Unsure if your anxiety aligns with the criteria for OCD or agoraphobia? People can develop a persistent fear of leaving the house for various reasons, and the factors contributing to these fears can be complex. Agoraphobia and OCD are two possible explanations for this sticky fear of leaving home. Let’s explore the commonalities and distinctions between them.
Understanding OCD
Obsessive-compulsive disorder (OCD) is characterised by persistent, intrusive thoughts (see examples of obsessions) and repetitive behaviours or mental acts (compulsions) aimed at reducing the distress caused by these thoughts.
Obsessions
Obsessions in OCD are distressing, intrusive thoughts, images, or urges that persistently enter a person’s mind. These thoughts are often unwanted and cause significant anxiety and discomfort. People with OCD may recognise that these obsessions are irrational, yet they struggle to let them go. The content of obsessions can vary widely, including fears of harm coming to oneself or others, contamination concerns, fears of making a mistake, or taboo thoughts that go against one’s values.
A person with OCD centred on the fear of leaving the house might experience obsessions regarding potential outcomes or emotions they might face during such outings. Examples of intrusive thoughts are “I will harm someone if I leave the house”, “I will get hurt or have an accident if I leave the house”, “I will get sick if I go out”, or “My house will burn down while I am away”.
Compulsions
Compulsions are repetitive actions or mental rituals performed in response to the distress triggered by obsessive thoughts. These behaviours are aimed at preventing feared events or reducing the anxiety associated with the obsessions. Examples include checking rituals, where individuals repeatedly verify locks or appliances; cleaning and washing excessively to ease contamination fears; counting; arranging objects in a specific manner; engaging in mental rituals like repeating words; seeking constant reassurance; avoiding triggering situations; or performing touch or tapping rituals. These compulsive behaviours provide temporary relief but contribute to the ongoing cycle of OCD.
Someone with a fear of leaving the house may adopt various avoidance strategies, such as refraining from going out, restricting outings to perceived safe spaces that do not trigger intrusive thoughts, or repeatedly checking that household appliances are switched off before departing.
Understanding agoraphobia
Agoraphobia is an anxiety disorder marked by an intense fear of situations or places where escape might be challenging or where assistance may not be readily available during distress. People with agoraphobia go to great lengths to avoid these situations.
Fears linked to agoraphobia include the dread of feeling trapped or overwhelmed, the fear of exposure or the inability to find a safe space, concerns about potential judgement from others or embarrassment, fear of confinement, and the apprehension of experiencing panic attacks or medical emergencies in public. The fear of being alone outside the home further intensifies these anxieties.
To cope with these fears, people often adopt avoidance behaviours, including the avoidance of crowded spaces such as shopping malls or public transportation. They may avoid open areas, opt for the company of a companion for added security, eschew social gatherings, stay away from enclosed spaces like elevators or tunnels, and minimise or avoid travel altogether.
Then, what are the differences between OCD and agoraphobia and how can I tell if it is one thing or the other?
Both conditions involve avoidance behaviours in response to anxiety. The experience of anxiety is a unifying factor, whether it’s linked to intrusive thoughts in OCD or specific environments in agoraphobia. Besides, the impact on daily functioning can be severe in both disorders.
However, OCD and agoraphobia have important differences that need to be taken into account when seeking therapy. Both people with OCD and agoraphobia tend to avoid situations that trigger fear and anxiety. However, unlike OCD, agoraphobia typically does not involve obsessions.
In OCD, the focus is on the content of these intrusive thoughts, while in agoraphobia, the fear is a fear of situations where escape might be difficult or help may not be readily available. The fear is directed more towards certain places or scenarios rather than intrusive thoughts.
Additionally, ritualised compulsive behaviours are more commonly associated with OCD rather than agoraphobia.
In OCD, the content of the obsessions can jump from one topic to another, or expand to different topics, while in agoraphobia, if left untreated, the fears and behaviours typically persist without significant variation.
Can you have both?
Yes, it is possible to have both OCD and agoraphobia simultaneously. Mental health conditions can coexist, and people may face challenges associated with different disorders concurrently. The co-occurrence of these conditions can complicate the overall mental health picture, and it may require a comprehensive and adapted approach to therapy.
Are the treatments different?
The most recommended therapy for both OCD and agoraphobia is cognitive-behavioural therapy (CBT) with exposure and response prevention (ERP). While CBT with ERP should be adapted to each disorder and situation, treatments for OCD and agoraphobia overlap.
In both disorders, ERP is one of the most important techniques. In ERP, the person is gradually exposed to their fears while preventing any typical response. In OCD, the typical response is a compulsion or control strategy, such as checking or reviewing memories. In agoraphobia, the typical response can be any avoidance or safety behaviour, or anything done to reduce anxiety. For example, leaving the house with toilet paper to alleviate the fear of peeing yourself when outside.
ERP aims to help the person lean into the distress, become comfortable with the uncomfortable and habituate to the unpleasant feeling. The more the person exposes themselves without any behaviour directed to reduce the distress, the more the person will get used to that sensation, which will decrease over time. By exposing oneself to the feared outcome, the person is testing if the threat is as extreme as thought or not. It also tests its capacity to cope with difficult situations, overall, making leaving the house less scary than it was at first.
The difference between OCD and agoraphobia lies in the type of exposure designed, depending on the fear. For example, someone with OCD might expose themselves to leaving the house after checking appliances just once or washing their hands only once in a restaurant. In contrast, someone dealing with agoraphobia could opt for exposure by spending 5 minutes outside the house or taking a bus. The key is to adapt the exposure exercises based on the unique fears of each person.
If you’re facing challenges with OCD or agoraphobia, our support can make a difference. We specialise in proven treatments for these conditions. Get in touch today to schedule your appointment!
Further reading
Do you offer OCD and agoraphobia therapy near me?
Edinburgh Therapy Service offers both in-person OCD and agoraphobia counselling in Edinburgh (United Kingdom), and online therapy accessible worldwide. We specialise in therapy for OCD and agoraphobia, offering CBT with ERP as the main treatment option.