Many people believe agoraphobia and autism are closely related. Yet, evidence suggests that the association between the two may be weaker than commonly assumed.
Below, we’ll examine the link between agoraphobia and autism, why we typically perceive the two as intrinsically linked, and how agoraphobia may impact an autistic individual’s everyday life.
What’s the Link Between Agoraphobia and Autism?
Research indicates that although agoraphobia appears to affect around 25% of individuals with autism, this condition is less prevalent than some other anxiety disorders, such as social phobia and generalized anxiety disorder.
In autism spectrum disorder (ASD), comorbidities are highly prevalent. Around 86% of individuals with autism have at least one comorbid psychiatric diagnosis.
The conditions most frequently associated with ASD are attentional deficit hyperactivity disorder (ADHD), anxiety, and depression. However, some believe it’s challenging to differentiate between the conditions due to their overlapping symptomatologies.
Agoraphobia and ASD
Evidence suggests that while agoraphobia is more common in ASD than in the wider population, you often see one without the other.
Previous research has shown that, among those with asperger syndrome (one form of ASD), 26% suffered from a phobia of some sort. Under the umbrella term ‘phobia’, they included agoraphobia, panic disorder, social phobia, and obsessive-compulsive disorder (OCD).
A comparative study broke “phobias” down into individual conditions. They found that around two thirds of the 63 ASD participants had social phobia, approximately 25% suffered from generalized anxiety disorder, and almost 23% from agoraphobia.
Interestingly, this effect only seems to appear in ASD adults with no intellectual disability.
Intellectual Disabilities, Autism and Agoraphobia: A Deeper Look
A recent 2020 study found that agoraphobia and social phobia rates were higher for autistic adults without intellectual disability than for ASD individuals with an intellectual disability as well as those in the general population.
Adults with ASD and intellectual disability were more likely to experience a non-specified group of ‘other phobias.’
Furthermore a study comparing 34 autistic adults with 20 adults with intellectual disabilities found that autistic participants scored significantly higher in:
- Agoraphobia
- Separation anxiety
- OCD
- Generalized anxiety disorder
These findings suggest that not only is agoraphobia more common in the ASD population than it is in the non-ASD population, but it’s also more likely to appear in moderate to higher-functioning ASD individuals than those functioning at a lower level.
Why Do We Overestimate the Link Between Agoraphobia and ASD?
The general public typically believes there’s a close link between agoraphobia and autism, despite the evidence suggesting it occurs less commonly than other comorbidities.
Why might this be?
It may come down to the presenting issues those with ASD display. For example, autistic individuals typically find socializing and highly stimulating environments overwhelming, which may make them less likely to enter crowded spaces.
They also often struggle with changes in their routines, so the unpredictability of cities and busy places can be highly anxiety-provoking. Agoraphobia is often confused with social anxiety for the same reason.
Autism & Social Anxiety Disorder
Richelle Whittaker, an educational psychologist and therapist, suggests that autism and social anxiety disorder have numerous overlapping symptoms:
- Agitation/nervousness
- Difficulties around change
- Avoidance of eye contact
- Reduced social communication skills
This idea may explain the broad assumption that those with ASD also typically have agoraphobia.
Agoraphobia in People with Autism
Agoraphobia is triggered by specific situations such as crowds, enclosed spaces (like elevators), bridges and public transport.
This fear worsens with the anxiety associated with the repercussions of being in these spaces–panic attacks and other incapacitating symptoms.
It’s estimated that around 1.3% of US adults experience agoraphobia during their lifetimes. Therefore, with a prevalence of 23% in ASD individuals, agoraphobia is much more common in the autistic population.
The question is, are autistic individuals born with a predisposition for agoraphobia, making them more prone to developing the condition, or is it a result of environmental factors?
Evidence suggests that autistic individuals may be more likely to experience anxiety as compared to the general population. There is less research looking into the relationship between autism and agoraphobia specifically.
Sensory Processing Sensitivity: A Possible Cause?
The connection between agoraphobia and autism may be partly due to sensory processing sensitivity.
Autistic individuals often struggle to process everyday sensory information and may have a hypersensitive sense of hearing, smell, touch, taste, or sight.
For example, ASD individuals who are oversensitive to light may find the bright, white lights of malls and stores overwhelming. At the same time, those who are particularly sensitive to sound may struggle to attend a soccer match.
When an ASD individual with sensory processing difficulty is exposed to over-stimulation, this can lead to sensory overload, also known as a ‘meltdown’. The presentation of a ‘meltdown’ differs depending on the ASD individual and the environment to which they’re exposed.
An autistic individual may withdraw from their environment by zoning out or staring blankly. Alternatively, they may demonstrate outward distress by crying, screaming, or attempting to run away.
People with ASD and agoraphobia may have a perpetual fear of going to new places and trying new things. The combination of these conditions can (and often does) result in social exclusion and a worse quality of life.
Related: In-person or online therapy for agoraphobia are both viable options when seeking treatment for the condition. However, for individuals with autism, it's recommended to seek agoraphobia treatment from a practitioner who also specializes in ASD.
The Bottom Line
Autism spectrum disorder is a developmental condition commonly associated with anxiety disorders. Evidence reveals that around ¼ of autistic individuals may experience agoraphobia, an intense fear of being trapped, helpless or embarrassed that is triggered by being in busy or enclosed spaces.
The link between the two conditions may come down to sensory processing difficulties. These appear particularly common in the ASD population and may result in a ‘meltdown’ in over-stimulating environments, thus leading to avoidance of these situations in the future.
However, we need more research to understand the relationship between these two complex conditions fully.
- Mohammadi, M. R., Ahmadi, N., Khaleghi, A., Zarafshan, H., Mostafavi, S. A., Kamali, K., Rahgozar, M., Ahmadi, A., Hooshyari, Z., Alavi, S. S., Shakiba, A., Salmanian, M., Molavi, P., Sarraf, N., Hojjat, S. K., Mohammadzadeh, S., Amiri, S., Arman, S., & Ghanizadeh, A. (2019). Prevalence of Autism and its comorbidities and the relationship with maternal psychopathology: A national population-based study. Archives of Iranian medicine, 22(10), 546–553.
- Roy, M., Prox-Vagedes, V., Ohlmeier, M. D., & Dillo, W. (2015). Beyond childhood: Psychiatric comorbidities and social background of adults with Asperger syndrome. Psychiatria Danubina, 27(1), 50–59.
- Joshi, G., Wozniak, J., Petty, C., Martelon, M. K., Fried, R., Bolfek, A., Kotte, A., Stevens, J., Furtak, S. L., Bourgeois, M., Caruso, J., Caron, A., & Biederman, J. (2013). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: A comparative study. Journal of Autism and Developmental Disorders, 43(6), 1314–1325. https://doi.org/10.1007/s10803-012-1679-5
- National Institute of Mental Health. (n.d.). Agoraphobia. https://www.nimh.nih.gov/health/statistics/agoraphobia#:~:text=Prevalence%20of%20Agoraphobia%20Among%20Adults,-Based%20on%20diagnostic&text=An%20estimated%201.3%25%20of%20U.S.,some%20time%20in%20their%20lives.
- Mayer, B. A. (2021, September 16). What's the link Between Autism and anxiety? experts weigh in. Healthline. https://www.healthline.com/health/autism/autism-and-anxiety#anxiety-signs
- National Autistic Society. (n.d.). Sensory differences–A guide for all audiences. https://www.autism.org.uk/advice-and-guidance/topics/sensory-differences/sensory-differences/all-audiences#:~:text=Processing%20everyday%20sensory%20information%20can,effect%20on%20a%20person%27s%20life.
- Nimmo-Smith, V., Heuvelman, H., Dalman, C., Lundberg, M., Idring, S., Carpenter, P., Magnusson, C., & Rai, D. (2020). Anxiety disorders in adults with Autism Spectrum Disorder: A population-based study. Journal of Autism and Developmental Disorders, 50(1), 308–318. https://doi.org/10.1007/s10803-019-04234-3
- Gilliott, A., & Standen, P. J. (2007). Levels of anxiety and sources of stress in adults with Autism. Journal of Intellectual Disabilities, 11(4), 359–370. https://doi.org/10.1177/1744629507083585
- Mayer, B. A. (2021, November 3). How to tell the difference between Social Anxiety and Autism. Healthline. https://www.healthline.com/health/autism/social-anxiety-vs-autism#similarities
