Agoraphobia and OCD – Are they related?

On the surface, some might say that agoraphobia and obsessive-compulsive disorder have a lot in common. Both disorders are often accompanied by rigid and inflexible coping behaviors, and both seem to be related to a sense of fear and anxiety.

But just how similar are these disorders? Do mental health experts classify them in the same diagnostic category? What is the degree of comorbidity?

Agoraphobia and OCD: Is there a relationship?

The DSM-5-TR classifies agoraphobia as an Anxiety Disorder, while OCD is listed separately in the Obsessive Compulsive and Related Disorders chapter. Both agoraphobia and OCD can impair day-to-day life, and both have anxiety as a common denominator.

Disorder Classification

First and foremost, Obsessive-Compulsive disorder and agoraphobia are not classified in the same category of disorders.

The latest edition of The Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR, lists agoraphobia as an independent Anxiety Disorder.

OCD, on the other hand, is categorized under the DSM’s ‘Obsessive Compulsive and Related Disorders chapter’ together with Trichotillomania and Body Dysmorphic Disorder.

Similarities between Agoraphobia and OCD

At their core, both disorders are strongly linked to fear and inflexible coping behaviors. But what else do these disorders have in common?

• Both disorders share anxiety as a commonly experienced symptom, along with safety seeking behaviors and overestimation of risk.
• Neurobiological similarities—both disorders involve, to some extent, the striatum and amygdala circuitry.
• Hypochondriasis and Specific Phobias were found as two of the main common predictors of Panic Disorder and agoraphobia.
• In patients suffering from both agoraphobia and panic attacks, behavioral treatment has been shown to reduce obsessive-compulsive symptoms.
• Cognitive-Behavior Therapy (Response Prevention in particular) and antidepressants have also been shown to improve both conditions.

Key differences between Obsessive-Compulsive Disorder and Agoraphobia

Other than being classified differently in the DSM-5-TR, both agoraphobia and OCD have a few other crucial points of difference:

• A key cognitive misbelief for OCD is excessive responsibility, while ‘fear of fear’ is a characteristic for agoraphobia.
• Anxiety is strictly connected to the specific obsessions’ nature for OCD, while in agoraphobia it refers to the anticipation or a situation perceived as alarming.
• Anxiety is not associated to OCD severity as it could be in agoraphobia.
• Situational avoidance in OCD presents in a highly stereotypical, repetitive way towards a specific factor (e.g., fear of contamination implies avoiding hospitals). However, it occurs in a more generalized manner in agoraphobia (e.g., all public spaces trigger agoraphobia).

Anxiety Disorders & OCD frequently occur together:

Research has discovered a lifetime prevalence of agoraphobia within OCD patients of 4.9%, a notably lower rate than patients who suffer from agoraphobia and Panic Disorder.

It’s also been found that agoraphobic individuals who suffered from panic attacks, report a remarkably higher number of obsessive-compulsive complaints compared to the general population.

Lastly, patients with both Obsessive-Compulsive Disorder and agoraphobia have also been reported to display higher rates of co-occurring impulsive-compulsive internet use, Social Phobia and Binge Eating Disorder when compared to patients with OCD, agoraphobia and Panic Disorder.

What causes both disorders?

The specific causes for these disorders are largely unknown; however, there are some associated risk factors:

• OCD – stress (caused by relational, occupational, or social factors), family history of OCD, and biological-cognitive factors.
• Agoraphobia – having a co-occurring disorder, a family history of agoraphobia, experiences of trauma, and neurochemistry.

The best solution for these conditions is seeking professional help as soon as possible; treatments include psychotherapy and/or medication.

In the meantime, a good self-care regimen may prove beneficial:

• OCD – a healthy diet, physical exercise, quality sleep, relaxation techniques, and having a support system in and outside of the family.
• Agoraphobia – a healthy diet, aerobic and anaerobic exercise, relaxation techniques, a trained service dog, avoiding substance use, and limiting caffeine.

In Summary

Agoraphobia and OCD are heterogeneous and complex conditions that can prevent living a healthy lifestyle

It should be noted, however, that it might be common to mildly experience the above symptoms from time to time because they are part of the human experience.

It’s important to keep in mind that a disorder diagnosis requires a specific number of symptoms comprising important areas of life (e.g., social or occupational) for a given amount of time.