The Differences Between Agoraphobia and Social Phobia
We’re all afraid of something, but phobias go far beyond the simple fear of a general or specific concept. People with this type of anxiety disorder experience severe stress, flight response, anxiety, and certain measurable physiological changes when exposed to their stressor. Agoraphobia and social phobia are different disorders and in order to treat them, you have to know their differences.
Sometimes, we attribute the term “phobia” to a simple rejection of certain uncomfortable situations, while in other cases, we don’t want to recognize that the reluctance to an abstract or concrete concept goes beyond what’s normal. On this opportunity, we want to immerse ourselves in the world of phobias, and we’ll tell you the most important differences between agoraphobia and social phobia. Keep reading.
General concepts about phobias
Before entering fully into the subject that concerns us here, we’ll want to explore the world of phobias from a general point of view. The Navarra University Clinic (CUN) defines this group of disorders as “a fear of situations or things that aren’t dangerous and that most people don’t find bothersome.”
On a clinical level, phobias are included in the group of anxiety disorders, whose common point is stress, fear, and behavioral changes associated with certain scenarios. There are 3 types of phobic pictures from a general point of view: Specific phobias, agoraphobia, and social phobia.
Specific phobias are the most well-known among the general population, as it’s common for people to develop an exaggerated fear of animals and arachnids (arachnophobia), heights (acrophobia), closed places (claustrophobia), or injections (trypanophobia). According to studies, these anxiety disorders affect 7.7% to 12.5% of the inhabitants.
General diagnostic criteria for phobias
Although specific phobias aren’t the same as agoraphobia or social phobia, their general diagnostic criteria help us to frame these anxiety disorders as a common pathological group. To detect them, the Diagnostic and Statistical Manual of Mental Disorders follows the points listed below:
- Marked fear or anxiety towards a specific object or situation (needles, animals, flying in an airplane, or seeing blood, for example). As we’ll see below, the phobias that concern us here are somewhat more diffuse.
- The phobic stressor almost always elicits an immediate anxiety and fear response.
- Feelings of fear and anxiety are out of proportion to the true “danger” that the patient faces.
- The object/event/situation that elicits the phobic response is intentionally and actively avoided.
- Exposure to the stressor causes distress observable at the physical level. This includes sweating, racing heartbeat, panting, choking, and gastric discomfort.
- The fear and anxiety towards the stressor are persistent, at least for more than 6 months.
- The sensation perceived by the patient can’t be explained by another disorder or clinical picture.
Diagnosing specific phobias is relatively simple, as there’s a specific object or situation that generates the response. In any case, agoraphobia and social phobia are more “diffuse” concepts, as we’ll see below when exposing their differences.
What are the differences between agoraphobia and social phobia?
First of all, we must emphasize that the existing types of phobias are anxiety disorders, but agoraphobia and social phobia are distinguished from specific phobias by a number of psychological criteria. Next, we’ll break down point by point the disparities between the two concepts.
1. Agoraphobia refers to the environment, while social phobia has to do with public evaluation
We’ll begin with the definitions of each of the conditions. The National Cancer Institute (NIH) defines agoraphobia as an intense fear of being in open places or in situations from which it may be difficult to escape (or where help isn’t available). Typically, these scenarios are perceived in public transit, shopping centers, or anywhere outside the home.
Exposure to the “unprotected place” causes clear clinical signs and can lead to a panic attack. Out of fear of symptoms, these people avoid problem spaces and tend to stay at home more. This condition differs from specific phobias because the scenario posed is non-specific.
On the other hand, the United States National Library of Medicine defines social phobia as a persistent and irrational fear of situations that may involve scrutiny and judgment by others, such as a party or a social event. In other words, fear is found in the possibility that the human environment will make negative judgments about the patient.
Again, social phobia is distinguished from specific phobias, as irrational fear extends to many generalized settings in which the patient has to socialize with other human beings. There are subclinical forms of this condition that can be considered more specific, but they’re not part of this anxiety disorder.
Therefore, the first of the differences between agoraphobia and social phobia can be summarized in the following point: A person with the disorder is afraid of the scene and lack of protection, while a patient with social phobia fears the human component of the situation and the judgments that others may perceive and make about them.
Although they’re different pictures, agoraphobia and social phobia are characterized by their general nature. Fear isn’t specific to an object or situation, but to a set of parameters.
2. They’re clinical conditions with diverse symptoms
The symptoms of agoraphobia and social phobia are different from each other, but both can lead to a panic attack depending on the scenario and the patient. Let’s see what they consist of separately.
The symptoms of agoraphobia
The Mayo Clinic summarizes the symptoms of agoraphobia, and we’ll present them to you in the following list:
- Fear of leaving home alone, crowds, waiting in a line with many people, closed spaces (cinemas, elevators, or small establishments), open spaces (trains, bridges, shopping centers, or parking lots) and fear of using public transport.
- Prolonged fear and anxiety regarding the events mentioned for a period of 6 months or more.
- Avoidance of events that produce anxiety and fear, which usually results in minimizing outings outside the home.
- Significant distress and problems arising from exposure to the event.
In addition, agoraphobia is characterized by the fear of having a panic attack in the aforementioned scenarios. Sometimes, the fear lies in the possible sensations that the environment generates in the person and not as much in what surrounds them.
The symptoms of social phobia
The same source cited above shows us the general symptoms of social phobia in the following list:
- Fear of situations in which the person could be judged, embarrassed, or humiliated
- Intense fear when interacting with strangers
- Intense fear of others noticing the patient’s anxiety
- Fear of physical symptoms that the social situation may generate, such as sweating, blushing, tremors, or instability of the voice
- Putting aside certain (or all) social situations out of fear of judgment or embarrassment
- Analyzing personal performance and possible failures after each social situation
- Expecting the worst possible consequences of a social situation
- Other physical symptoms, such as a rapid heartbeat, flushing, hyperhidrosis (excessive sweating), muscle tension, dizziness, and feeling stuck
As you can see, people with social phobia manifest their symptoms when they have to interact with the human environment, while patients with agoraphobia are afraid of the scenario itself or the panic attack that it may cause.
Symptoms of a panic attack
Situations that lead to social phobia or agoraphobia can lead to a panic attack. To close this section, we’ll show you its symptoms:
- Fear of dying or feeling of impending doom
- Palpitations and tachycardia, that is, an increase in heart rate above 100 beats per minute
- Chills, hot flashes, and nausea
- Chest pain and headache
- Difficulty breathing and feeling short of breath
- A feeling of disconnection and unreality
- A very intense fear that the panic attack will recur once it ends
Panic attacks can recur over time and are difficult to treat, but they don’t cause death on their own. As much as patients feel that they’re on the verge of dying, they must be convinced that all the sensations they have will pass in a variable time interval and that they’re not in real danger.
Social phobia and agoraphobia present with different symptoms, but both anxiety disorders can cause panic attacks.
3. The epidemiological patterns of both disorders are different
Anxiety disorders like these are very common in general society, as it’s estimated that 17.2% of the general population in countries like the United States presents one or more forms of these clinical pictures. The most common of all is a simple or specific phobia, with a prevalence of 8.8% of the population.
Beyond general statistics, other differences between agoraphobia and social phobia are their own epidemiological figures. For example, the Statpearls medical portal estimates that agoraphobia occurs in 1.7% of the general population. It also mentions that the majority of cases are established before the age of 35 and that the epidemiological peak is at 17 years of age.
At the same time, social phobia is much more common than agoraphobia. It’s estimated that it affects 5-10% of the entire world population and that the chances of suffering it throughout life reach up to 15% in certain age groups. This makes it the most common anxiety disorder in the world and the third most diagnosed psychiatric illness, second only to addiction and depression.
Social phobia is much more prevalent than agoraphobia and affects children, adolescents, and adults equally.
4. The causes of each clinical picture are very different
Talking about the causality of psychiatric disorders is quite complex, as most of them are multifactorial entities that respond to genetic predisposition, previous experiences, brain structure, hormonal imbalances, and much more. However, there are certain predisposing factors that are associated with each anxiety disorder.
Causes of agoraphobia
In part, some cases of agoraphobia can be explained by the following parameters:
- Use of certain substances: The chronic use of tranquilizers and benzodiazepines has been associated in some investigations with the appearance of agoraphobia. Interestingly, these same drugs are used to alleviate other anxiety disorders.
- Attachment theory: Although this issue is quite complex, the central concept can be summarized by the patient’s intolerance toward being away from a “secure base”, such as their home.
- Spatial theory: In recent years, the relationship of the environment with the appearance of agoraphobia has been analyzed with special interest. It’s believed that this anxiety disorder could be linked to the modernization of the environment, that is, to the presence of many open spaces, vehicles, clusters of people, and urbanized structures.
Beyond these theories, there’s no consensus on the degree of relationship that experiences during childhood, the patient’s personality, and psychosocial risks may have in the development of agoraphobia.
Causes of social phobia
In contrast, we’ll present some of the triggers of social phobia in the following list:
- Genetics: It’s complex to identify genetic markers that link the DNA of a family tree with social anxiety, but a certain correlation has been detected. For example, identical twin brothers who are raised in different environments have a 30-50% chance of having the condition at the same time.
- Social experiences: Unlike agoraphobia, social phobia can be linked in many cases to certain specific traumatic events.
- Cultural influences: Education focused on shame and reserve has historically been associated with social anxiety. For example, children are more likely to present this type of phobia when the importance of the opinion of others is overemphasized and shame is used as a weapon to repress them.
- The consumption of certain substances: Alcohol is often used to alleviate the symptoms of social phobia, but excessive consumption can make it worse in the long term.
Therefore, we can summarize this point in that the causality of social phobia is somewhat better known than that of agoraphobia. Although both clinical pictures continue to present many unknowns, genetic inference and cultural influences have been further explored in the social sphere.
Two anxiety disorders that need to be treated
Here, we’ve presented the main differences between agoraphobia and social phobia, but you shouldn’t forget that both clinical pictures are about disorders that must be treated. Experiencing panic when leaving the house and being in public spaces or going to a social gathering isn’t normal: Being an introvert is a trait, but having phobic tendencies indicates a disease.
Both disorders respond well to the joint action of psychotherapy and a pharmacological approach. If you’ve seen yourself reflected in any of these lines and you have symptoms of any psychiatric disorder for more than a few days, don’t hesitate to seek professional help. Getting better is always possible if you get the right care on time.It might interest you...
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