Agoraphobia

Excerpt

Agoraphobia is the anxiety that occurs when one is in a public or crowded place, from which a potential escape is difficult, or help may not be readily available. It is characterized by the fear that a panic attack or panic-like symptoms may occur in these situations. Individuals with agoraphobia, therefore, strive to avoid such situations or locations.

In the DSM-IV, agoraphobia was not a formal psychiatric diagnosis but was instead considered a qualifier of panic disorder. Panic disorder is characterized by recurrent or unexpected panic attacks, presenting as abrupt and intense surges of fear with various associated physical symptoms such as palpitations, shortness of breath, nausea, chest pain, dizziness, fear of dying, etc. In the currently-used DSM-5, agoraphobia is considered a distinct diagnosis that can occur independently of other diagnoses, such as generalized anxiety disorder or panic disorder. In the DSM-5, the condition is defined as “marked fear or anxiety about actual or anticipated exposure of public spaces, with the symptoms of fear or anxiety occurring most of the time in at least two of five common, different situations.” To meet the criteria for the diagnosis, an individual must both fear the exposure to public places and must also make active attempts to avoid such situations, either through behavioral or cognitive modifications. This fear or anxiety should not be in the context of a realistic threat, explained by sociocultural context, or occur in the context of substance use or withdrawal. To formally diagnose a patient with agoraphobia, the diagnostic criteria must be present for greater than six months.