Agoraphobia

Excerpt

Agoraphobia is characterized by anxiety or fear in various situations arising from thoughts that escape may be difficult or help may not be readily available in certain situations. This fear often centers on the possibility of experiencing panic-like symptoms or other embarrassing or incapacitating episodes. Individuals with agoraphobia tend to avoid these situations or require a companion for support. In severe cases of agoraphobia, individuals may become homebound or dependent on others for basic needs, which increases the risk of depression.

In previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), agoraphobia was combined with panic disorder. Please see StatPearls' companion resource, "Panic Disorder," for more information. However, in the DSM, 5th ed., Text Revision (DSM-5-TR), agoraphobia and panic disorder are no longer linked, and agoraphobia is diagnosed independently of panic disorder. This change reflects research indicating that many individuals with agoraphobia do not experience panic disorder. Nonetheless, the DSM-5-TR notes that approximately 90% of individuals with agoraphobia have comorbid mental health conditions, such as other anxiety disorders, depressive disorders, posttraumatic stress disorder, or alcohol use disorder. Additionally, about 15% of individuals with agoraphobia report experiencing suicidal thoughts or behaviors.

Agoraphobia is diagnosed according to DSM-5-TR criteria when an individual experiences marked fear or anxiety about at least 2 of the following 5 situations—using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside the home alone. These situations almost always trigger disproportionate fear or anxiety, leading the individual to actively avoid them and resulting in clinically significant distress or functional impairment. This fear or anxiety cannot be attributed to a realistic threat, sociocultural factors, or substance use or withdrawal. Symptoms must persist for at least 6 months to confirm the diagnosis of agoraphobia.