Agoraphobia ICD-11 Diagnostic Requirements Explained
Updated: Oct 8
Author: Ukrainian Psychological Hub · Published: October 1, 2026 · Editorial Policy
In ICD-11, agoraphobia is coded 6B02. The diagnosis is defined by a persistent pattern of marked and excessive fear or anxiety across multiple situations in which escape may feel difficult or help may seem unavailable if something frightening, incapacitating, or embarrassing happens. The feared situations are avoided, entered only under special conditions such as having a companion, or endured with intense fear or anxiety. The pattern must persist for an extended period, cause clinically significant distress or impairment, and not be better explained by another mental disorder. These are clinical diagnostic requirements, not an online self-test. The primary source is the World Health Organization's 2024 ICD-11 Clinical Descriptions and Diagnostic Requirements.
The central diagnostic idea is not simply fear of open spaces. ICD-11 organizes anxiety and fear-related disorders partly by the focus of apprehension: what the person believes may happen, and in which situations that anticipated outcome drives fear, avoidance, or reliance on safety conditions. This distinction is important because panic disorder, specific phobia, social anxiety disorder, separation anxiety disorder, trauma-related disorders, depressive disorders, psychotic disorders, medical conditions, and realistic situational danger can all produce avoidance for different reasons. The diagnosis therefore depends on the whole pattern rather than a single symptom, place, or panic episode. For the broader clinical entity page, see Agoraphobia: Symptoms, Causes, Diagnosis, and Treatment.
ICD-11 agoraphobia in one sentence
ICD-11 agoraphobia is a fear-and-avoidance disorder centered on multiple situations where escape or access to help is perceived as difficult if a feared adverse event occurs. The clinical pattern includes marked fear or anxiety, a characteristic focus of apprehension, avoidance or highly distressed endurance, persistence over time, and meaningful distress or impairment. The ICD-11 CDDR places agoraphobia within the broader Anxiety or fear-related disorders classification, but it remains its own diagnosis with its own requirements.
What the ICD-11 diagnostic requirements are designed to do
The WHO CDDR is a clinician-facing diagnostic manual. It was created to support accurate and reliable identification of mental, behavioral, and neurodevelopmental disorders across clinical settings and countries. Its diagnostic requirements are intentionally written as clinically usable descriptions rather than as a self-administered checklist. A diagnosis therefore involves clinical judgment about the pattern, persistence, context, functional impact, alternative explanations, and the person's own feared outcomes.
This format reflects the broader ICD-11 approach described by Kogan and colleagues: anxiety and fear-related disorders are differentiated in substantial part by their focus of apprehension, while the guidelines emphasize essential diagnostic features. Global field research involving 1,840 clinicians found that the ICD-11 anxiety and fear-related guidelines had diagnostic accuracy and clinical utility that were generally equivalent or superior to ICD-10, although boundary cases still require judgment. Rebello and colleagues' field study is especially relevant here because it shows why diagnostic requirements should be applied as a structured clinical formulation rather than reduced to symptom matching.
The essential ICD-11 requirements for agoraphobia
1. Fear or anxiety must involve multiple situations
The feared pattern concerns multiple situations in which leaving may seem difficult or obtaining help may seem unlikely if a feared event occurs. The WHO gives common examples such as public transportation, crowds, being outside the home alone, shops or theaters, and standing in line. These examples describe the diagnostic territory; they are not a fixed list that every person must reproduce exactly.
What matters clinically is the shared function of the situations. A subway, a shopping center, a long queue, a highway, and a large auditorium can look unrelated physically, yet they may belong to the same agoraphobic pattern if the person fears being trapped, unable to leave, unable to get help, or exposed to an incapacitating or embarrassing event. Conversely, fear restricted to one narrowly defined object or situation may fit specific phobia more closely than agoraphobia, depending on the focus of fear and the full assessment.
2. The person anticipates a specific negative outcome
Agoraphobia is not diagnosed from location alone. ICD-11 asks what the person is afraid will happen in those situations. A common focus is having a panic attack or panic-like symptoms when escape or help would be difficult. The feared outcome can also involve other incapacitating or embarrassing events, such as falling, fainting, losing bladder control, becoming disoriented, or otherwise being unable to function safely.
This focus-of-apprehension principle is one of the most useful distinctions in the ICD-11 architecture. If the central fear is negative evaluation by other people, the clinical formulation may point toward social anxiety disorder. If the central fear is separation from an attachment figure, separation anxiety disorder enters the differential. If fear is tied to a circumscribed stimulus itself rather than to escape or help across a broader set of situations, specific phobia may fit better. The content of the fear therefore matters as much as the visible behavior.
3. The situations are avoided, entered under special conditions, or endured with intense fear
ICD-11 recognizes several behavioral expressions of the same underlying pattern. A person may actively avoid the feared situations. Another person may still enter them but only with a companion, at a particular time of day, near an exit, along a carefully planned route, or while carrying items they believe will make the situation safer. Someone else may enter without those accommodations but experience intense fear or anxiety throughout.
These safety conditions are clinically important because a person's life can look outwardly functional while requiring substantial additional effort. A person who still commutes, shops, works, or attends appointments may nevertheless organize daily life around escape routes, companions, proximity to medical help, or avoidance of peak crowds. ICD-11 allows impairment to be recognized when ordinary functioning is maintained only through significant extra effort.
4. The pattern persists for an extended period
The ICD-11 CDDR describes agoraphobic symptoms as persistent over an extended period, for example at least several months. This is deliberately different from treating a few days or weeks of situational fear as a disorder. Short-lived avoidance after a stressful event, during a temporary medical problem, or at a developmentally understandable stage may not meet the disorder threshold when it resolves and does not meaningfully interfere with life.
The phrase “at least several months” is important. It should not be silently converted into the DSM's six-month rule. ICD-11 and DSM-5-TR overlap substantially, but they are separate classification systems with different wording and some different operational choices. First and colleagues' comparison of ICD-11 and DSM-5 diagnostic requirements explains the broader reasons the two systems sometimes converge and sometimes use different levels of specification.
5. The pattern causes significant distress or impairment
A clinically significant pattern must affect the person's life. The relevant impact may appear in work, education, relationships, caregiving, travel, health care access, shopping, social participation, or the ability to leave home independently. Distress alone can be clinically significant, but impairment can also be visible in the amount of life reorganized around avoidance.
Severity cannot be inferred from distance traveled or whether someone is housebound. Housebound agoraphobia can occur, but it represents a severe possible presentation rather than a diagnostic requirement. A person may travel widely with a trusted companion while remaining substantially impaired, whereas another person may stay home for reasons unrelated to agoraphobic fear. Functional analysis is more informative than a single behavioral snapshot.
6. Another mental disorder must not better explain the presentation
ICD-11 requires clinicians to consider whether the fear and avoidance are better accounted for by another mental disorder. This differential step is central. Avoiding a crowded place because of fear of panic-like incapacitation is clinically different from avoiding it because of fear of being judged, fear of contamination, trauma reminders, paranoid beliefs, profound loss of interest, or a realistic threat.
This is why a formal assessment asks not only where a person avoids going but also what they predict will happen, when symptoms began, whether fear occurs outside those situations, what safety behaviors are used, what the consequences are, and whether another condition provides a more coherent explanation. The broader anxiety assessment and differential-diagnosis process provides context for this step.
What counts as “multiple situations” in ICD-11?
ICD-11 uses the concept of multiple situations rather than reproducing the DSM's exact two-of-five situation rule. The CDDR examples cover transport, crowds, being outside the home alone, shops or theaters, and queues, but the diagnosis is built around the functional relationship among situations: the person anticipates difficulty escaping or obtaining help if a feared adverse event occurs.
This means the diagnostic question is not “How many boxes can be checked?” A clinician looks for breadth across situations together with a coherent focus of apprehension. A single elevator fear, for example, may be more consistent with a specific phobia when it is circumscribed to elevators or enclosed spaces. Fear of elevators, trains, shopping centers, highways, and being far from home may instead form an agoraphobic pattern when the common concern is being unable to escape or obtain help.
A 2025 review of the transition from ICD-10 to ICD-11 notes that ICD-11 simplified several anxiety-disorder requirements and did not retain a precise minimum symptom count in the way some earlier operational systems did. It also emphasizes the separation of agoraphobia and panic disorder as independently diagnosable conditions. See Domschke and Zwanzger's review.
Does ICD-11 agoraphobia require panic attacks?
No. Panic attacks are common in agoraphobia, but they are not required for an agoraphobia diagnosis. Some people have a history of panic attacks that helped shape their avoidance. Others fear different incapacitating or embarrassing outcomes. Still others may have little recent experience of panic because their avoidance and safety behaviors prevent them from entering the situations in which attacks previously occurred.
ICD-11 explicitly separates agoraphobia from panic disorder. If panic attacks occur only in agoraphobic situations, the pattern does not automatically establish a separate panic disorder; an ICD-11 panic-attack qualifier can be used where appropriate. If a person also has recurrent unexpected panic attacks that are not restricted to agoraphobic situations and meets the remaining panic-disorder requirements, both diagnoses can be assigned. The dedicated ICD-11 Panic Disorder diagnostic-requirements article explains that separate diagnostic territory.
This distinction prevents a common error: treating every panic attack as proof of panic disorder or treating every agoraphobic presentation as a consequence of panic disorder. A panic attack is an episode. Panic disorder is a disorder defined by a specific recurrent pattern and its aftermath. Agoraphobia is defined by its own situational fear-and-avoidance pattern.
Avoidance and safety behaviors in agoraphobia
Avoidance is often the most visible part of agoraphobia, but it exists on a continuum. Complete avoidance is only one form. A person may travel only with someone else, sit beside an exit, drive only on surface streets, shop only at quiet hours, choose routes near hospitals, carry medication or water for reassurance, or repeatedly scan for exits. These behaviors can reduce immediate distress while also preserving the belief that the situation could not be managed without the safety condition.
The presence of a safety behavior does not by itself diagnose agoraphobia. People use companions, route planning, medication, mobility supports, and other precautions for many legitimate reasons. Diagnostic significance depends on why the behavior is used, whether the feared outcome is disproportionate to actual circumstances, how persistent the pattern is, and whether it contributes to substantial distress or impairment.
Normal caution, realistic danger, and medical or physical limitations
ICD-11 includes an explicit boundary with normality. Temporary avoidance can be understandable during periods of stress, after a frightening event, or at certain developmental stages. The distinction becomes clinical when the fear-and-avoidance pattern persists, is excessive in relation to the situation, and materially restricts functioning.
Medical conditions and physical disabilities require particular care in assessment. Someone with recurrent fainting, severe balance problems, seizures, mobility limitations, gastrointestinal urgency, respiratory disease, or another health condition may reasonably avoid environments where assistance would be difficult. ICD-11 supports an agoraphobia diagnosis only when the anxiety or avoidance goes beyond what would be expected from the medical condition or disability and creates additional significant impairment.
This boundary matters because an online description cannot determine whether dizziness, fainting, breathlessness, palpitations, or other physical symptoms are caused by anxiety. New, severe, unexplained, or medically concerning symptoms require appropriate medical assessment rather than being attributed to agoraphobia solely because they occur in feared places.
Differential diagnosis: conditions that can resemble agoraphobia
Panic disorder
Panic disorder is characterized by recurrent unexpected panic attacks together with persistent concern about additional attacks or their consequences, or maladaptive behavior change. Agoraphobia focuses on multiple situations in which escape or help may be difficult if a feared event occurs. The disorders can co-occur, but one does not automatically imply the other.
Specific phobia
Specific phobia is usually organized around a circumscribed object or situation and the danger associated with that stimulus. Agoraphobia spans multiple situations linked by concerns about escape, help, or incapacitating or embarrassing outcomes. A fear of one elevator, one animal, one medical procedure, or one type of height should not be relabeled agoraphobia merely because avoidance occurs.
Social anxiety disorder
Social anxiety disorder is organized around fear of negative evaluation, humiliation, rejection, or scrutiny. A person with social anxiety may avoid restaurants, stores, lines, public transportation, or crowds, which can look similar behaviorally to agoraphobia. The decisive question is what the person fears: evaluation by others versus being unable to escape or obtain help if a feared event occurs.
Separation anxiety disorder
Separation anxiety disorder centers on separation from attachment figures and feared consequences of that separation. A person may avoid leaving home or traveling alone, but the reason for the avoidance is different from agoraphobia. The same outward behavior can therefore belong to a different diagnostic pattern.
Post-traumatic stress disorder and other trauma-related conditions
Trauma-related avoidance is tied to reminders of a traumatic event, re-experiencing, or perceived trauma-linked danger. Agoraphobic avoidance is organized around an anticipated immediate outcome in situations where escape or help feels difficult. Trauma history can coexist with agoraphobia, so differential diagnosis is about the function and meaning of avoidance rather than the mere fact that both conditions can involve fear.
Depressive disorders
Depression can reduce leaving home because of loss of interest, low energy, hopelessness, psychomotor slowing, or social withdrawal. That pattern differs from staying home because multiple outside situations are feared as difficult to escape or manage. Depression and agoraphobia can also co-occur, which means clinicians may need to account for more than one process.
Psychotic disorders
Avoidance driven by persecutory delusions, severe suspiciousness, or other psychotic experiences is not agoraphobia simply because public places are avoided. ICD-11 specifically directs clinicians to consider whether psychotic symptoms better account for the behavior.
Medical, neurological, substance, and medication-related causes
Physical symptoms that resemble panic or anxiety can occur in medical and neurological conditions and can be influenced by substances or medications. Assessment therefore considers timing, onset, health history, medication changes, substance use, and red flags. A psychiatric diagnosis does not replace appropriate medical evaluation when the symptom pattern indicates that another cause may be present.
ICD-11 agoraphobia versus DSM-5-TR
ICD-11 and DSM-5-TR recognize the same broad clinical phenomenon, and both treat agoraphobia as a diagnosis that is separate from panic disorder. Their operational wording is not identical, so a reader should not mix requirements from the two systems into a hybrid checklist. The companion page Agoraphobia DSM-5-TR Criteria Explained owns the DSM-5-TR criteria intent.
Situation structure
DSM-5-TR uses a more explicit operational structure: intense fear is associated with two or more of five named categories—public transportation, open spaces, enclosed places, lines or crowds, and being outside the home alone. Current U.S. patient guidance from the American Psychiatric Association and the National Institute of Mental Health reflects this two-or-more structure. ICD-11 instead describes fear or anxiety across multiple situations where escape or help may be difficult and provides examples rather than the same fixed two-of-five rule.
Duration
DSM-5-TR uses a typical duration threshold of six months or more. ICD-11 describes persistence over an extended period, for example at least several months. For a page specifically about ICD-11, the ICD wording should be preserved rather than replaced with the DSM threshold.
Panic disorder relationship
Both systems now separate panic disorder and agoraphobia diagnostically, allowing them to be diagnosed together when each disorder's requirements are met. This is a major change from older classification traditions that tightly linked agoraphobia to panic disorder. The distinction is described in the ICD-11 development literature by Kogan and colleagues and in cross-system analysis by First and colleagues.
Why the systems are not interchangeable
A clinician may use ICD-11 for health-system coding and diagnostic documentation while another setting uses DSM-5-TR. The systems overlap strongly, but their wording, thresholds, coding architecture, and intended uses are not identical. The correct approach is to apply the requirements of the classification actually being used, while understanding where another system differs.
How clinicians assess possible ICD-11 agoraphobia
A clinical assessment usually begins with the person's own description rather than a diagnostic label. The clinician maps which situations provoke fear or avoidance, what the person expects might happen, whether symptoms occur before entering the situation or only once inside it, and what is required to make the situation tolerable.
The assessment then examines persistence and functional impact. Important questions include how long the pattern has been present, whether it has expanded to additional situations, whether work or education has changed, whether appointments are missed, whether travel or caregiving has become restricted, and whether independent functioning has narrowed.
Clinicians also ask about panic attacks, because their pattern can change the formulation. Expected panic in an agoraphobic setting and recurrent unexpected panic across contexts are not diagnostically equivalent. The assessment may also cover depression, trauma symptoms, social-evaluation fears, obsessive-compulsive symptoms, separation fears, psychotic symptoms, substance use, medications, and medical conditions when relevant.
The final step is not a score calculation. It is a synthesis: does the person show the ICD-11 agoraphobic pattern, is the duration and clinical threshold met, and is another explanation more coherent? This is the distinction between symptom measurement, screening, clinical assessment, and formal diagnosis.
Can a questionnaire or online test diagnose ICD-11 agoraphobia?
No questionnaire score establishes an ICD-11 agoraphobia diagnosis by itself. Screening tools and severity measures can organize information, identify people who may need fuller assessment, or track change over time. They do not replace the diagnostic interview, differential diagnosis, medical context, or clinical judgment required by the CDDR.
This distinction is visible even in the American Psychiatric Association's own DSM-5-TR assessment-measures resources: disorder-specific severity measures are instruments for measuring symptoms and severity, not substitutes for the complete diagnostic process. A person can score high because of overlapping symptoms, and a person can have clinically important avoidance that a short questionnaire does not capture well.
Three examples that show why the focus of apprehension matters
Example 1: broad escape-and-help fear
A person avoids buses, supermarkets, cinemas, long lines, and driving on highways. They fear becoming dizzy, panicking, and being unable to leave quickly or obtain help. They travel only with a partner and have maintained this pattern for many months, causing major work and social restrictions. This pattern illustrates the core agoraphobic architecture, although only a full assessment could determine whether all diagnostic requirements are met.
Example 2: unexpected panic without broad situational fear
Another person has sudden panic attacks at home, at work, and while relaxing, then spends weeks worrying about another attack. They do not consistently avoid multiple escape-difficult situations. This presentation may point more strongly toward panic disorder than agoraphobia. The presence of panic is therefore not enough to choose between the diagnoses.
Example 3: one circumscribed fear
A third person uses trains, shops, crowds, and theaters without difficulty but has intense fear only in elevators because they believe the elevator itself may malfunction. That narrow stimulus pattern is different from the broader escape-and-help focus typical of agoraphobia and may fit specific phobia more closely.
Why diagnostic precision matters for treatment planning
This article does not own the treatment intent, but diagnostic formulation has treatment consequences. The WHO CDDR notes that the feared outcome can matter for treatment planning. Exposure-based interventions, for example, are more precise when they target the situations, predictions, avoidance patterns, and safety behaviors that actually maintain fear rather than assuming that every person with agoraphobia fears exactly the same thing. Etiology and risk mechanisms remain separate; see What Causes Agoraphobia? Panic, Learning, Avoidance, and Risk Factors.
When panic sensations are central, treatment may also need to address catastrophic interpretations of bodily sensations. When realistic medical limitations are present, the plan must distinguish adaptive safety needs from fear-driven restriction. When another disorder better explains avoidance, treatment should be organized around that disorder rather than around an agoraphobia label.
When to seek professional assessment
Professional assessment is worth considering when fear or avoidance has persisted for months, is expanding to more situations, requires increasing reliance on companions or safety rituals, restricts work or education, interferes with health care or daily responsibilities, or causes significant distress. Assessment is also important when panic-like or physical symptoms are new, severe, unexplained, or changing.
Urgent medical symptoms should be evaluated on their own merits. Chest pain, fainting, severe shortness of breath, new neurological symptoms, or other concerning physical signs should not be assumed to be anxiety because they occur in a feared setting. Psychological and medical explanations are not mutually exclusive, and the safest diagnostic process considers both when clinically indicated.
Frequently asked questions
What is the ICD-11 code for agoraphobia?
The ICD-11 code for agoraphobia is 6B02. It is classified within Anxiety or fear-related disorders in the ICD-11 chapter on mental, behavioral, and neurodevelopmental disorders. The WHO CDDR provides the clinical diagnostic requirements.
Does ICD-11 require panic attacks for agoraphobia?
No. Panic attacks may occur and may be central to the person's feared outcome, but agoraphobia can be diagnosed without panic disorder and without a history of recurrent unexpected panic attacks. The essential pattern is the situational fear, apprehension, avoidance or distressed endurance, persistence, and clinical impact.
Can someone have both agoraphobia and panic disorder?
Yes. ICD-11 treats them as separate diagnoses. Both can be assigned when the requirements for each are met. If panic attacks occur only in agoraphobic situations, that alone does not establish panic disorder.
Does agoraphobia mean fear of open spaces?
No. Open spaces can be part of the pattern, but the diagnosis is broader. Public transportation, crowds, queues, enclosed public places, being outside the home alone, and other contexts may become feared when escape or help is perceived as difficult.
Does ICD-11 require exactly two situation categories?
ICD-11 describes multiple situations but does not use the DSM's exact two-of-five operational rule. This is one reason an ICD-11 diagnostic page should not simply reproduce a DSM checklist.
How long must agoraphobia last in ICD-11?
The ICD-11 CDDR describes persistence over an extended period, for example at least several months. DSM-5-TR uses a typical six-month threshold, so the two systems should be distinguished.
Is being housebound required?
No. Housebound presentations can occur in severe agoraphobia, but they are not required. Some people remain highly active only because they use companions, restricted routes, timing strategies, or other safety conditions.
Can a medical condition cause similar avoidance?
Yes. Health conditions and physical disabilities can make certain situations realistically difficult or unsafe. ICD-11 calls for agoraphobia only when fear and avoidance exceed what would be expected from the condition and create additional clinically significant impairment.
Can an online agoraphobia test diagnose the disorder?
No. A test or questionnaire may screen for symptoms or measure severity, but diagnosis requires clinical assessment of the pattern, duration, impairment, differential diagnosis, and relevant medical or substance-related factors.
Is an “anxiety attack” part of the ICD-11 requirements?
“Anxiety attack” is common informal language, but it is not a standalone ICD-11 diagnosis and should not be treated as a diagnostic criterion for agoraphobia. A clinician would clarify whether the person means a panic attack, escalating anxiety, a stress reaction, or another experience.
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References
Domschke, K., & Zwanzger, P. (2025). Taxonomy of anxiety disorders—a comparison of ICD-10 and ICD-11. Der Nervenarzt, 96(Suppl 1), 1–5. PubMed / DOI 10.1007/s00115-025-01842-6
First, M. B., Gaebel, W., Maj, M., et al. (2021). An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry, 20(1), 34–51. PubMed / DOI 10.1002/wps.20825
Kogan, C. S., Stein, D. J., Maj, M., First, M. B., Emmelkamp, P. M. G., & Reed, G. M. (2016). The classification of anxiety and fear-related disorders in the ICD-11. Depression and Anxiety, 33(12), 1141–1154. PubMed / DOI 10.1002/da.22530
Rebello, T. J., Keeley, J. W., Kogan, C. S., et al. (2019). Anxiety and fear-related disorders in the ICD-11: Results from a global case-controlled field study. Archives of Medical Research, 50(8), 490–501. PubMed / DOI 10.1016/j.arcmed.2019.12.012
Reed, G. M., Sharan, P., Rebello, T. J., et al. (2018). The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: Results among adult patients in mental health settings of 13 countries. World Psychiatry, 17(2), 174–186. PubMed / DOI 10.1002/wps.20524
World Health Organization. (2024). Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. WHO