(See also Overview of Anxiety Disorders Overview of Anxiety Disorders Everyone periodically experiences fear and anxiety. Fear is an emotional, physical, and behavioral response to an immediately recognizable external threat (eg, an intruder, a car spinning on... read more .)
The situations are avoided, or they may be endured but with substantial anxiety. About 30 to 50% of people with agoraphobia also have panic disorder Panic Attacks and Panic Disorder A panic attack is the sudden onset of a discrete, brief period of intense discomfort, anxiety, or fear accompanied by somatic and/or cognitive symptoms. Panic disorder is occurrence of repeated... read more .
Agoraphobia without panic disorder affects about 2% of women and 1% of men during any 12-month period. Peak age at onset is the early 20s; first appearance after age 40 is unusual.
Symptoms and Signs of Agoraphobia
Common examples of situations or places that create fear and anxiety include standing in line at a bank or at a supermarket checkout, sitting in the middle of a long row in a theater or classroom, and using public transportation, such as a bus or an airplane. Some people develop agoraphobia after a panic attack in a typical agoraphobic situation. Others simply feel uncomfortable in such a situation and may never or only later have panic attacks there. Agoraphobia often interferes with function and, if severe enough, can cause people to become housebound.
Diagnosis of Agoraphobia
Clinical criteria
Diagnosis is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
To meet the DSM-5 criteria for diagnosis, patients must have marked, persistent (≥ 6 months) fear of or anxiety about ≥ 2 of the following situations:
Using public transportation
Being in open spaces (eg, parking lot, marketplace)
Being in an enclosed place (eg, shop, theater)
Standing in line or being in a crowd
Being alone outside the home
Fear must involve thoughts that escape from the situation might be difficult or that patients would receive no help if they became incapacitated by fear or a panic attack. In addition, all of the following should be present:
The same situations nearly always trigger fear or anxiety.
Patients actively avoid the situation and/or require the presence of a companion.
The fear or anxiety is out of proportion to the actual threat (taking into account sociocultural norms).
The fear, anxiety, and/or avoidance cause significant distress or significantly impair social or occupational functioning.
Also, the fear and anxiety cannot be more correctly characterized as a different mental disorder (eg, social anxiety disorder Social Phobia Social phobia is fear of and anxiety about being exposed to certain social or performance situations. These situations are avoided or endured with substantial anxiety. Phobias are a type of... read more , body dysmorphic disorder Body Dysmorphic Disorder Body dysmorphic disorder is characterized by preoccupation with ≥ 1 perceived defects in physical appearance that are not apparent or appear only slight to other people. The preoccupation with... read more ).
Treatment of Agoraphobia
Cognitive-behavioral therapy
Sometimes a selective serotonin reuptake inhibitor (SSRI)
If untreated, agoraphobia usually waxes and wanes in severity. Agoraphobia may disappear without formal treatment, possibly because some affected people conduct their own form of exposure therapy. But if agoraphobia interferes with functioning, treatment is needed.
Cognitive-behavioral therapy is effective for agoraphobia. Cognitive-behavioral therapy involves teaching patients to recognize and control their distorted thinking and false beliefs as well as instructing them on exposure therapy Exposure therapy Specific phobic disorders consist of persistent, unreasonable, intense fears (phobias) of specific situations, circumstances, or objects. The fears provoke anxiety and avoidance. The causes... read more .
Many patients with agoraphobia benefit from drug therapy with an SSRI.
