Agoraphobia

Definition

Agoraphobia is an anxiety disorder characterized by intense fear related to being in situations from which escape might be difficult or embarrassing (i.e., being on a bus or train), or in which help might not be available in the event of a panic attack or panic symptoms. Panic is defined as extreme and unreasonable fear and anxiety.

According to the handbook used by mental health professionals to diagnose mental disorders, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, also known as the DSM-IV-TR, patients with agoraphobia are typically afraid of such symptoms as feeling dizzy, having an attack of diarrhea, fainting, or "going crazy."

The word "agoraphobia" comes from two Greek words that mean "fear" and "marketplace." The anxiety associated with agoraphobia leads to avoidance of situations that involve being outside one's home alone, being in crowds, being on a bridge, or traveling by car or public transportation. Agoraphobia may intensify to the point that it interferes with a person's ability to take a job outside the home or to carry out such ordinary errands and activities as picking up groceries or going out to a movie.

Description

The close association in agoraphobia between fear of being outside one's home and fear of having panic symptoms is reflected in DSM-IV-TR classification of two separate disorders: panic disorder (PD) with agoraphobia, and agoraphobia without PD. PD is essentially characterized by sudden attacks of fear and panic. There may be no known reason for the occurrence of panic attacks; they are frequently triggered by fear-producing events or thoughts, such as driving, or being in an elevator. PD is believed due to an abnormal activation of the body's hormonal system, causing a sudden "fight-or-flight" response.

The chief distinction between PD with agoraphobia and agoraphobia without PD is that patients who are diagnosed with PD with agoraphobia meet all criteria for PD; in agoraphobia without PD, patients are afraid of panic-like symptoms in public places, rather than full-blown panic attacks.

People with agoraphobia appear to suffer from two distinct types of anxiety— panic, and the anticipatory anxiety related to fear of future panic attacks. Patients with agoraphobia are sometimes able to endure being in the situations they fear by "gritting their teeth," or by having a friend or relative accompany them.

In the United States' diagnostic system, the symptoms of agoraphobia can be similar to those of specific phobia and social phobia. In agoraphobia and specific phobia, the focus is fear itself; with social phobia, the person's focus is on how others are perceiving him/her. Patients diagnosed with agoraphobia tend to be more afraid of their own internal physical sensations and similar cues than of the reactions of others per se. In cases of specific phobia, the person fears very specific situations, whereas in agoraphobia, the person generally fears a variety of situations (being outside of the home alone, or traveling on public transportation including a bus, train, or automobile, for example). An example of a patient diagnosed with a specific phobia rather than agoraphobia would be the person whose fear is triggered only by being in a bus, rather than a car or taxi. The fear of the bus is more specific than the agoraphobic's fear of traveling on public transportation in general. The DSM-IVTR remarks that the differential diagnosis of agoraphobia "can be difficult because all of these conditions are characterized by avoidance of specific situations."