting smaller, and day-to-day life is shaped by “Will I panic?” rather than “What do I want to do?”.
A useful question is:
“Is anxiety sometimes part of my life, or is it quietly running the show?”
If anxious thoughts and avoidance are beginning to dictate where you can go, who you can see and what you can do, that’s moving closer to agoraphobia territory.
Simple self-check questions
The following is not a diagnostic tool, but a self-test for agoraphobia .
You might like to read them slowly and answer “rarely / sometimes / often”.
Everyday life and avoidance
- Do you plan outings around escape routes, exits or where you can sit to leave quickly?
- Do you avoid certain places (e.g. supermarkets, shopping centres, motorways, public transport) because you’re afraid you might panic or feel trapped?
- Have you switched to online options (shopping, appointments, social contact) mainly to avoid leaving home?
- Do you feel you need someone with you to do things you used to do alone (e.g. short journeys, local shops, cafés)?
- Do you regularly say “no” to invitations because of how you might feel getting there or being there, rather than whether you want to go?
Thoughts and fears
- When you think about leaving home, do you often imagine worst-case scenarios (collapsing, not getting help, “going mad” in public)?
- Do you frequently worry days in advance about specific trips, appointments, or places?
- Do you ever think, “I’ll only go if I can sit near the exit / leave whenever I want / drive my own car,” and avoid it if that’s not possible?
- Do you feel embarrassed or ashamed about how anxious you feel outside, and try to hide it from others?
Body and panic
- Have you had sudden surges of anxiety or panic (racing heart, breathlessness, dizziness, shaking, feeling unreal) in specific places, and then avoided those places afterwards? nhs.uk+1
- Do you get anxious just from remembering a past panic episode or imagining one happening again?
- Do you ever think, “If I have a panic attack there, no one will help me or I won’t be able to escape”?
Impact on your life
- Have you started to limit how far from home you’ll travel, even for nice things?
- Are important parts of your life (work, study, parenting, relationships) beginning to suffer because of how much you avoid going out?
- Do you feel your world is gradually getting smaller, and it takes more energy and planning just to do normal things?
If you’re noticing a pattern of “often” to several of these, especially around avoidance, needing a safe person, and panic fears, it doesn’t mean you definitely “have agoraphobia” – that needs a proper assessment – but it does mean that you really should look at your anxiety as it is pointing towards quite a restricted life.
When to get professional support
You don’t have to wait until you’re housebound to ask for help. In fact, the early signs of agoraphobia are the ideal time to get support, because habits of avoidance are easier to shift when they’re still fairly new.
Here are some pointers that it’s worth speaking to someone:
- Avoidance is spreading
You notice more and more places on your “no” list – not just one tricky situation. - You’re rearranging your life around fear
You choose jobs, routes, appointments and social plans based primarily on “Will I panic?” rather than “Is this right for me?” - You’re feeling low, stuck or ashamed
You might feel frustrated with yourself, guilty about letting others down, or a bit hopeless that things will change. - You’re using alcohol or tablets just to manage leaving the house
That’s a big red flag that the anxiety is too heavy to carry by yourself. - You’ve had frequent or intense panic attacks, and now you’re avoiding places because of them
This often points to panic disorder with agoraphobic avoidance, which responds very well to evidence-based treatment.
Where to start in Ireland
Your GP
When I worked in private practice, most people that I saw for therapy were referred by their GP.
I would recommend getting an appointment, or telephone conversation if you find it hard to go out, and then can help you with the next steps. The HSE seems to favour the stepped care approach adopted by the NHS, where you start with self-help before moving on to intensive therapy.
Talking therapies
Psychological therapies such as Cognitive Behavioural Therapy (CBT) are considered first-line treatments for panic and agoraphobia. A CBT therapist can help you understand how your brain’s alarm system works, and guide you through graded exposure to help you get your life back..
Private and online therapy
If waiting lists are long, you might choose private anxiety counselling. If leaving home is already very difficult, you can look at my online self-help program for panic and agoraphobia.
Recap
If after reading this article you can see the early warning signs of agoraphobia in your life, try not to be frightened of it; it is in fact a good thing, as you are in the position to do something about it before it gets to the stage of actually having agoraphobia.
