DefinitionA phobia is a marked fear of an object or a particular kind of situation that is unrealistic when compared to possible danger involved. Those with phobias understand and know that their fear is inappropriate or excessive, but will do whatever is necessary to avoid the object or situation. Many people are fearful of certain situations or objects that make them uncomfortable. However, someone with a phobia has a disruptive fear, meaning that it affects their daily life.
A social phobia is an intense, unrealistic fear of social situations that may involve scrutiny, exposure, or unfamiliar people. Those with social phobias avoid situations in which they might be criticized or evaluated, and may experience intense anxiety, and act inappropriately. It is commonly referred to as social anxiety disorder.
Agoraphobia is considered a specific phobia if distress is limited to three or less specific situations (i.e., fear manifests when the sufferer visits one of a few different locations).
SymptomsAgoraphobia is characterized by the tendency to avoid going outside, remaining in the home for extensive periods of time, as well as excessive fear of being alone, or of not being in control while in public. There is an increasing need to depend on others to do household errands that would require leaving home. Other symptoms include severe anxiety or panic attack while in public manifest by trembling, hyperventilation, agitation, heart palpitations, light-headedness and sweating. There may even be nausea, a feeling of helplessness or as if the body or world is "not real." In most cases, panic attacks precede agoraphobia.
Diagnostic CriteriaPsychologists and psychiatrists diagnose agoraphobia based upon specified criteria in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV-TR published by the American Psychiatric Association. All conditions must be met to necessitate a mental diagnosis.
Agoraphobia is diagnosed without panic disorder if there is marked anxiety about being in public places or in situations in which it would be embarrassing, if a panic attack were to occur. There must not be any previous history of panic attack or disorder for this diagnosis. Particular situations are avoided or endured with intense anxiety and worry about the possibility of a panic attack occurring. Agoraphobia must not be better explained by any other mental disorder such as social phobia, or a specific phobia which is limited to one kind of situation, such as aboard trains. In social phobia, there is actual fear of social situations attributable to embarrassment because of the possibility of being evaluated, or of being in unfamiliar company.
Agoraphobia with panic disorder is diagnosable if panic attacks are recurrent and sudden. They must be completely unexpected. One of the panic attacks must be followed by at least 1 month of worry about having more, or worry concerning the outcome of the attacks (going to die, losing control, etc.) or a change in daily life as a result of the attacks, especially those affecting employment or relationships. Panic attacks cannot be due to substance abuse, medication or a medical diagnosis, and must not be better explained by a different mental disorder such as social phobia.
Panic DisorderAccording to the National Institutes of Mental Health, in a third of all cases, agoraphobia is diagnosed along with panic disorder. Panic disorder is marked by frequent panic attacks, also called "anxiety attacks." A panic attack is a sudden attack of extreme apprehension, fear and feelings of doom. These attacks are also accompanied by physical manifestations such as a pounding heart, labored respiration, chest pain, nausea, feelings of the throat closing and smothering. There may be an intense fear of losing control, as many who experience panic attacks think they are going to have a heart attack, or die.
Those who suffer from panic attacks may avoid situations where they may not be able to easily escape or get help if an attack occurred, or they may avoid situations where an attack previously occurred. As a result, being in public places where many people are likely--such as grocery stores, mass transit and churches--causes intense anxiety and is avoided as much as possible. Travel is likely to be very restricted, and in effect, the sufferer's enjoyment of daily life is greatly diminished.
Whether agoraphobia is diagnosed with or without panic disorder, panic symptoms are experienced when in a place where it would be difficult or embarrassing to escape.
TreatmentTypical treatment for agoraphobia with or without panic disorder consists of cognitive behavioral therapy (CBT) and antidepressant drug therapy. CBT involves the use of exposure to the feared situation. Because it is known that those with panic disorder tend to overreact to body sensations, the therapist actually elicits sensations of anxiety while teaching methods of control. As this demonstrates that bodily sensations can be created as well as controlled, they appear less frightening. Another kind of exposure technique used to treat those with agoraphobia and panic disorder focuses on assisting an individual to identify thoughts that make bodily sensations frightening. The therapist then aids them in challenging those belief statements.
Commonly prescribed medications include Paxil, Prozac, Tofranil and benzodiazepines such as Xanax. It is important to note that medications offer protection only while they are being taken, as symptoms return once they are discontinued. Agoraphobia is an anxiety disorder characterized by an intense fear or dread of being in open spaces where getting out would be difficult or embarrassing. Such places include airplanes, and buses. Those with agoraphobia may be afraid to leave home, and the condition manifests with intense physical symptoms of fear and anxiety.