Agoraphobia. fear and avoidance of spaces

Agoraphobia is an anxiety disorder characterized by intense fear or anxiety about being in situations or places from which escape might be difficult or where help might not be available if panic or other disabling or embarrassing symptoms develop.

This anxiety leads to active avoidance of such situations.

Definition and Feared Situations

Agoraphobia involves a marked fear of two or more of the following five situations:

• Using public transportation (cars, buses, trains, boats, airplanes).

• Being in open spaces (car parks, markets, bridges).

• Being in enclosed places (shops, theaters, cinemas).

• Queuing or being in a crowd.

• Being outside home alone.

The fear or anxiety results from the thought that escape might be difficult or that help might not be available if panic-like or other disabling symptoms occur.

Associated Features

People with agoraphobia often actively avoid these situations, require the presence of a companion to deal with them, or endure them with intense fear or anxiety.

The anxiety is disproportionate to the actual danger posed by the situations and to the sociocultural context.

This fear, anxiety, or avoidance is persistent (usually for six months or more) and causes clinically significant distress or impairment in important areas of functioning.

Relationship to Panic Disorder

Agoraphobia often develops as a complication of panic disorder.

After experiencing unexpected panic attacks, the person may begin to fear and avoid places or situations where the attacks occurred or where you fear they might occur, especially if escape would be difficult or embarrassing.

However, agoraphobia may also be diagnosed in the absence of a history of panic disorder, if the fear centers on other disabling symptoms (for example, fear of falling in the elderly, or fear of incontinence).

Impact and Treatment

Agoraphobia can be extremely limiting, sometimes even confining the person to their home in severe cases.

Treatment often includes graded exposure therapy to the feared situations, along with cognitive restructuring and anxiety management techniques, often within the framework of cognitive behavioral therapy.