Agoraphobia

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Fear of Crowds

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Agoraphobic Situations

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Fear of Public Transportation

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Treatment

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Agoraphobia

Anxiety disorders are a group of disorders characterized by individual fears and phobias within a specified set of criteria listed in the DSM-V, (Diagnostic and statistical manual of mental disorders (5th ed.))

Agoraphobia is a classification within this group consisting of behavioral symptoms that include an irrational and inexplicable fear of leaving the safety of your home, with further fears of being in a public space, fear of being ridiculed or judged while outside of your home, fear of being in a situation from which you cannot escape, and fear of being separated for any period of time from a loved one or safe individual.  However, most commonly known is that agoraphobia is a fear of wide open spaces.

This fear can be perpetuated in certain environments such as large supermarkets, crowded festivals, and within various modes of transportation.  

An individual suffering from agoraphobia will follow any measure to avoid leaving their homes, or to avoid such places that will increase their anxiety, interfering with their work or social lives and significantly decreasing quality of life. 

Within the new DSM-V, criteria for agoraphobia do not require fear to be experienced at extreme lengths; it only requires to  be disproportional to the threat or danger of the situation or environment.

History of Agoraphobia

The Latin Translation of ‘gathering of people, or place of gathering’, or ‘fear of the marketplace’, agoraphobia made its first appearance in the DSM-III under the American Psychiatric Association in 1980, however the definition and term of the disorder was first introduced in 1871 by Carl Westphal, a psychiatrist from Berlin who was able to see a correlation within three of his male adult patients and symptoms of fear and phobia of wide open places, yet he could not successfully explain the epidemiology of Agoraphobia. 

According to the NIMH (National Institute of Mental Health) 0.8% of Americans live with agoraphobia, with 40% having severe enough symptoms to interfere with their daily lives.

Symptoms of Agoraphobia as per the DSM-V

  • Fear of leaving their home for extended periods of time
  • Fear of being alone in social situations
  • Fear of losing control in a public place
  • Fear of being in places where it would be difficult to escape from such as an elevator, or mode of transportation
  • Fear of being detached from one's safe individual or loved one
  • Feelings of anxiousness, anxiety or agitation during any of these situations

Agoraphobia is concurrent with a panic disorder as individuals suffering from agoraphobia will experience symptoms of panic disorder such as nausea, chest pain, hearth palpitations, shortness of breath, dizziness, trembling, sweating, chills, and numbness

Causes

Although the direct cause of agoraphobia is not known, there are key factors that can increase the chances of developing this disorder. A confirmed diagnosis of other anxiety disorders such as General Anxiety Disorder, Claustrophobia, Depression, history of abuse, history of sexual abuse, chronic stress, poor health and socio-economic status, as well as a genetic predisposition all play a role in the development. The disorder can develop anywhere between early childhood and late adolescence, with a higher prevalence in women.

DSM-V Criteria

In order to be diagnosed with agoraphobia, you must meet the following criteria as outlined in the DSM-V.  In order to avoid over diagnosis of agoraphobia the symptoms are no longer required to be extreme.

"The new DSM-5 criteria state that the symptoms for all ages must have a duration of at least 6 months. The anxiety, panic attack, or phobic avoidance associated with the specific situation is not better accounted for by another mental disorder"  (APA, 2013).

The key factor to diagnosis is the disproportionate feelings of fear and dread to the situation, with an impulsive and immediate reaction of anxiety and dread upon exposure to the specific stimulus.  The individual is aware of their disproportionate fear relative to the stimulus, however the reaction is unavoidable.

Treatments

Under the new DSM-V agoraphobia is no longer categorized under a panic disorder, and is considered a separate disorder.  However, because they are concurrent of one another, they may still be treated together. 

  • SSRI's selective serotonin re-uptake inhibitors - a common treatment for anxiety disorders that manipulate serotonin levels in your brain
  • CBT cognitive behavioral therapy – offers new ways of interpreting a situation
  • VRET virtual reality exposure therapy - has proven to work well independently of other treatments
  • On-line virtual therapy - within the safety of their own home this therapy will increase the prospect of the individual attending the virtual meetings.

Living with Agoraphobia

Agoraphobia can range from mild to severe and can significantly reduce quality of life, relationships, work and school.  The best form of prevention is to keep active, minimize stress, and maintain a healthy diet and lifestyle.  

Sources

  1. file:///C:/Users/Owner/Downloads/9780387283692-c2.pdf
  2.  http://www.sciencedirect.com/science/article/pii/088761859190018O
  3. http://www.uptodate.com/contents/agoraphobia-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis
  4. http://www.healthline.com/health/agoraphobia
  5. http://www.theravive.com/therapedia/Agoraphobia-DSM--5-300.22-(F40.00)
  6. https://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

 

 

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