Agoraphobia: Difference between revisions
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'''Agoraphobia'''<ref name="DSM5" /> is an [[anxiety disorder]] characterized by symptoms of [[anxiety]] in situations where the person perceives their environment to be unsafe with no way to escape.<ref name="DSM5">{{citation|author=American Psychiatric Association | '''Agoraphobia'''<ref name="DSM5" /> is an [[anxiety disorder]] characterized by symptoms of [[anxiety]] in situations where the person perceives their environment to be unsafe with no way to escape.<ref name="DSM5">{{citation |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders (5th ed.) |pages=[https://archive.org/details/diagnosticstatis0005unse/page/217 217–221, 938] |year=2013 |url=https://archive.org/details/diagnosticstatis0005unse/page/217 |location=Arlington |publisher=American Psychiatric Publishing |isbn=978-0-89042-555-8}}</ref> These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own.<ref name="DSM5" /> Being in these situations may result in a [[panic attack]].<ref name="NIH2016">{{cite web |title=Agoraphobia |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024921/ |access-date=11 August 2016 |website=PubMed Health}}{{dead link|date=July 2025|bot=medic}}{{cbignore|bot=medic}}</ref> Those affected will go to great lengths to avoid these situations.<ref name="DSM5" /> In severe cases, people may become completely unable to leave their homes.<ref name="NIH2016" /> | ||
<!-- Cause and diagnosis --> | <!-- Cause and diagnosis --> | ||
Agoraphobia is believed to be due to a combination of [[Genetics|genetic]] and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.<ref name=DSM5 /> In the [[DSM-5]], agoraphobia is classified as a [[phobia]] along with [[specific phobia]]s and [[social phobia]].<ref name=DSM5 /><ref name=Wy2008>{{cite book|last1=Wyatt|first1=Richard Jed| | Agoraphobia is believed to be due to a combination of [[Genetics|genetic]] and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.<ref name=DSM5 /> In the [[DSM-5]], agoraphobia is classified as a [[phobia]] along with [[specific phobia]]s and [[social phobia]].<ref name=DSM5 /><ref name="Wy2008">{{cite book |last1=Wyatt |first1=Richard Jed |url=https://books.google.com/books?id=4ZUikjcnM2QC&pg=PA91 |title=Wyatt's Practical Psychiatric Practice: Forms and Protocols for Clinical Use |last2=Chew |first2=Robert H. |date=2008 |publisher=American Psychiatric Pub |isbn=978-1-58562-687-8 |pages=90–91 |language=en |archive-url=https://web.archive.org/web/20160821133303/https://books.google.com/books?id=4ZUikjcnM2QC&pg=PA91 |archive-date=2016-08-21 |url-status=live}}</ref> Other conditions that can produce similar symptoms include [[separation anxiety]], [[posttraumatic stress disorder|post-traumatic stress disorder]], and [[major depressive disorder]].<ref name=DSM5 /> The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and [[suicidal ideation]].<ref name=":2">{{cite journal |last1=Shin |first1=Jin |last2=Park |first2=Doo-Heum |last3=Ryu |first3=Seung-Ho |last4=Ha |first4=Jee Hyun |last5=Kim |first5=Seol Min |last6=Jeon |first6=Hong Jun |date=2020-07-24 |title=Clinical implications of agoraphobia in patients with panic disorder |journal=Medicine |volume=99 |issue=30 |article-number=e21414 |doi=10.1097/MD.0000000000021414 |issn=0025-7974 |pmc=7387026 |pmid=32791758}}</ref><ref>{{cite journal |last1=Teismann |first1=Tobias |last2=Lukaschek |first2=Karoline |last3=Hiller |first3=Thomas S. |last4=Breitbart |first4=Jörg |last5=Brettschneider |first5=Christian |last6=Schumacher |first6=Ulrike |last7=Margraf |first7=Jürgen |last8=Gensichen |first8=Jochen |last9=Jena Paradies Study Group |date=2018-09-24 |title=Suicidal ideation in primary care patients suffering from panic disorder with or without agoraphobia |journal=BMC Psychiatry |volume=18 |issue=1 |page=305 |doi=10.1186/s12888-018-1894-5 |issn=1471-244X |pmc=6154913 |pmid=30249220 |doi-access=free}}</ref><references group="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387026/" /><!-- Treatment and epidemiology --> | ||
Without treatment, it is uncommon for agoraphobia to resolve.<ref name="DSM5" /> Treatment is typically with a type of [[counselling]] called [[cognitive behavioral therapy]] (CBT).<ref name="Wy2008" /><ref>{{cite journal|last1=Pompoli|first1=A|last2=Furukawa|first2=TA|last3=Imai|first3=H|last4=Tajika|first4=A|last5=Efthimiou|first5=O|last6=Salanti|first6=G|title=Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.|journal=The Cochrane Database of Systematic Reviews | Without treatment, it is uncommon for agoraphobia to resolve.<ref name="DSM5" /> Treatment is typically with a type of [[counselling]] called [[cognitive behavioral therapy]] (CBT).<ref name="Wy2008" /><ref>{{cite journal |last1=Pompoli |first1=A |last2=Furukawa |first2=TA |last3=Imai |first3=H |last4=Tajika |first4=A |last5=Efthimiou |first5=O |last6=Salanti |first6=G |date=13 April 2016 |title=Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. |journal=The Cochrane Database of Systematic Reviews |volume=2016 |issue=4 |article-number=CD011004 |doi=10.1002/14651858.CD011004.pub2 |pmc=7104662 |pmid=27071857}}</ref> CBT results in resolution for about half of people.<ref name="Lancet2016">{{cite journal |last1=Craske |first1=MG |last2=Stein |first2=MB |date=24 June 2016 |title=Anxiety. |journal=Lancet |volume=388 |issue=10063 |pages=3048–3059 |doi=10.1016/S0140-6736(16)30381-6 |pmid=27349358 |s2cid=208789585}}</ref> In some instances, those with a diagnosis of agoraphobia have reported taking [[benzodiazepine]]s and [[antipsychotic]]s.<ref name=":2" /> Agoraphobia affects about 1.7% of adults.<ref name="DSM5" /> Women are affected about twice as often as men. The condition is rare in children, often begins in adolescence or early adulthood, and becomes more common at age 65 or above.<ref name="DSM5" /> | ||
== Etymology == | == Etymology == | ||
The term ''agoraphobia'' was coined in German in 1871 by pioneering German psychologist [[Karl Friedrich Otto Westphal]] (1833–1890) in his article "{{lang|de|Die Agoraphobie, eine neuropathische Erscheinung}}" in the journal ''Archiv für Psychiatrie und Nervenkrankheiten'', Berlin, 1871–72; 3: 138–161. It is derived from [[Ancient Greek|Greek]] {{lang|grc|ἀγορά}} ({{Transliteration|grc|agorā́}}), meaning {{gloss|[[Agora|place of assembly]]}} or {{gloss|market-place}} and {{lang|grc|-φοβία}} ({{Transliteration|grc|-phobía}}), meaning {{gloss|fear}}.<ref>{{cite web |title=Collins dictionary |url=https://www.collinsdictionary.com/dictionary/english/agora |access-date=17 September 2020}}</ref><ref>{{cite book|last1=Elster|first1=Charles Harrington|title=Verbal Advantage: Ten Easy Steps to a Powerful Vocabulary|date=2009|publisher=Diversified Publishing|isbn=978-0-307-56097-1|page | The term ''agoraphobia'' was coined in German in 1871 by pioneering German psychologist [[Karl Friedrich Otto Westphal]] (1833–1890) in his article "{{lang|de|Die Agoraphobie, eine neuropathische Erscheinung}}" in the journal ''Archiv für Psychiatrie und Nervenkrankheiten'', Berlin, 1871–72; 3: 138–161. It is derived from [[Ancient Greek|Greek]] {{lang|grc|ἀγορά}} ({{Transliteration|grc|agorā́}}), meaning {{gloss|[[Agora|place of assembly]]}} or {{gloss|market-place}} and {{lang|grc|-φοβία}} ({{Transliteration|grc|-phobía}}), meaning {{gloss|fear}}.<ref>{{cite web |title=Collins dictionary |url=https://www.collinsdictionary.com/dictionary/english/agora |access-date=17 September 2020}}</ref><ref>{{cite book |last1=Elster |first1=Charles Harrington |url=https://books.google.com/books?id=aJxfrKSb7u4C&pg=PT717 |title=Verbal Advantage: Ten Easy Steps to a Powerful Vocabulary |date=2009 |publisher=Diversified Publishing |isbn=978-0-307-56097-1 |page=PT717 |language=en |archive-url=https://web.archive.org/web/20160821130114/https://books.google.com/books?id=aJxfrKSb7u4C&pg=PT717 |archive-date=2016-08-21 |url-status=live}}</ref> | ||
== Signs and symptoms == | == Signs and symptoms == | ||
Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of a known, controllable space, usually their home.<ref name="DSM5" /> | Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of a known, controllable space, usually their home.<ref name="DSM5" /> | ||
Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks".<ref>{{cite web|url=http://www.dictionary.nowok.co.uk/agoraphobia.php | Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks".<ref>{{cite web |title=Agoraphobia – Dictionary of Psychotherapy |url=http://www.dictionary.nowok.co.uk/agoraphobia.php |archive-url=https://web.archive.org/web/20160403100715/http://www.dictionary.nowok.co.uk/agoraphobia.php |archive-date=2016-04-03 |access-date=2016-03-23}}</ref> In these cases, the patient is fearful of a particular place because they have previously experienced a panic attack at the same location. Fearing the onset of another panic attack, the patient is fearful or avoids a location. Some refuse to leave their homes in medical emergencies because the fear of being outside of their comfort areas is too great.<ref>{{cite web |title=Agoraphobia |url=https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/agoraphobia |archive-url=https://web.archive.org/web/20170322204034/https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/agoraphobia |archive-date=22 March 2017 |access-date=21 March 2017 |website=betterhealth.vic.gov.au}}</ref> | ||
The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making a diagnosis of [[panic disorder]]. Other syndromes like [[obsessive–compulsive disorder]] or [[post-traumatic stress disorder]] can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome.<ref>{{cite web|url=http://psychcentral.com/disorders/sx29.htm | The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making a diagnosis of [[panic disorder]]. Other syndromes like [[obsessive–compulsive disorder]] or [[post-traumatic stress disorder]] can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome.<ref>{{cite web |date=2016-05-17 |title=Agoraphobia Symptoms |url=http://psychcentral.com/disorders/sx29.htm |work=Psych Central.com}}</ref> | ||
People with agoraphobia may experience temporary [[separation anxiety disorder]] when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends.<ref>{{cite web|url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987| | People with agoraphobia may experience temporary [[separation anxiety disorder]] when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends.<ref>{{cite web |title=Agoraphobia – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987 |access-date=2019-07-01 |website=Mayo Clinic |language=en}}</ref><ref>{{cite web |title=What Are Anxiety Disorders? |url=https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders |access-date=2019-07-01 |website=psychiatry.org}}</ref> | ||
People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia".<ref>{{cite book|last1=Adamec|first1=Christine | People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia".<ref>{{cite book |last1=Adamec |first1=Christine |url=https://books.google.com/books?id=E2imSyZZDh0C&q=macrophobia |title=The Encyclopedia of Phobias, Fears, and Anxieties, Third Edition |publisher=Infobase Publishing |year=2010 |isbn=978-1-4381-2098-0 |page=328}}</ref> | ||
=== Panic attacks === | === Panic attacks === | ||
Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, [[epinephrine]] is released in large amounts, triggering the body's natural [[fight-or-flight]] response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.<ref name="NIH4.2">{{cite book | Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, [[epinephrine]] is released in large amounts, triggering the body's natural [[fight-or-flight]] response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.<ref name="NIH4.2">{{cite book |author=David Satcher |title=Mental Health: A Report of the Surgeon General |year=1999 |chapter=Chapter 4.2 |display-authors=etal |access-date=2006-03-07 |chapter-url=http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html |archive-url=https://web.archive.org/web/20060427125157/http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html |archive-date=2006-04-27 }}</ref> Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report a fear of dying, fear of losing control of emotions, or fear of losing control of behaviors.<ref name="NIH4.2" /> | ||
== Causes == | == Causes == | ||
Agoraphobia is believed to be due to a combination of [[Genetics|genetic]] and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.<ref name=DSM5 /> | Agoraphobia is believed to be due to a combination of [[Genetics|genetic]] and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.<ref name=DSM5 /> | ||
Research has uncovered a link between agoraphobia and difficulties with spatial orientation.<ref>{{cite journal |vauthors=Yardley L, Britton J, Lear S, Bird J, Luxon LM | title = Relationship between balance system function and agoraphobic avoidance | journal = Behav Res Ther | volume = 33 | issue = 4 | pages = 435–9 | Research has uncovered a link between agoraphobia and difficulties with spatial orientation.<ref>{{cite journal |vauthors=Yardley L, Britton J, Lear S, Bird J, Luxon LM |date=May 1995 |title=Relationship between balance system function and agoraphobic avoidance |journal=Behav Res Ther |volume=33 |issue=4 |pages=435–9 |doi=10.1016/0005-7967(94)00060-W |pmid=7755529}}</ref><ref>{{cite journal |vauthors=Jacob RG, Furman JM, Durrant JD, Turner SM |year=1996 |title=Panic, agoraphobia, and vestibular dysfunction |journal=Am J Psychiatry |volume=153 |issue=4 |pages=503–512 |doi=10.1176/ajp.153.4.503 |pmid=8599398}}</ref> Individuals without agoraphobia are able to maintain balance by combining information from their [[vestibular system]], their [[visual system]], and their [[proprioceptive]] sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds).<ref name="Jacob et al 1997">{{cite journal |vauthors=Jacob RG, Furman JM, Durrant JD, Turner SM |year=1997 |title=Surface dependence: a balance control strategy in panic disorder with agoraphobia |journal=Psychosom Med |volume=59 |issue=3 |pages=323–30 |doi=10.1097/00006842-199705000-00016 |pmid=9178344 |s2cid=9789982}}</ref> Likewise, they may be confused by sloping or irregular surfaces.<ref name="Jacob et al 1997" /> | ||
In a [[virtual reality]] study, agoraphobics showed | In a [[virtual reality]] study, agoraphobics showed more difficulty integrating sensory changes than non-agoraphobics and are "more sensitive to sensory conflicts" than the general population.<ref>{{cite journal |vauthors=Viaud-Delmon I, Warusfel O, Seguelas A, Rio E, Jouvent R |date=October 2006 |title=High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality |url=https://hal.archives-ouvertes.fr/hal-03411683/file/EurPsy2006.pdf |journal=Eur. Psychiatry |volume=21 |issue=7 |pages=501–8 |doi=10.1016/j.eurpsy.2004.10.004 |pmid=17055951 |s2cid=6932961}}</ref> | ||
=== Substance-induced === | === Substance-induced === | ||
Chronic use of [[tranquilizer]]s and sleeping pills such as [[benzodiazepine]]s has been linked to onset of agoraphobia.<ref>{{cite book | Chronic use of [[tranquilizer]]s and sleeping pills such as [[benzodiazepine]]s has been linked to onset of agoraphobia.<ref>{{cite book |title=Counselling: The BACP Counselling Reader |vauthors=Hammersley D, Beeley L |publisher=Sage |year=1996 |isbn=978-0-8039-7477-7 |veditors=Palmer S, Dainow S, Milner P |volume=1 |pages=211–4 |chapter=The effects of medication on counselling |chapter-url=https://books.google.com/books?id=wnIBEQKQi7IC}}</ref> In 10 patients who had developed agoraphobia during [[benzodiazepine dependence]], symptoms abated within the first year of assisted withdrawal.<ref>{{cite journal |author=Ashton H |date=June 1987 |title=Benzodiazepine withdrawal: outcome in 50 patients |journal=Br J Addict |volume=82 |issue=6 |pages=665–71 |doi=10.1111/j.1360-0443.1987.tb01529.x |pmid=2886145}}</ref> Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to the [[long-term effects of alcohol consumption]] causing a distortion in brain chemistry.<ref name="pmid17592911">{{cite journal |vauthors=Cosci F, Schruers KR, Abrams K, Griez EJ |date=June 2007 |title=Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship |journal=J Clin Psychiatry |volume=68 |issue=6 |pages=874–80 |doi=10.4088/JCP.v68n0608 |pmid=17592911}}</ref> | ||
Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. [[Self-medication]] or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.<ref name="pmid19961810">{{cite journal |vauthors=Cosci F, Knuts IJ, Abrams K, Griez EJ, Schruers KR | title = Cigarette smoking and panic: a critical review of the literature | journal = J Clin Psychiatry | volume = 71 | issue = 5 | pages = 606–15 | Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. [[Self-medication]] or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.<ref name="pmid19961810">{{cite journal |vauthors=Cosci F, Knuts IJ, Abrams K, Griez EJ, Schruers KR |date=May 2010 |title=Cigarette smoking and panic: a critical review of the literature |journal=J Clin Psychiatry |volume=71 |issue=5 |pages=606–15 |doi=10.4088/JCP.08r04523blu |pmid=19961810}}</ref> | ||
=== Attachment theory === | === Attachment theory === | ||
{{Main|Attachment theory}} | {{Main|Attachment theory}} | ||
Some scholars<ref>G. | |||
Some scholars<ref>{{cite book |last=Liotti |first=G. |title=Attachment Across the Life Cycle |year=1996 |isbn=978-1-134-93454-6 |editor1=C. Murray-Parkes |page=216 |chapter=Insecure attachment and agoraphobia |editor2=J. Stevenson-Hinde |editor3=P. Marris}}</ref><ref>{{cite book |last=Bowlby |first=John |title=Attachment and Loss |date=1998 |publisher=Pimlico |isbn=978-0-7126-6621-3 |volume=2: Separation}}</ref> have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.<ref>{{cite journal |author=Jacobson K |year=2004 |title=Agoraphobia and Hypochondria as Disorders of Dwelling |journal=International Studies in Philosophy |volume=36 |issue=2 |pages=31–44 |doi=10.5840/intstudphil2004362165}}</ref> Recent empirical research has also linked attachment and spatial theories of agoraphobia.<ref>{{cite journal |author=Holmes J |year=2008 |title=Space and the secure base in agoraphobia: a qualitative survey |journal=Area |volume=40 |issue=3 |pages=357–382 |bibcode=2008Area...40..375H |doi=10.1111/j.1475-4762.2008.00820.x}}</ref> | |||
=== Spatial theory === | === Spatial theory === | ||
In the social sciences, a perceived clinical bias<ref> | In the social sciences, a perceived clinical bias<ref>{{cite book |last=Davidson |first=Joyce |title=Phobic Geographies: The Phenomenology and Spatiality of Identity |date=2017-10-24 |publisher=Routledge |isbn=978-1-315-24686-4 |doi=10.4324/9781315246864 |orig-date=2003}}</ref> exists in agoraphobia research. Branches of the social sciences, especially [[geography]], have increasingly become interested in what may be thought of as a [[Three-dimensional space|spatial]] phenomenon. One such approach links the development of agoraphobia with [[modernity]].<ref>{{cite journal |author=Holmes J |year=2006 |title=Building Bridges and Breaking Boundaries: Modernity and Agoraphobia |url=http://www.ucl.ac.uk/opticon1826/archive/issue1 |url-status=live |journal=Opticon 1826 |volume=1 |page=1 |doi=10.5334/opt.010606 |url-access=subscription |archive-url=https://web.archive.org/web/20160303233808/http://www.ucl.ac.uk/opticon1826/archive/issue1 |archive-date=2016-03-03 |doi-access=free}}</ref> Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating a conflict in the mind of agoraphobic individuals. | ||
=== Evolutionary perspectives === | === Evolutionary perspectives === | ||
Some [[Evolutionary psychiatry|evolutionary models]] propose that agoraphobia—like other specific phobias—may be rooted in adaptive mechanisms that helped early humans avoid threats in open or unfamiliar environments. From this viewpoint, fear and avoidance behaviors could have been selectively favored if they aided survival—for instance, by prompting individuals to steer clear of potentially dangerous surroundings or minimize exposure to predators and pathogens. According to preparedness models, human defensive systems are especially sensitive to cues linked to ancestral threats and can rapidly form strong, lasting fear associations with them. In modern life, such defenses might become mismatched to relatively low-risk environments, producing disproportionate anxiety responses.<ref>{{Cite book |last=Del Giudice |first=Marco |title=Evolutionary psychopathology: a unified approach |date=2018 |publisher=Oxford University Press |isbn=978-0-19-024684-6 |location=New York, NY |pages=335–342}}</ref> | Some [[Evolutionary psychiatry|evolutionary models]] propose that agoraphobia—like other specific phobias—may be rooted in adaptive mechanisms that helped early humans avoid threats in open or unfamiliar environments. From this viewpoint, fear and avoidance behaviors could have been selectively favored if they aided survival—for instance, by prompting individuals to steer clear of potentially dangerous surroundings or minimize exposure to predators and pathogens. According to preparedness models, human defensive systems are especially sensitive to cues linked to ancestral threats and can rapidly form strong, lasting fear associations with them. In modern life, such defenses might become mismatched to relatively low-risk environments, producing disproportionate anxiety responses.<ref>{{Cite book |last=Del Giudice |first=Marco |title=Evolutionary psychopathology: a unified approach |date=2018 |publisher=Oxford University Press |isbn=978-0-19-024684-6 |location=New York, NY |pages=335–342}}</ref> | ||
An additional [[evolutionary psychology]] view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a [[specific phobia]] explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred.<ref>{{cite journal | author = Bracha HS | title = Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder | journal = Progress in Neuro-Psychopharmacology and Biological Psychiatry | volume = 30 | issue = 5 | pages = 827–853 | An additional [[evolutionary psychology]] view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a [[specific phobia]] explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred.<ref>{{cite journal |author=Bracha HS |year=2006 |title=Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder |url=http://cogprints.org/5013/1/2006_P.N.P._Neuro-evolution_of_fear_circuit_disorders.pdf |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=30 |issue=5 |pages=827–853 |doi=10.1016/j.pnpbp.2006.01.008 |pmc=7130737 |pmid=16563589}}</ref><ref>{{cite journal |vauthors=Raffaello S, Alessandra SM, Alessandra S |year=2011 |title=[Primary agoraphobia specific symptoms: from natural information to mental representations] |url=http://www.gipsicopatol.it/issues/2011/vol17-3/02%20Spiti.pdf |journal=Italian Journal of Psychopathology |language=it |volume=17 |issue=3 |pages=265–276 |archive-url=https://web.archive.org/web/20120426082624/http://www.gipsicopatol.it/issues/2011/vol17-3/02%20Spiti.pdf |archive-date=2012-04-26}}</ref> | ||
== Diagnosis == | == Diagnosis == | ||
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.<ref>[[American Psychiatric Association]], 1998</ref> Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.<ref>{{cite book | Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.<ref>[[American Psychiatric Association]], 1998</ref> Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.<ref>{{cite book |author=Barlow DH |title=Anxiety and its disorders: The nature and treatment of anxiety and panic |publisher=Guilford Press |year=1988}}</ref> Early treatment of panic disorder can often prevent agoraphobia.<ref>{{cite web |last=pmhdev |title=Agoraphobia – National Library of Medicine |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/ |archive-url=https://web.archive.org/web/20140330112146/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/ |archive-date=30 March 2014 |access-date=25 January 2017}}</ref> Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other mental disorders such as depression.<ref>{{cite web |last1=Kenny |first1=Tim |last2=Lawson |first2=Euan |title=Agoraphobia |url=http://www.patient.info/health/agoraphobia-leaflet |archive-url=https://web.archive.org/web/20150607021823/http://patient.info/health/agoraphobia-leaflet |archive-date=7 June 2015 |access-date=8 December 2014 |website=Patient.info}}</ref> | ||
=== Agoraphobia without history of panic disorder === | === Agoraphobia without history of panic disorder === | ||
'''Agoraphobia without a history of panic disorder''' (also called '''primary agoraphobia''') is an [[anxiety disorder]] where the individual with the diagnosis does not meet the [[DSM-5]] criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of [[panic attack]]s. Agoraphobia can be caused by [[Trauma (psychology)|traumatic]] experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, [[generalized anxiety disorder]], [[avoidant personality disorder]] and [[social phobia]]. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic".<ref>Barlow | '''Agoraphobia without a history of panic disorder''' (also called '''primary agoraphobia''') is an [[anxiety disorder]] where the individual with the diagnosis does not meet the [[DSM-5]] criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of [[panic attack]]s. Agoraphobia can be caused by [[Trauma (psychology)|traumatic]] experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, [[generalized anxiety disorder]], [[avoidant personality disorder]] and [[social phobia]]. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic".<ref>{{Cite book |last1=Barlow |first1=D. H. |title=Clinical handbook of psychological disorders: a step-by-step treatment manual |last2=Waddell |first2=M. T. |date=1985 |publisher=Guilford Press |isbn=978-0-89862-648-3 |editor-last=Barlow |editor-first=David H. |location=New York |chapter=Agoraphobia}}</ref> In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.{{citation needed|date=May 2024}} | ||
According to the [[DSM-IV-TR]], a widely used manual for diagnosing [[mental disorder]]s, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence.<ref name=BehaveNet>{{cite book |title=Diagnostic and Statistical Manual of Mental Disorders |edition=4th, text revision ([[DSM-IV-TR]]) | | According to the [[DSM-IV-TR]], a widely used manual for diagnosing [[mental disorder]]s, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence.<ref name="BehaveNet">{{cite book |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders |publisher=<!-- pacify Citation bot --> |year=2000 |isbn=0-89042-025-4 |edition=4th, text revision ([[DSM-IV-TR]]) |location=<!-- pacify Citation bot --> |chapter=Diagnostic criteria for 300.22 Agoraphobia Without History of Panic Disorder |access-date=2007-06-28 |chapter-url=https://www.behavenet.com/diagnostic-criteria-30022-agoraphobia-without-history-panic-disorder}}</ref> The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be [[Comorbidity|diagnosed together]].<ref>{{cite web |last=Administration |first=Substance Abuse and Mental Health Services |date=June 2016 |title=Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5 |url=https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/ |access-date=2023-11-04 |website=ncbi.nlm.nih.gov |language=en}}</ref> | ||
== Treatments == | == Treatments == | ||
=== Therapy === | === Therapy === | ||
[[Systematic desensitization]] can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.<ref>{{cite journal |vauthors=Fava GA, Rafanelli C, Grandi S, Conti S, Ruini C, Mangelli L, Belluardo P | title = Long-term outcome of panic disorder with agoraphobia treated by exposure | journal = Psychological Medicine | volume = 31 | issue = 5 | pages = 891–898 | [[Systematic desensitization]] can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.<ref>{{cite journal |vauthors=Fava GA, Rafanelli C, Grandi S, Conti S, Ruini C, Mangelli L, Belluardo P |year=2001 |title=Long-term outcome of panic disorder with agoraphobia treated by exposure |journal=Psychological Medicine |volume=31 |issue=5 |pages=891–898 |doi=10.1017/S0033291701003592 |pmid=11459386 |s2cid=5652068}}</ref> Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely.<ref>{{cite web |date=18 November 2017 |title=Agoraphobia – Diagnosis & Treatment |url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993 |access-date=15 May 2020 |publisher=Mayo Clinic}}</ref><ref name=GelderMayouGeddes2005 /> In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until the symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise.<ref name=GelderMayouGeddes2005 /> | ||
A related exposure treatment is {{lang|la|[[in vivo]]}} exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects.<ref name=":0">{{cite journal |last1=Sanchez-Meca |last2=Rosa-Alcazar |last3=Marin-Martinez |last4=Gomez-Conesa|date=11 September 2008|title=Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis|journal=Clinical Psychology Review|volume=30|issue=1|pages=37–50|doi=10.1016/j.cpr.2009.08.011|pmid=19775792}}</ref> This treatment was largely effective with an effect size from ''d ='' 0.78 to ''d ='' 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment).<ref name=":0" /> | A related exposure treatment is {{lang|la|[[in vivo]]}} exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects.<ref name=":0">{{cite journal |last1=Sanchez-Meca |last2=Rosa-Alcazar |last3=Marin-Martinez |last4=Gomez-Conesa |date=11 September 2008 |title=Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis |journal=Clinical Psychology Review |volume=30 |issue=1 |pages=37–50 |doi=10.1016/j.cpr.2009.08.011 |pmid=19775792}}</ref> This treatment was largely effective with an effect size from ''d ='' 0.78 to ''d ='' 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment).<ref name=":0" /> | ||
Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals. Further research showed there was no significant effect between using group CBT versus individual CBT.<ref name=":0" /> | Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals. Further research showed there was no significant effect between using group CBT versus individual CBT.<ref name=":0" /> | ||
[[Cognitive restructuring]] has also proved useful in treating agoraphobia.<ref name=pmge>{{Cite journal |last1=Emmelkamp |first1=Paul M. G. |last2=Mersch |first2=Peter Paul |date=March 1982 |title=Cognition and exposure in vivo in the treatment of agoraphobia: Short-term and delayed effects |url=http://link.springer.com/10.1007/BF01185728 |journal=Cognitive Therapy and Research |language=en |volume=6 |issue=1 |pages=77–90 |doi=10.1007/BF01185728 |issn=0147-5916|url-access=subscription }}</ref> This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.<ref name=pmge/> | [[Cognitive restructuring]] has also proved useful in treating agoraphobia.<ref name="pmge">{{Cite journal |last1=Emmelkamp |first1=Paul M. G. |last2=Mersch |first2=Peter Paul |date=March 1982 |title=Cognition and exposure in vivo in the treatment of agoraphobia: Short-term and delayed effects |url=http://link.springer.com/10.1007/BF01185728 |journal=Cognitive Therapy and Research |language=en |volume=6 |issue=1 |pages=77–90 |doi=10.1007/BF01185728 |issn=0147-5916 |url-access=subscription}}</ref> This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.<ref name=pmge/> | ||
[[Relaxation technique]]s are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.<ref>{{cite web|url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993| | [[Relaxation technique]]s are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.<ref>{{cite web |title=Agoraphobia – Diagnosis and treatment – Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993 |access-date=2019-07-01 |website=mayoclinic.org |language=en}}</ref> | ||
Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method.<ref>{{cite journal|last1=Fernández-Álvarez|first1=Javier|last2=Fernández-Álvarez|first2=Héctor|date=2021|title=Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects?|journal=Frontiers in Psychology|volume=12 | Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method.<ref>{{cite journal |last1=Fernández-Álvarez |first1=Javier |last2=Fernández-Álvarez |first2=Héctor |date=2021 |title=Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects? |journal=Frontiers in Psychology |language=English |volume=12 |doi=10.3389/fpsyg.2021.589536 |issn=1664-1078 |pmc=7933024 |pmid=33679513 |doi-access=free |article-number=589536}}</ref> Similar to traditional face-to-face interventions, VCP can be used to administer CBT.<ref name=":1">{{cite journal |last1=Bouchard |first1=Stéphane |last2=Allard |first2=Micheline |last3=Robillard |first3=Geneviève |last4=Dumoulin |first4=Stéphanie |last5=Guitard |first5=Tanya |last6=Loranger |first6=Claudie |last7=Green-Demers |first7=Isabelle |last8=Marchand |first8=André |last9=Renaud |first9=Patrice |last10=Cournoyer |first10=Louis-Georges |last11=Corno |first11=Giulia |date=2020-08-21 |title=Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial |journal=Frontiers in Psychology |volume=11 |doi=10.3389/fpsyg.2020.02164 |issn=1664-1078 |pmc=7472915 |pmid=32973638 |doi-access=free |article-number=2164}}</ref> | ||
[[Virtual reality]] computer stimulated therapy has been suggested to help people with [[psychosis]] and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).<ref>{{cite journal |date=20 July 2023 |title=Virtual reality could help people with psychosis and agoraphobia |url=https://evidence.nihr.ac.uk/alert/virtual-reality-could-help-people-with-psychosis-and-agoraphobia/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59108 |s2cid=260053713 |url-access=subscription }}</ref> | [[Virtual reality]] computer stimulated therapy has been suggested to help people with [[psychosis]] and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).<ref>{{cite journal |date=20 July 2023 |title=Virtual reality could help people with psychosis and agoraphobia |url=https://evidence.nihr.ac.uk/alert/virtual-reality-could-help-people-with-psychosis-and-agoraphobia/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_59108 |s2cid=260053713 |url-access=subscription}}</ref> | ||
=== Medications === | === Medications === | ||
Antidepressant medications most commonly used to treat anxiety disorders are mainly [[selective serotonin reuptake inhibitor]]s. [[Benzodiazepine]]s, [[monoamine oxidase inhibitor]]s, and [[tricyclic antidepressants]] are also sometimes prescribed for treatment of agoraphobia.<ref>{{cite journal|last1=Lydiard|first1=R. Bruce|last2=Ballenger|first2=James C.|date=16 June 1987|title=Antidepressants in panic disorder and agoraphobia|journal=Journal of Affective Disorders|volume=13|issue=2|pages=153–168|doi=10.1016/0165-0327(87)90020-6|pmid=2960710}}</ref> Antidepressants are important because some have anxiolytic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy.<ref name=GelderMayouGeddes2005 /> A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.<ref name=GelderMayouGeddes2005>{{cite book | last1 = Gelder | first1 = Michael G. | last2 = Mayou | first2 = Richard. | last3 = Geddes | first3 = John | Antidepressant medications most commonly used to treat anxiety disorders are mainly [[selective serotonin reuptake inhibitor]]s. [[Benzodiazepine]]s, [[monoamine oxidase inhibitor]]s, and [[tricyclic antidepressants]] are also sometimes prescribed for treatment of agoraphobia.<ref>{{cite journal |last1=Lydiard |first1=R. Bruce |last2=Ballenger |first2=James C. |date=16 June 1987 |title=Antidepressants in panic disorder and agoraphobia |journal=Journal of Affective Disorders |volume=13 |issue=2 |pages=153–168 |doi=10.1016/0165-0327(87)90020-6 |pmid=2960710}}</ref> Antidepressants are important because some have anxiolytic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy.<ref name=GelderMayouGeddes2005 /> A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.<ref name="GelderMayouGeddes2005">{{cite book |last1=Gelder |first1=Michael G. |url=https://archive.org/details/psychiatry0000geld |title=Psychiatr |last2=Mayou |first2=Richard. |last3=Geddes |first3=John |publisher=Oxford University Press |year=2005 |isbn=978-0-19-852863-0 |location=New York |url-access=registration}}</ref> | ||
=== Alternative medicine === | === Alternative medicine === | ||
[[Eye movement desensitization and reprocessing]] (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.<ref> | [[Eye movement desensitization and reprocessing]] (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.<ref> | ||
{{cite journal |author1=Goldstein, Alan J. |author2=de Beurs, Edwin |author3=Chambless, Dianne L. |author4=Wilson, Kimberly A. | title = EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions | journal = Journal of Consulting and Clinical Psychology | volume = 68 | issue = 6 | pages = 947–957 | | {{cite journal |author1=Goldstein, Alan J. |author2=de Beurs, Edwin |author3=Chambless, Dianne L. |author4=Wilson, Kimberly A. |year=2000 |title=EMDR for Panic Disorder With Agoraphobia: Comparison With Waiting List and Credible Attention-Placebo Control Conditions |journal=Journal of Consulting and Clinical Psychology |volume=68 |issue=6 |pages=947–957 |citeseerx=10.1.1.527.315 |doi=10.1037/0022-006X.68.6.947 |pmid=11142547}}</ref> As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.<ref>{{cite web |last=Agoraphobia Resource Center |title=Agoraphobia treatments—Eye movement desensitization and reprogramming |url=http://www.agoraphobia.ws/treatment-emdr.htm |archive-url=https://web.archive.org/web/20080405230027/http://www.agoraphobia.ws/treatment-emdr.htm |archive-date=5 April 2008 |access-date=2008-04-18}} | ||
</ref> | </ref> | ||
Many people with anxiety disorders benefit from joining a [[self-help]] or [[support group]] (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests [[aerobic exercise]] may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.<ref>{{cite web |last | Many people with anxiety disorders benefit from joining a [[self-help]] or [[support group]] (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests [[aerobic exercise]] may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.<ref>{{cite web |last=National Institute of Mental Health |title=How to get help for anxiety disorders |url=http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml |archive-url=https://web.archive.org/web/20080704192950/http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml |archive-date=2008-07-04 |access-date=2008-04-18}}</ref> | ||
== Epidemiology == | == Epidemiology == | ||
Agoraphobia occurs about twice as often in women as it does in men. Age of onset is typically mid to late twenties, though it can occur at any age.<ref>{{Cite journal | | Agoraphobia occurs about twice as often in women as it does in men. Age of onset is typically mid to late twenties, though it can occur at any age.<ref>{{Cite journal |last1=Tearnan |first1=Blake H. |last2=Telch |first2=Michael J. |last3=Keefe |first3=Peter |date=1984-01-01 |title=Etiology and onset of agoraphobia: A critical review |journal=Comprehensive Psychiatry |volume=25 |issue=1 |pages=51–62 |doi=10.1016/0010-440X(84)90022-1 |issn=0010-440X |pmid=6141894 }}</ref><ref name="Magee-1996">{{cite journal |vauthors=Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC |date=Feb 1996 |title=Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. |journal=Arch Gen Psychiatry |volume=53 |issue=2 |pages=159–68 |doi=10.1001/archpsyc.1996.01830020077009 |pmid=8629891}}</ref> | ||
Panic disorder with or without agoraphobia affects roughly 5.1% of Americans,<ref name=":0" /> and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting with panic disorders as well.<ref name=":0" /> | Panic disorder with or without agoraphobia affects roughly 5.1% of Americans,<ref name=":0" /> and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting with panic disorders as well.<ref name=":0" /> | ||
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* [[Woody Allen]], actor, director, musician<ref>{{cite magazine|url=http://www.vanityfair.com/culture/features/2005/12/woodyallen200512?currentPage=4 | * [[Woody Allen]], actor, director, musician<ref>{{cite magazine |author=Peter Biskind |date=10 October 2006 |title=Reconstructing Woody |url=http://www.vanityfair.com/culture/features/2005/12/woodyallen200512?currentPage=4 |url-status=live |archive-url=https://web.archive.org/web/20121017064819/http://www.vanityfair.com/culture/features/2005/12/woodyallen200512?currentPage=4 |archive-date=2012-10-17 |magazine=Vanity Fair |issue=December}}</ref> | ||
* [[Isaac Asimov]], [[science fiction]] writer, reportedly had a mild case of agoraphobia<ref>http://lce-asimov.weebly.com/claustrophobia-and-agoraphobia-within-issac-asimovs-nightfall.html</ref><ref>https://scifi.stackexchange.com/questions/33063/why-did-asimov-feature-fear-of-contact-so-often-in-his-work</ref><ref>http://lce-asimov.weebly.com/summary-of-alan-c-elmss-from-nightfall-to-dawn-asimov-as-acrophobe.html</ref><ref>https://sf-encyclopedia.com/entry/asimov_isaac</ref> | * [[Isaac Asimov]], [[science fiction]] writer, reportedly had a mild case of agoraphobia<ref>{{cite web |title=Claustrophobia and Agoraphobia within Issac Asimov's "Nightfall" |url=http://lce-asimov.weebly.com/claustrophobia-and-agoraphobia-within-issac-asimovs-nightfall.html}}</ref><ref>{{cite web |title=Why did Asimov feature fear of contact so often in his work? |url=https://scifi.stackexchange.com/questions/33063/why-did-asimov-feature-fear-of-contact-so-often-in-his-work}}</ref><ref>{{cite web |title=Summary of Alan C. Elms's "From "Nightfall" to Dawn: Asimov as Acrophobe |url=http://lce-asimov.weebly.com/summary-of-alan-c-elmss-from-nightfall-to-dawn-asimov-as-acrophobe.html}}</ref><ref>{{cite web |title=SFE: Asimov, Isaac |url=https://sf-encyclopedia.com/entry/asimov_isaac}}</ref> | ||
* [[Kim Basinger]], actress<ref name=Phobias>{{cite book|last1=Saul|first1=Helen|title=Phobias : fighting the fear.|date=2003|publisher=Arcade | * [[Kim Basinger]], actress<ref name="Phobias">{{cite book |last1=Saul |first1=Helen |url=https://books.google.com/books?id=10TAV1iAoiwC&q=Kim+Basinger+agoraphobia&pg=PA6 |title=Phobias: fighting the fear. |date=2003 |publisher=Arcade |isbn=978-1-55970-693-3 |location=New York |page=6 |access-date=11 September 2015 |archive-url=https://web.archive.org/web/20151016095110/https://books.google.com/books?id=10TAV1iAoiwC&pg=PA6#v=onepage&q=Kim%20Basinger |archive-date=16 October 2015 |url-status=live}}</ref> | ||
* [[Earl Campbell]], [[American football]] player<ref>{{cite web|last=Murray|first=Jim|date=1991-08-15|title=Campbell Breaks Free Again|url=https://www.latimes.com/archives/la-xpm-1991-08-15-sp-633-story.html|access-date=2023-01-06|website=Los Angeles Times|language=en-US}}</ref> | * [[Earl Campbell]], [[American football]] player<ref>{{cite web |last=Murray |first=Jim |date=1991-08-15 |title=Campbell Breaks Free Again |url=https://www.latimes.com/archives/la-xpm-1991-08-15-sp-633-story.html |access-date=2023-01-06 |website=Los Angeles Times |language=en-US}}</ref> | ||
* [[Macaulay Culkin]], actor<ref>{{cite news|url=http://transcripts.cnn.com/TRANSCRIPTS/0405/27/lkl.00.html | * [[Macaulay Culkin]], actor<ref>{{cite news |date=2004-05-27 |title=CNN.com – Transcripts |url=http://transcripts.cnn.com/TRANSCRIPTS/0405/27/lkl.00.html |url-status=live |archive-url=https://web.archive.org/web/20090720052649/http://transcripts.cnn.com/TRANSCRIPTS/0405/27/lkl.00.html |archive-date=2009-07-20 |access-date=2009-08-07 |publisher=CNN}}</ref> | ||
* [[Paula Deen]], chef, author, and television personality<ref>{{cite news | * [[Paula Deen]], chef, author, and television personality<ref>{{cite news |author=Julia Moskin |date=28 February 2007 |title=From Phobia To Fame: A Southern Cook's Memoir |url=https://www.nytimes.com/2007/02/28/dining/28deen.html |url-status=live |archive-url=https://web.archive.org/web/20170201112729/http://www.nytimes.com/2007/02/28/dining/28deen.html |archive-date=1 February 2017 |newspaper=The New York Times}}</ref> | ||
* [[H.L. Gold]], science fiction editor<ref>{{cite encyclopedia|title=Horace L. Gold | encyclopedia=Encyclopædia Britannica|url=https://www.britannica.com/biography/Horace-L-Gold|access-date=2023-01-06|author= Erik Gregerson | * [[H.L. Gold]], science fiction editor<ref>{{cite encyclopedia |year=2011 |title=Horace L. Gold |encyclopedia=Encyclopædia Britannica |url=https://www.britannica.com/biography/Horace-L-Gold |access-date=2023-01-06 |author=Erik Gregerson}}</ref> | ||
* [[Daryl Hannah]], actress<ref>{{IMDb name|id=0000435|name=Daryl Hannah|section=bio}}. Retrieved 28 November 2007.</ref> | * [[Daryl Hannah]], actress<ref>{{IMDb name|id=0000435|name=Daryl Hannah|section=bio}}. Retrieved 28 November 2007.</ref> | ||
* [[Miranda Hart]], actress and comedian<ref name="Ellis-Petersen">{{cite news |last1=Ellis-Petersen |first1=Hannah |title=Miranda Hart: 'I used to think fame would justify my whole existence |url=https://www.theguardian.com/tv-and-radio/2017/may/26/miranda-hart-fame-would-justify-existence-comedian-interview |access-date=14 September 2023 |work=The Guardian | * [[Miranda Hart]], actress and comedian<ref name="Ellis-Petersen">{{cite news |last1=Ellis-Petersen |first1=Hannah |date=26 May 2017 |title=Miranda Hart: 'I used to think fame would justify my whole existence |url=https://www.theguardian.com/tv-and-radio/2017/may/26/miranda-hart-fame-would-justify-existence-comedian-interview |access-date=14 September 2023 |work=The Guardian}}</ref> | ||
* [[Howard Hughes]], [[aviator]], [[industrialist]], [[film producer]] and [[philanthropist]]<ref>{{cite web|url=http://www.crimelibrary.com/criminal_mind/forensics/psych_autopsy/4.html | * [[Howard Hughes]], [[aviator]], [[industrialist]], [[film producer]] and [[philanthropist]]<ref>{{cite web |title=Psychological Autopsy can help understand controversial deaths |url=http://www.crimelibrary.com/criminal_mind/forensics/psych_autopsy/4.html |archive-url=https://web.archive.org/web/20150214053314/http://www.crimelibrary.com/criminal_mind/forensics/psych_autopsy/4.html |archive-date=14 February 2015 |access-date=25 January 2017 |website=truTV.com}}</ref> | ||
* [[Olivia Hussey]], actress<ref> | * [[Olivia Hussey]], actress<ref>{{Cite magazine |date=1992-03-16 |title=Forever Juliet |url=http://www.oliviahussey.com/olivia_scrapbook/clippings/people.htm |archive-url=https://web.archive.org/web/20120318064857/http://www.oliviahussey.com/olivia_scrapbook/clippings/people.htm |archive-date=18 March 2012 |magazine=People |via=www.oliviahussey.com |access-date=4 January 2009 }}</ref><ref>{{IMDb name|id=0001377|name=Olivia Hussey|section=bio}}</ref> | ||
* [[Shirley Jackson]], writer<ref name="Churchwell 2017">{{cite web | last=Churchwell | first=Sarah | title=Shirley Jackson: A Rather Haunted Life by Ruth Franklin review – beyond spooky | * [[Shirley Jackson]], writer<ref name="Churchwell 2017">{{cite web |last=Churchwell |first=Sarah |date=2017-02-10 |title=Shirley Jackson: A Rather Haunted Life by Ruth Franklin review – beyond spooky |url=http://www.theguardian.com/books/2017/feb/10/shirley-jackson-ruth-franklin-review-a-rather-haunted-life |access-date=2021-03-09 |website=The Guardian}}</ref><ref>{{Cite web |author=[[Jonathan Lethem]] |title=Monstrous acts and little murders |url=http://www1.salon.com/jan97/jackson970106.html |archive-url=https://web.archive.org/web/20120429204027/http://www1.salon.com/jan97/jackson970106.html |archive-date=29 April 2012 |website=www.salon.com |access-date=15 September 2025 |url-status=live }}</ref> | ||
* [[Elfriede Jelinek]], writer, Nobel Prize laureate in Literature in 2004<ref>{{cite web |author=Mike Conklin. |url=https://www.chicagotribune.com/2004/12/10/where-is-elfriede-jelinek/ | * [[Elfriede Jelinek]], writer, Nobel Prize laureate in Literature in 2004<ref>{{cite web |author=Mike Conklin. |date=2004-12-10 |title=Where is Elfriede Jelinek? |url=https://www.chicagotribune.com/2004/12/10/where-is-elfriede-jelinek/ |url-status=live |archive-url=https://web.archive.org/web/20130617035833/http://articles.chicagotribune.com/2004-12-10/features/0412090437_1_literature-social-phobia-place |archive-date=2013-06-17 |access-date=2013-05-08 |work=Chicago Tribune}}</ref> | ||
* [[Mike Patton]], musician<ref>{{cite news |last1=Hatfield |first1=Amanda |title=Mike Patton discusses agoraphobia diagnosis, canceling Faith No More shows in new interview |url=https://www.brooklynvegan.com/mike-patton-discusses-agoraphobia-diagnosis-canceling-faith-no-more-shows-in-new-interview/ |access-date=21 July 2022 |work=Brooklyn Vegan | * [[Mike Patton]], musician<ref>{{cite news |last1=Hatfield |first1=Amanda |date=19 July 2022 |title=Mike Patton discusses agoraphobia diagnosis, canceling Faith No More shows in new interview |url=https://www.brooklynvegan.com/mike-patton-discusses-agoraphobia-diagnosis-canceling-faith-no-more-shows-in-new-interview/ |access-date=21 July 2022 |work=Brooklyn Vegan}}</ref> | ||
* [[Bolesław Prus]], journalist and [[novelist]]<ref> | * [[Bolesław Prus]], journalist and [[novelist]]<ref>{{cite book |title=Wspomnienia o Bolesławie Prusie |publisher=Państwowy Instytut Wydawniczy (State Publishing Institute) |year=1962 |editor-last=Fita |editor-first=Stanisław |location=Warsaw |page=113 |language=pl |trans-title=Reminiscences about Bolesław Prus}}</ref> | ||
* [[Marilyn (musician)|Peter Robinson]], musician<ref> | * [[Marilyn (musician)|Peter Robinson]], musician<ref>{{cite AV media |title=Whatever Happened to the Gender Benders? |type=Documentary |publisher=Channel 4 |location=United Kingdom}}</ref> | ||
* [[Barbra Streisand]], singer and songwriter<ref name="V 2014 x443">{{cite web | last=V | first=Justin | * [[Barbra Streisand]], singer and songwriter<ref name="V 2014 x443">{{cite web |last=V |first=Justin |date=2014-11-21 |title=Famous People With Agoraphobia |url=https://www.morningsiderecovery.com/addiction-blog/famous-figures-suffered-agoraphobia/ |access-date=2023-07-26 |website=Morningside Recovery}}</ref> | ||
* [[Ben Weasel]], singer and songwriter<ref>{{cite web |title=Ben Weasel featured on Carson Daly |url=https://www.punknews.org/article/40202/ben-weasel-featured-on-carson-daly |website=punknews.org | * [[Ben Weasel]], singer and songwriter<ref>{{cite web |date=14 October 2010 |title=Ben Weasel featured on Carson Daly |url=https://www.punknews.org/article/40202/ben-weasel-featured-on-carson-daly |website=punknews.org |language=en}}</ref> | ||
* [[Brian Wilson]], singer and songwriter<ref>{{cite web|last=McNair|first=James|url=https://www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html| | * [[Brian Wilson]], singer and songwriter<ref>{{cite web |last=McNair |first=James |date=3 September 2007 |title=Brian Wilson: Here Comes the Sun |url=https://www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html |url-access=subscription |archive-url=https://web.archive.org/web/20090120172307/http://www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html |archive-date=20 January 2009 |work=The Independent}}</ref> | ||
{{colend}} | {{colend}} | ||
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== External links == | == External links == | ||
{{ | {{sister project links||d=Q174589|c=no|n=no|b=no|v=no|voy=no|m=no|mw=no|s=no|wikt=anxiety|species=no}} | ||
*[http://www.adaa.org/ Anxiety Disorders Association of America] Information for families, clinicians & researchers | *[http://www.adaa.org/ Anxiety Disorders Association of America] Information for families, clinicians & researchers | ||
*[http://www.anxietycanada.ca/ Anxiety Disorders Association of Canada] Registered Canadian non-profit organization, promotes prevention, treatment & management of anxiety disorders | *[http://www.anxietycanada.ca/ Anxiety Disorders Association of Canada] Registered Canadian non-profit organization, promotes prevention, treatment & management of anxiety disorders | ||
*[http://www.anxietyuk.org.uk/ ANXIETY UK (Formerly the National Phobics Society)] Nationally registered charity in the UK; provides information, support & understanding | *[http://www.anxietyuk.org.uk/ ANXIETY UK (Formerly the National Phobics Society)] Nationally registered charity in the UK; provides information, support & understanding | ||
*[http://www.phobic.org.nz/ The Phobic Trust (Of New Zealand)] Registered charitable trust in New Zealand; provides information about treatment, education & support to people with anxiety disorders | *[http://www.phobic.org.nz/ The Phobic Trust (Of New Zealand)] Registered charitable trust in New Zealand; provides information about treatment, education & support to people with anxiety disorders | ||
*[http://www.sadag.co.za/ South African Depression and Anxiety group (National Charity)] Counseling, mental health awareness programs: media & public speaking outreach & rural outreach initiatives | *[http://www.sadag.co.za/ South African Depression and Anxiety group (National Charity)] {{Webarchive|url=https://web.archive.org/web/20101013022857/http://www.sadag.co.za/ |date=13 October 2010 }} Counseling, mental health awareness programs: media & public speaking outreach & rural outreach initiatives | ||
* [https://web.archive.org/web/20091115190338/http://www.nhsdirect.nhs.uk/help/bodykey/questions/index.aspx?nodes=%2f7ddGPON8Ig%3d Self help guide] (NHS Direct) | * [https://web.archive.org/web/20091115190338/http://www.nhsdirect.nhs.uk/help/bodykey/questions/index.aspx?nodes=%2f7ddGPON8Ig%3d Self help guide] (NHS Direct) | ||
Latest revision as of 20:15, 16 November 2025
Template:Short description Script error: No such module "Distinguish". Template:Cs1 config Template:Use dmy dates Template:Infobox medical condition
Agoraphobia[1] is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no way to escape.[1] These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own.[1] Being in these situations may result in a panic attack.[2] Those affected will go to great lengths to avoid these situations.[1] In severe cases, people may become completely unable to leave their homes.[2]
Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.[1] In the DSM-5, agoraphobia is classified as a phobia along with specific phobias and social phobia.[1][3] Other conditions that can produce similar symptoms include separation anxiety, post-traumatic stress disorder, and major depressive disorder.[1] The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicidal ideation.[4][5] Without treatment, it is uncommon for agoraphobia to resolve.[1] Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT).[3][6] CBT results in resolution for about half of people.[7] In some instances, those with a diagnosis of agoraphobia have reported taking benzodiazepines and antipsychotics.[4] Agoraphobia affects about 1.7% of adults.[1] Women are affected about twice as often as men. The condition is rare in children, often begins in adolescence or early adulthood, and becomes more common at age 65 or above.[1]
Etymology
The term agoraphobia was coined in German in 1871 by pioneering German psychologist Karl Friedrich Otto Westphal (1833–1890) in his article "Script error: No such module "Lang"." in the journal Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1871–72; 3: 138–161. It is derived from Greek Script error: No such module "Lang". (Template:Transliteration), meaning Template:Gloss or Template:Gloss and Script error: No such module "Lang". (Template:Transliteration), meaning Template:Gloss.[8][9]
Signs and symptoms
Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of a known, controllable space, usually their home.[1]
Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks".[10] In these cases, the patient is fearful of a particular place because they have previously experienced a panic attack at the same location. Fearing the onset of another panic attack, the patient is fearful or avoids a location. Some refuse to leave their homes in medical emergencies because the fear of being outside of their comfort areas is too great.[11]
The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making a diagnosis of panic disorder. Other syndromes like obsessive–compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome.[12]
People with agoraphobia may experience temporary separation anxiety disorder when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends.[13][14]
People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia".[15]
Panic attacks
Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.[16] Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report a fear of dying, fear of losing control of emotions, or fear of losing control of behaviors.[16]
Causes
Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.[1]
Research has uncovered a link between agoraphobia and difficulties with spatial orientation.[17][18] Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system, their visual system, and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds).[19] Likewise, they may be confused by sloping or irregular surfaces.[19]
In a virtual reality study, agoraphobics showed more difficulty integrating sensory changes than non-agoraphobics and are "more sensitive to sensory conflicts" than the general population.[20]
Substance-induced
Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia.[21] In 10 patients who had developed agoraphobia during benzodiazepine dependence, symptoms abated within the first year of assisted withdrawal.[22] Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to the long-term effects of alcohol consumption causing a distortion in brain chemistry.[23]
Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.[24]
Attachment theory
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Some scholars[25][26] have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.[27] Recent empirical research has also linked attachment and spatial theories of agoraphobia.[28]
Spatial theory
In the social sciences, a perceived clinical bias[29] exists in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.[30] Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating a conflict in the mind of agoraphobic individuals.
Evolutionary perspectives
Some evolutionary models propose that agoraphobia—like other specific phobias—may be rooted in adaptive mechanisms that helped early humans avoid threats in open or unfamiliar environments. From this viewpoint, fear and avoidance behaviors could have been selectively favored if they aided survival—for instance, by prompting individuals to steer clear of potentially dangerous surroundings or minimize exposure to predators and pathogens. According to preparedness models, human defensive systems are especially sensitive to cues linked to ancestral threats and can rapidly form strong, lasting fear associations with them. In modern life, such defenses might become mismatched to relatively low-risk environments, producing disproportionate anxiety responses.[31]
An additional evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred.[32][33]
Diagnosis
Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.[34] Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.[35] Early treatment of panic disorder can often prevent agoraphobia.[36] Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other mental disorders such as depression.[37]
Agoraphobia without history of panic disorder
Agoraphobia without a history of panic disorder (also called primary agoraphobia) is an anxiety disorder where the individual with the diagnosis does not meet the DSM-5 criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks. Agoraphobia can be caused by traumatic experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, generalized anxiety disorder, avoidant personality disorder and social phobia. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic".[38] In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.Script error: No such module "Unsubst".
According to the DSM-IV-TR, a widely used manual for diagnosing mental disorders, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence.[39] The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be diagnosed together.[40]
Treatments
Therapy
Systematic desensitization can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.[41] Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely.[42][43] In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until the symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise.[43]
A related exposure treatment is Script error: No such module "Lang". exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects.[44] This treatment was largely effective with an effect size from d = 0.78 to d = 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment).[44]
Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals. Further research showed there was no significant effect between using group CBT versus individual CBT.[44]
Cognitive restructuring has also proved useful in treating agoraphobia.[45] This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.[45]
Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.[46]
Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method.[47] Similar to traditional face-to-face interventions, VCP can be used to administer CBT.[48]
Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).[49]
Medications
Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. Benzodiazepines, monoamine oxidase inhibitors, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia.[50] Antidepressants are important because some have anxiolytic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy.[43] A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.[43]
Alternative medicine
Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.[51] As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.[52]
Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.[53]
Epidemiology
Agoraphobia occurs about twice as often in women as it does in men. Age of onset is typically mid to late twenties, though it can occur at any age.[54][55]
Panic disorder with or without agoraphobia affects roughly 5.1% of Americans,[44] and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting with panic disorders as well.[44]
Society and culture
Notable cases
- Woody Allen, actor, director, musician[56]
- Isaac Asimov, science fiction writer, reportedly had a mild case of agoraphobia[57][58][59][60]
- Kim Basinger, actress[61]
- Earl Campbell, American football player[62]
- Macaulay Culkin, actor[63]
- Paula Deen, chef, author, and television personality[64]
- H.L. Gold, science fiction editor[65]
- Daryl Hannah, actress[66]
- Miranda Hart, actress and comedian[67]
- Howard Hughes, aviator, industrialist, film producer and philanthropist[68]
- Olivia Hussey, actress[69][70]
- Shirley Jackson, writer[71][72]
- Elfriede Jelinek, writer, Nobel Prize laureate in Literature in 2004[73]
- Mike Patton, musician[74]
- Bolesław Prus, journalist and novelist[75]
- Peter Robinson, musician[76]
- Barbra Streisand, singer and songwriter[77]
- Ben Weasel, singer and songwriter[78]
- Brian Wilson, singer and songwriter[79]
See also
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References
Sources
- Balaram K, Marwaha R. Agoraphobia. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 January ([1])
Further reading
- Agoraphobia Without a History or Panic Disorder May Be Part of the Panic Disorder Syndrome. Journal of Nervous & Mental Disease, 190(9):624–630, September 2002.
- The Relationship of Agoraphobia and Panic in a Community Sample of Adolescents and Young Adults.
External links
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- Anxiety Disorders Association of America Information for families, clinicians & researchers
- Anxiety Disorders Association of Canada Registered Canadian non-profit organization, promotes prevention, treatment & management of anxiety disorders
- ANXIETY UK (Formerly the National Phobics Society) Nationally registered charity in the UK; provides information, support & understanding
- The Phobic Trust (Of New Zealand) Registered charitable trust in New Zealand; provides information about treatment, education & support to people with anxiety disorders
- South African Depression and Anxiety group (National Charity) Template:Webarchive Counseling, mental health awareness programs: media & public speaking outreach & rural outreach initiatives
- Self help guide (NHS Direct)
Template:Medical condition classification and resources
Template:Mental and behavioural disorders
- ↑ a b c d e f g h i j k l Script error: No such module "citation/CS1".
- ↑ a b Script error: No such module "citation/CS1".Template:Dead linkTemplate:Cbignore
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- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ a b Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ a b Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ American Psychiatric Association, 1998
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ a b c d Script error: No such module "citation/CS1".
- ↑ a b c d e Script error: No such module "Citation/CS1".
- ↑ a b Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Template:Cite magazine
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Template:Trim/bio Biography for Daryl Hannah at IMDbTemplate:EditAtWikidataScript error: No such module "Check for unknown parameters".. Retrieved 28 November 2007.
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Template:Cite magazine
- ↑ Template:Trim/bio Biography for Olivia Hussey at IMDbTemplate:EditAtWikidataScript error: No such module "Check for unknown parameters".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".