Psychological Disorders: Agoraphobia
American
Description
A. The presence of Agoraphobia related to fear of developing panic-like
symptoms (e.g., dizziness or diarrhea).
Criteria for Agoraphobia:
1.
Anxiety about being in places or situations from which escape might
be difficult (or embarrassing) or in which help may not be available
in the event of having an unexpected or situationally predisposed
Panic Attack or panic-like symptoms. Agoraphobic fears typically involve
characteristic clusters of situations that include being outside the
home alone; being in a crowd or standing in a line; being on a bridge;
and traveling in a bus, train, or automobile.
Note: Consider the diagnosis of Specific Phobia if the avoidance is
limited to one or only a few specific situations, or Social Phobia
if the avoidance is limited to social situations.
2.
The situations are avoided (e.g., travel is restricted) or else are
endured with marked distress or with anxiety about having a Panic
Attack or panic-like symptoms, or require the presence of a companion.
3.
The anxiety or phobic avoidance is not better accounted for by another
mental disorder, such as Social Phobia (e.g., avoidance limited to
social situations because of fear of embarrassment), Specific Phobia
(e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive
Disorder (e.g., avoidance of dirt in someone with an obsession about
contamination), Posttraumatic Stress Disorder (e.g., avoidance of
stimuli associated with a severe stressor), or Separation Anxiety
Disorder (e.g., avoidance of leaving home or relatives).
B. Criteria have never been met for Panic Disorder.
C. The disturbance is not due to the direct physiological effects
of a substance (e.g., a drug of abuse, a medication) or a general
medical condition.
D. If an associated general medical condition is present, the fear
described in Criterion A is clearly in excess of that usually associated
with the condition.
European
Description
The term "agoraphobia" is used here with a wider meaning
than it has when originally introduced and as it is still used in
some countries. It is now taken to include fears not only of open
spaces but also of related aspects such as the presence of crowds
and the difficulty of immediate easy escape to a safe place (usually
home). The term therefore refers to an interrelated and often overlapping
cluster of phobias embracing fears of leaving home: fear of entering
shops, crowds, and public places, or of travelling alone in trains,
buses, or planes. Although the severity of the anxiety and the extent
of avoidance behaviour are variable, this is the most incapacitating
of the phobic disorders and some sufferers become completely housebound;
many are terrified by the thought of collapsing and being left helpless
in public. The lack of an immediately available exit is one of the
key features of many of these agoraphobic situations. Most sufferers
are women and the onset is usually early in adult life. Depressive
and obsessional symptoms and social phobias may also be present but
do not dominate the clinical picture. In the absence of effective
treatment, agoraphobia often becomes chronic, though usually fluctuating.
Diagnostic
Guidelines
All the following criteria should be fulfilled for a definite diagnosis:
(a)
the psychological or autonomic symptoms must be primarily manifestations
of anxiety and not secondary to other symptoms, such as delusions
or obsessional thoughts;
(b) the anxiety must be restricted to (or occur mainly in) at least
two of the following situations: crowds, public places, travelling
away from home, and travelling alone; and
(c) avoidance of the phobic situation must be, or have been, a prominent
feature.
Differential
Diagnosis
It must be remembered that some agoraphobics experience little anxiety
because they are consistently able to avoid their phobic situations.
The presence of other symptoms such as depression, depersonalization,
obsessional symptoms, and social phobias does not invalidate the diagnosis,
provided that these symptoms do not dominate the clinical picture.
However, if the patient was already significantly depressed when the
phobic symptoms first appeared, depressive episode may be a more appropriate
main diagnosis; this is more common in late-onset cases.
The
present or absence of panic disorder in the agoraphobic situation
on a majority of occasions may be recorded by means of a fifth character