Agoraphobia

For patient information click here

WikiDoc Resources for Agoraphobia
Articles
Most recent articles on Agoraphobia Most cited articles on Agoraphobia Review articles on Agoraphobia Articles on Agoraphobia in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Agoraphobia Images of Agoraphobia Photos of Agoraphobia Podcasts & MP3s on Agoraphobia Videos on Agoraphobia
Evidence Based Medicine
Cochrane Collaboration on Agoraphobia Bandolier on Agoraphobia TRIP on Agoraphobia
Clinical Trials
Ongoing Trials on Agoraphobia at Clinical Trials.gov Trial results on Agoraphobia Clinical Trials on Agoraphobia at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Agoraphobia NICE Guidance on Agoraphobia NHS PRODIGY Guidance FDA on Agoraphobia CDC on Agoraphobia
Books
Books on Agoraphobia
News
Agoraphobia in the news Be alerted to news on Agoraphobia News trends on Agoraphobia
Commentary
Blogs on Agoraphobia
Definitions
Definitions of Agoraphobia
Patient Resources / Community
Patient resources on Agoraphobia Discussion groups on Agoraphobia Patient Handouts on Agoraphobia Directions to Hospitals Treating Agoraphobia Risk calculators and risk factors for Agoraphobia
Healthcare Provider Resources
Symptoms of Agoraphobia Causes & Risk Factors for Agoraphobia Diagnostic studies for Agoraphobia Treatment of Agoraphobia
Continuing Medical Education (CME)
CME Programs on Agoraphobia
International
Agoraphobia en Espanol Agoraphobia en Francais
Business
Agoraphobia in the Marketplace Patents on Agoraphobia
Experimental / Informatics
List of terms related to Agoraphobia

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.

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. 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.

Epidemiology and Demographics

Prevalence

The prevalence of agoraphobia is:

• In adolescents and adults is 1,700 per 100,000 (1.7%) of the overall population.
• Twelve-month individuals older than 65 years is 400 per 100,000 (0.4%) of the overall population.

Every year approximately 1.7% of adolescents and adults have a diagnosis of agoraphobia. Females are twice as likely as males to experience agoraphobia.

Twelve-month prevalence in individuals older than 65 years is 0.4%.

Prevalence

The one-year prevalence of agoraphobia is about 5 percent. About one third of people with Panic Disorder progress to develop Agoraphobia. Agoraphobia occurs about twice as commonly among women as it does in men (Magee et al., 1996).

Diagnosis

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and the subsequent worry, preoccupation, and avoidance. Thus, the formal diagnosis of panic disorder with agoraphobia was established. However, for those people in communities or clinical settings who do not meet full criteria for panic disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used (DSM-IV).

Diagnostic Criteria

DSM-V Diagnostic Criteria for Intellectual Disability

“

A. Marked fear or anxiety about two (or more) of the following five situations: 1. Using public transportation (e.g., automobiles, buses, trains, ships, planes). 2. Being in open spaces (e.g., parking lots, marketplaces, bridges). 3. Being in enclosed places (e.g., shops, theaters, cinemas). 4. Standing in line or being in a crowd. 5. Being outside of the home alone. AND B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence). AND C. The agoraphobic situations almost always provoke fear or anxiety. AND D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. AND E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the socio cultural context. AND F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. AND G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND H. If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive. AND I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder): and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorhic disorder), reminders of traumatic events (as in post traumatic stress disorder), or fear of separation (as in separation anxiety disorder). 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 .

”

Association with panic attacks

Main article: 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. These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior.

Treatments

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.

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.

Alternate theories

Attachment theory

Some scholars (e.g., Liotti 1996, Bowlby 1998) 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) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.

Agoraphobics

• Philip K. Dick, American science fiction writer
• Emily Dickinson, American Poet
• Robert Alan, A citizen of Oregon
• Woody Allen, American film director
• Kim Basinger, American actress
• Roy Castle, British TV presenter
• Ronald Jones (musician), American musician, guitarist for Flaming Lips
• Elfriede Jelinek, Nobel laureate for Literature, 2004
• Paula Deen, American cook, restaurateur, writer, and TV personality, (after her parents died, recovered, while working at a bank was robbed at gun point, the disorder came back, but recovered again.)
• Rose McGowan, American actress
• Ben Weasel, American musician, frontman of Screeching Weasel
• Edvard Munch, Norwegian Symbolist painter, printmaker, and an important forerunner of Expressionistic art.
• Alessandro Manzoni, Italian novelist and poet
• Peter Robinson, British musician known simply as Marilyn.
• Edna Turnblad, a fictional character created by John Waters who refuses to leave her apartment.
• Maureen Leahy, Citizen of California
• Robert Reynolds, a fictional character in the Marvel Universe

See also

• Agoraphobia Without History of Panic Disorder