Case 9: A woman who travels only with a companion or by taxi

Case 9: A woman who travels only with a companion or by taxi

A 27-year-old woman, referred for back and neck pain, who can no longer go out alone, wait in a queue or use public transport.

  • 2 min read
  • Checked 01 Nov 2026

The case

A 27-year-old woman is referred for an opinion because of back and neck pain. She finds it hard to go out on her own for fear of fainting, and lately she cannot bear to wait in queues. She travels only with someone else or by taxi, because on any public transport she feels short of breath. Several times she has called an ambulance for palpitations and been told that her heart is healthy. Her thyroid hormones are normal. She still works, but has asked her employer to let her do part of her work from home.

Summary

Diagnosis

Agoraphobia, one of the anxiety disorders.

What points to it

  • Fear of being out alone, in queues and on public transport: places where escape would be hard, or help might not come, if she fainted.
  • Avoidance: she goes out only with a companion or by taxi, and works from home.
  • Anxiety in those situations: breathlessness, palpitations.
  • Normal heart and thyroid.
  • The agoraphobic fear and avoidance are the main reason she functions less well.

What else it could be

Panic disorder, if attacks also come out of the blue, and generalised anxiety, if she is anxious outside the feared places too: either can coexist, but here agoraphobia dominates. In social anxiety the fear is of being watched and judged, not of being trapped. Depression can make a person stay at home, and so can persecutory delusions in a psychosis. Her back and neck pain needs its own assessment; muscle tension from anxiety often contributes.

Management

  • Explain the anxious nature of her symptoms, and agree to stop tests and emergency calls that are not needed.
  • CBT with graded exposure: she faces the avoided situations step by step, from the easiest, without a companion or taxi as a safety behaviour.
  • An SSRI, an antidepressant, as in panic disorder.
  • Benzodiazepines at most for a short time: they can reinforce avoidance.
  • Encourage her to keep working, and not to extend working from home.

Outlook

Fair with treatment. Untreated, avoidance tends to spread and the condition becomes chronic. Exposure-based treatment helps most people; long, severe avoidance does worse.