Agoraphobia: Difference between revisions
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==Overview== | ==Overview== | ||
Agoraphobia is an [[anxiety disorder]] which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape. In more specific and analytical terms, it is actually a fear of [[panic attack]]s; literally, a fear of fear. As a result, severe sufferers of agoraphobia may become confined to their homes, experiencing difficulty traveling from this "safe place." | |||
==Definition== | ==Definition== | ||
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*Behavioral inhibition | *Behavioral inhibition | ||
*Genetic predisposition | *Genetic predisposition | ||
*Neurotic disposition(neuroticism) | *Neurotic disposition (neuroticism) | ||
*Negative events in childhood | *Negative events in childhood | ||
:*Separation | :*Separation | ||
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:*Attacked | :*Attacked | ||
:*Mugged<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | :*Mugged<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
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}} | }} | ||
==Association with | ==Association with Panic Attacks== | ||
{{main|Panic attack}} | {{main|Panic attack}} | ||
Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, adrenaline is released in large amounts for several minutes causing the classical "fight or flight" condition. The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. <ref name="NIH4.2">{{cite book | year=1999 | chapter=Chapter 4.2| author=David Satcher etal.| title='''Mental Health: A Report of the Surgeon General'''| url=http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html}}</ref> These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. <ref name="NIH4.2"/> | Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, adrenaline is released in large amounts for several minutes causing the classical "fight or flight" condition. The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. <ref name="NIH4.2">{{cite book | year=1999 | chapter=Chapter 4.2| author=David Satcher etal.| title='''Mental Health: A Report of the Surgeon General'''| url=http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html}}</ref> These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. <ref name="NIH4.2"/> | ||
== | ==Treatment== | ||
Agoraphobia can be successfully treated in many cases through a very gradual process of [[graduated exposure therapy]] combined with [[cognitive therapy]] and sometimes [[anti-anxiety]] or [[antidepressant]] medications. Treatment options for agoraphobia and [[panic disorder]] are similar. | Agoraphobia can be successfully treated in many cases through a very gradual process of [[graduated exposure therapy]] combined with [[cognitive therapy]] and sometimes [[anti-anxiety]] or [[antidepressant]] medications. Treatment options for agoraphobia and [[panic disorder]] are similar. | ||
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Anti-anxiety medications include [[benzodiazepines]] such as [[alprazolam]]. Anti-depressant medications which are used to treat anxiety disorders are mainly in the SSRI ([[selective serotonin reuptake inhibitor]]) class such as [[sertraline]], [[paroxetine]] and [[fluoxetine]]. [[Hypnosis]] is a possible alternative treatment. {{fact|date=July 2007}} | Anti-anxiety medications include [[benzodiazepines]] such as [[alprazolam]]. Anti-depressant medications which are used to treat anxiety disorders are mainly in the SSRI ([[selective serotonin reuptake inhibitor]]) class such as [[sertraline]], [[paroxetine]] and [[fluoxetine]]. [[Hypnosis]] is a possible alternative treatment. {{fact|date=July 2007}} | ||
==Alternate | ==Alternate Theories== | ||
===Attachment | ===Attachment Theory=== | ||
Some scholars (e.g., Liotti 1996,<ref>G. Liotti, (1996). ''Insecure attachment and agoraphobia'', in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.</ref> [[Bowlby]] 1998<ref>J. Bowlby, (1998). ''Attachment and Loss'' (Vol. 2: Separation).</ref>) have explained agoraphobia as an [[attachment]] deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. | Some scholars (e.g., Liotti 1996,<ref>G. Liotti, (1996). ''Insecure attachment and agoraphobia'', in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.</ref> [[Bowlby]] 1998<ref>J. Bowlby, (1998). ''Attachment and Loss'' (Vol. 2: Separation).</ref>) have explained agoraphobia as an [[attachment]] deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. | ||
===Spatial | ===Spatial Theory=== | ||
In the social sciences there is a perceived clinical bias (e.g., Davidson 2003<ref>J. Davidson, (2003). ''Phobic Geographies''</ref>) in agoraphobia research. Branches of the social sciences, especially [[geography]], have increasingly become interested in what may be thought of as a [[spatial]] phenomenon. | In the social sciences there is a perceived clinical bias (e.g., Davidson 2003<ref>J. Davidson, (2003). ''Phobic Geographies''</ref>) in agoraphobia research. Branches of the social sciences, especially [[geography]], have increasingly become interested in what may be thought of as a [[spatial]] phenomenon. | ||
==References== | ==References== | ||
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{{Mental and behavioural disorders}} | {{Mental and behavioural disorders}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Overview
Agoraphobia is an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape. In more specific and analytical terms, it is actually a fear of panic attacks; literally, a fear of fear. As a result, severe sufferers of agoraphobia may become confined to their homes, experiencing difficulty traveling from this "safe place."
Definition
The word "agoraphobia" is an English adoption of the Greek words agora (αγορά) and phobos (φόβος), literally translated as "a fear of the marketplace." This translation is the reason for the common misconception that agoraphobia is a fear of open spaces, and is not clinically accurate.
Agoraphobia describes a condition where the sufferer becomes uneasy is environments that are unfamiliar or where he/she perceives that he has little control. Triggers may include crowds, wide open spaces or traveling alone even for short distances. The anxiety is often compounded by a fear of social embarrassment in case of panic attacks or appearing distraught i,n public.[1]
People with agoraphobia may experience panic attacks in situations where they feel trapped, insecure, out of control, or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to their home. [2] Some people with agoraphobia are comfortable seeing visitors, but only in a defined space they feel in control of. Such people may live for years without leaving their homes, while happily seeing visitors and working, as long as they can stay within their safety zones. The safety zones can vary, from not being able to leave home, or not being able to make eye contact. If the person leaves their 'safety zone' they can have an anxiety attack.
Differential Diagnosis
- Acute stress disorder
- Major depressive disorder
- Other medical conditions
- Panic disorder
- Post traumatic stress disorder
- Separation anxiety disorder
- Social anxiety disorder (social phobia)
- Specific phobia, situational type[3]
Epidemiology and Demographics
Prevalence
The prevalence of agoraphobia is 1,700 per 100,000 (1.7%) of the overall population.[3]
Risk Factors
- Anxiety sensitivity
- Behavioral inhibition
- Genetic predisposition
- Neurotic disposition (neuroticism)
- Negative events in childhood
- Separation
- Death of parent
- Stressful events
- Attacked
- Mugged[3]
Diagnosis
Diagnostic Criteria
DSM-V Diagnostic Criteria for Agoraphobia[3]
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Note:Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned . |
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Association with Panic Attacks
Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, adrenaline is released in large amounts for several minutes causing the classical "fight or flight" condition. The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. [4] These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. [4]
Treatment
Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications. Treatment options for agoraphobia and panic disorder are similar.
Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. [5]
Anti-anxiety medications include benzodiazepines such as alprazolam. Anti-depressant medications which are used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class such as sertraline, paroxetine and fluoxetine. Hypnosis is a possible alternative treatment. [citation needed]
Alternate Theories
Attachment Theory
Some scholars (e.g., Liotti 1996,[6] Bowlby 1998[7]) have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.
Spatial Theory
In the social sciences there is a perceived clinical bias (e.g., Davidson 2003[8]) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.
References
- ↑ http://psychcentral.com/disorders/sx29.htm
- ↑ "Treatment of Panic Disorder", NIH Consens Statement, 9 (2): 1–24, Sep 25–27, 1991
- ↑ 3.0 3.1 3.2 3.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ 4.0 4.1 David Satcher; et al. (1999). "Chapter 4.2". Mental Health: A Report of the Surgeon General.
- ↑ Fava, G.A.; Rafanelli, C.; Grandi, S.; Cinto, S.; Ruini, C. "Long-term outcome of panic disorder with agoraphobia treated by exposure". Psychological Medicine. Cambridge University Press. 31: 891–898.
- ↑ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
- ↑ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
- ↑ J. Davidson, (2003). Phobic Geographies