According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) agoraphobia is characterized by the essential feature of intense fear or anxiety prompted by the actual or predicted exposure to a variety of the following situations: using public transportation, being in wide open areas (such as parking lots), being in closed spaces (such as stores), standing in line or in the middle of a crowd, or being alone outside of one’s home. An individual must fear at least two of these situations, and to the extent that something awful might happen.
What Is a Person with Agoraphobia Like?
An individual diagnosed with the most severe form of agoraphobia is stuck in the confines of his or her home (more than one-third of individuals with the disorder). One’s fear and anxiety disallows him or her to leave the house and forces he or she to rely on others for basic needs. It is common for those diagnosed with agoraphobia to develop depression and also attempt and abuse inappropriate self-medications strategies, such as alcohol or sedative medication.
Diagnostic Criteria for Agoraphobia DSM-5 300.22 (F40.00)
The only essential characteristic of agoraphobia is the strong fear of the previously listed circumstances, but the following are all evaluated and considered in order to make a diagnosis:
- An individual has extreme anxiety about two or more of the following situations:
- Using public transportation
- Being in open areas
- Being in closed-off areas
- Standing in line or a crowd
- Being alone outside of the house
- He or she avoids the above situations because the individual believes they may become stuck or help might be unavailable in the event that the individual begins to panic.
- The listed situations usually incite fear or anxiety.
- The listed situations are avoided, require help from a loved one, or are endured with a strong fear.
- The fear the individual has is out of proportion to the possibility of danger.
- The fear or avoidance is persistent, as it typically lasts for at least 6 months or longer.
- The fear or avoidance causes the individual significant distress.
- If another medical condition exists alongside of this disorder, the fear or avoidance is undoubtedly excessive.
- The fear or avoidance is not better explained by the symptoms of another mental disorder or a situational circumstance.
Who Is at Risk of Developing This Disorder?
Each year, about 1.7% of adults and children are diagnosed with agoraphobia. The disorder is more likely to effect women than men and two-thirds of all cases set in before the age of 35. Additionally, there are a few specifically at higher risk of developing agoraphobia: those with anxiety sensitivity, those who have had rough childhoods, and those at danger of inheriting the disorder from a family member.
Other Possible Diagnoses
Sometimes one’s fears can be better explained or attributed to another disorder. The following are common ones that accompany agoraphobia or hold responsibility for the symptoms:
- Situational Specific Phobia: This should be diagnosed if the fear and avoidance is allocated to just one of the agoraphobic situations previously discussed. Furthermore, if an individual fears a situation for reasons unrelated to panic-like symptoms, a specific phobia may fit the bill.
- Separation Anxiety Disorder: The difference here is that the thoughts are about detachment from significant others or one’s home, rather than a focus on panic-like symptoms.
- Social Anxiety Disorder: This disorder focuses on the fear of being negatively assessed.
- Panic Disorder: Agoraphobia is not to be diagnosed if the individual’s fears and avoidances do not extend past one agoraphobic situation.
- Acute Stress Disorder and Posttraumatic Stress Disorder: This can be determined based on whether the fear and avoidance is only related to and triggered by situations that spark traumatic memories in an individual.
- Major Depressive Disorder: This disorder may cause an individual to avoid leaving home because of feelings of apathy, low-self esteem, and loss of energy; avoidance is unrelated to fears of panic-like attacks.
- Other Medical Conditions: Agoraphobia should not be diagnosed if avoidance of these specific situations is believed to be due to a physiological consequence of a medical condition.
Is There Treatment for Agoraphobia?
It is rare for one who suffers with agoraphobia to recover completely. However, the disorder can be treated with either psychotherapy or medication. Psychotherapy helps the patient set goals and learn skills to reduce anxiety symptoms, cognitive behavioral therapy being the most effective form. This form focuses on how to determine what triggers panic-like symptoms, on ways to directly confront and challenge one’s worries, and how to change unwanted behaviors through desensitization. Certain forms of antidepressants and anti-anxiety medication can also prove effective.