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'''For patient information click [[Agoraphobia (patient information)|here]]'''
'''For patient information click [[Agoraphobia (patient information)|here]]'''


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{{CMG}}; {{AE}} {{KS}}, {{HW}}
{{CMG}}; {{AE}} {{KS}}, {{HW}}, {{I.D.}}


==Overview==
==Overview==
Agoraphobia is an [[anxiety disorder]] characterized by intense terror and [[anxiety]] over any place or situation from which one might not easily be able to escape. This often leads sufferers to avoid leaving their homes, using public transportation or air travel, or being in crowded spaces.<ref name="pmid20855043">{{cite journal| author=Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al.| title=Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). | journal=J Am Acad Child Adolesc Psychiatry | year= 2010 | volume= 49 | issue= 10 | pages= 980-9 | pmid=20855043 | doi=10.1016/j.jaac.2010.05.017 | pmc=2946114 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20855043  }} </ref> The average [[age of onset]] of agoraphobia is 20 years.<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref> Agoraphobia is closely associated with panic disorder; the two are commonly comorbid. Patients with agoraphobia often exhibit depressive symptoms, as well as social or specific phobias, which can make the disorder difficult to diagnose.<ref name="#7">World Heart Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10). Geneva, Switzerland. Retrieved 29 September 2016.</ref> Patients with severe agoraphobia may become confined to their homes. The word "agoraphobia" is an English adoption of the [[Greek language|Greek]] words ''[[agora]]'' (αγορά) and ''[[phobos]]'' (φόβος), literally translated as "a fear of the marketplace."  This etymology is the reason for the common misconception that agoraphobia is a fear of open spaces.
Agoraphobia is an [[Anxiety disorders|anxiety disorder]] characterized by intense terror and [[anxiety]] over any place or situation from which one might not easily be able to escape. This often leads sufferers to avoid leaving their homes, using public transportation or air travel, or being in crowded spaces. The average [[age of onset]] of agoraphobia is 20 years. Agoraphobia is closely associated with [[panic disorder]]; the two are commonly [[comorbid]]. Patients with agoraphobia often exhibit [[depressive]] symptoms, as well as social or specific [[phobias]], which can make the disorder difficult to diagnose. Patients with severe agoraphobia may become confined to their homes. The word "agoraphobia" is an English adoption of the [[Greek language|Greek]] words ''agora'' (αγορά) and ''phobos'' (φόβος), literally translated as "a fear of the marketplace."  This etymology is the reason for the common misconception that agoraphobia is a fear of open spaces.


==Historical Perspective==
==Historical Perspective==
Agoraphobia was first described by Karl Friedrich Otto Westphal, a German psychiatrist, in 1871. Westphal coined the term after observing three of his patients, who exhibited severe anxiety and dread upon traveling to certain public areas of Berlin, the city where he worked.  
*In 1871, Agoraphobia was first described by Karl Friedrich Otto Westphal, a German psychiatrist.
*Westphal coined the term after observing three of his patients, who exhibited severe [[anxiety]] and dread upon traveling to certain public areas of Berlin, in the city where he worked.


==Classification==
==Classification==
The DSM-V, released in 2013, classifies agoraphobia as a [[phobia]].<ref name= DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*The [[DSM|DSM-V]], released in 2013, classifies agoraphobia as a [[phobia]].<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
The ICD-10 places agoraphobia under the subcategory of "Phobic anxiety disorders," which falls under the category of "Neurotic, stress-related and somatoform disorders."<ref name="#7"></ref> Within the former subcategory, agoraphobia is grouped together with:<ref name="#7"></ref>
*The ICD-10 places agoraphobia under the subcategory of "Phobic anxiety disorders," which falls under the category of "Neurotic, [[stress|stress-related]] and [[somatoform disorders]]."<ref name="#7">World Heart Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10). Geneva, Switzerland. Retrieved 29 September 2016.</ref>
*social phobias
*Within the former subcategory, agoraphobia is grouped together with:<ref name="#7" />
*specific/isolated phobias
**[[Social phobia|Social phobias]]
*other phobic anxiety disorders
**Specific/isolated phobias
*phobic anxiety disorder, unspecified
**Other [[phobic anxiety disorders]]
**[[Phobic anxiety disorder]], unspecified


Though some experts have argued that agoraphobia can reasonably be thought of as a severe consequence of panic disorder, a comparison of the multivariate comorbidity patterns of agoraphobia and panic disorder supports the independent classification of these disorders.<ref name="pmid26480214">{{cite journal| author=Greene AL, Eaton NR| title=Panic disorder and agoraphobia: A direct comparison of their multivariate comorbidity patterns. | journal=J Affect Disord | year= 2016 | volume= 190 | issue=  | pages= 75-83 | pmid=26480214 | doi=10.1016/j.jad.2015.09.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26480214  }} </ref>
*Though some experts have argued that agoraphobia can reasonably be thought of as a severe consequence of [[panic disorder]], a comparison of the multivariate comorbidity patterns of agoraphobia and [[panic disorder]] supports the independent classification of these disorders.<ref name="pmid26480214">{{cite journal| author=Greene AL, Eaton NR| title=Panic disorder and agoraphobia: A direct comparison of their multivariate comorbidity patterns. | journal=J Affect Disord | year= 2016 | volume= 190 | issue=  | pages= 75-83 | pmid=26480214 | doi=10.1016/j.jad.2015.09.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26480214  }} </ref>


==Pathophysiology==
==Pathophysiology==
Similar to many other mental disorders, agoraphobia may be associated with childhood trauma and bullying. Compared to individuals who were not bullied, victims of bullying were found to be 4.6 times more likely to experience panic attacks or agoraphobia.<ref name="pmid23426798">{{cite journal| author=Copeland WE, Wolke D, Angold A, Costello EJ| title=Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. | journal=JAMA Psychiatry | year= 2013 | volume= 70 | issue= 4 | pages= 419-26 | pmid=23426798 | doi=10.1001/jamapsychiatry.2013.504 | pmc=3618584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23426798  }} </ref>


Agoraphobia may be related to defects in balance. Researchers who noticed a similarity between the situations commonly avoided by sufferers of agoraphobia and the types of environments that trigger disorientation in people with balance disorders administered a battery of audiovestibular tests, coupled with moving platform posturography, to 36 subjects with agoraphobic symptoms and 20 normal, healthy controls. Over 60% of the former group were destabilized by these disorienting conditions, compared to a mere 10% of the control group. Postural instability was found to be highly related to agoraphobic avoidance  (r = 0.63, P < 0.01), event after the researchers controlled for symptoms, anxiety and agoraphobic cognitions.<ref name="pmid7755529">{{cite journal| author=Yardley L, Britton J, Lear S, Bird J, Luxon LM| title=Relationship between balance system function and agoraphobic avoidance. | journal=Behav Res Ther | year= 1995 | volume= 33 | issue= 4 | pages= 435-9 | pmid=7755529 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7755529  }} </ref>
===Relationship to Balance Disorders===
*Agoraphobia may be related to defects in balance. Researchers who noticed a similarity between the situations commonly avoided by sufferers of agoraphobia and the types of environments that trigger disorientation in people with balance disorders administered a battery of audiovestibular tests, coupled with moving platform posturography, to 36 subjects with agoraphobic symptoms and 20 normal, healthy controls.
**Over 60% of the former group were destabilized by these disorienting conditions, compared to a mere 10% of the control group.
**Postural instability was found to be highly related to agoraphobic avoidance  (r = 0.63, P < 0.01), event after the researchers controlled for [[symptoms]], [[anxiety]], and [[agoraphobic cognitions]].<ref name="pmid7755529">{{cite journal| author=Yardley L, Britton J, Lear S, Bird J, Luxon LM| title=Relationship between balance system function and agoraphobic avoidance. | journal=Behav Res Ther | year= 1995 | volume= 33 | issue= 4 | pages= 435-9 | pmid=7755529 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7755529  }} </ref>


===Attachment Theory===
===Attachment Theory===
Some scholars (e.g., Liotti  1996,<ref>G. Liotti, (1996). ''Insecure attachment and agoraphobia'', in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.</ref> [[Bowlby]] 1998<ref>J. Bowlby, (1998). ''Attachment and Loss'' (Vol. 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.
*Some scholars (e.g., Liotti  1996, Bowlby 1998) have explained agoraphobia as an [[attachment]] deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.<ref>G. Liotti, (1996). ''Insecure attachment and agoraphobia'', in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.</ref><ref>J. Bowlby, (1998). ''Attachment and Loss'' (Vol. 2: Separation).</ref>


===Spatial Theory===
===Spatial Theory===
In the social sciences there is a perceived clinical bias (e.g., Davidson 2003<ref>J. Davidson, (2003). ''Phobic Geographies''</ref>) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.
*In the social sciences, there is a perceived clinical bias (e.g., Davidson 2003) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.<ref>J. Davidson, (2003). ''Phobic Geographies''</ref>


===Associated Conditions===
===Associated Conditions===
Commonly comorbid conditions include:<ref name="pmid26487813">{{cite journal| author=Bandelow B, Michaelis S| title=Epidemiology of anxiety disorders in the 21st century. | journal=Dialogues Clin Neurosci | year= 2015 | volume= 17 | issue= 3 | pages= 327-35 | pmid=26487813 | doi= | pmc=4610617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26487813  }} </ref>
*Commonly comorbid conditions include:<ref name="pmid26487813">{{cite journal| author=Bandelow B, Michaelis S| title=Epidemiology of anxiety disorders in the 21st century. | journal=Dialogues Clin Neurosci | year= 2015 | volume= 17 | issue= 3 | pages= 327-35 | pmid=26487813 | doi= | pmc=4610617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26487813  }} </ref>
*[[Panic disorder]]
**[[Panic disorder]]
*[[SAD]]
**[[SAD]]
*[[Specific phobia]]
**[[Specific phobia]]
 
==Causes==
The exact cause of agoraphobia is unknown. In some instances, someone who has a panic attack may begin to exhibit signs of agoraphobia out of fear that another panic attack will occur.<ref name="#8">NIH: U.S. National Library of Medicine. (2016). Agoraphobia. https://medlineplus.gov/ency/article/000923.htm Retrieved 29 September 2016.</ref>


==Differential Diagnosis==
==Differential Diagnosis==
Agoraphobia must be differentiated from other disorders with similar symptomology:<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Agoraphobia must be differentiated from other disorders with similar [[symptomology]], including:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*[[Acute stress disorder]]  
**[[Acute stress disorder]]  
*[[Major depressive disorder]]
**[[Major depressive disorder]]
*Other medical conditions
**Other medical conditions
:*[[Parkinson's disease]]
***[[Parkinson's disease]]
:*[[Multiple sclerosis]]
***[[Multiple sclerosis]]
*[[Panic disorder]] without agoraphobia
**[[Panic disorder]] without agoraphobia
*[[Post traumatic stress disorder]]
**[[Post traumatic stress disorder]]
*[[Separation anxiety disorder]]
**[[Separation anxiety disorder]]
*[[Social anxiety disorder]] ([[social phobia]])
**[[Social anxiety disorder]] ([[social phobia]])
*Specific phobia, situational type
**Specific [[phobia]], situational type


==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Prevalence===
===Prevalence===
The prevalence of agoraphobia is 1,700 per 100,000 (1.7%) of the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*The prevalence of agoraphobia is 1,700 per 100,000 (1.7%) of the overall population.<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


===Age===
===Age===
*Among children ages 13 to 18, there is a lifetime prevalence of 2.4% for agoraphobia.<ref name="pmid20855043">{{cite journal| author=Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al.| title=Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). | journal=J Am Acad Child Adolesc Psychiatry | year= 2010 | volume= 49 | issue= 10 | pages= 980-9 | pmid=20855043 | doi=10.1016/j.jaac.2010.05.017 | pmc=2946114 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20855043  }} </ref>
*Among children, ages 13 to 18, there is a lifetime prevalence of 2,400 per 100,000 (2.4%) for agoraphobia.<ref name="pmid20855043">{{cite journal| author=Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al.| title=Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). | journal=J Am Acad Child Adolesc Psychiatry | year= 2010 | volume= 49 | issue= 10 | pages= 980-9 | pmid=20855043 | doi=10.1016/j.jaac.2010.05.017 | pmc=2946114 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20855043  }} </ref>
*Among adults in the United States, agoraphobia has a 12-month prevalence of 0.8%. 40.6% of these cases are classified as "severe."<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref>
*Among adults in the United States, agoraphobia has a 12-month prevalence of 800 per 100,000 (0.8%). 40.6% of these cases are classified as "severe."<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref>


===Gender===
===Gender===
No gender disparity in the incidence of agoraphobia has been widely established.<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref>
*No gender disparity in the incidence of agoraphobia has been widely established.<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref>
*Some studies have suggested that panic disorder patients with agoraphobia are more likely to be female than patients who have panic disorder but not agoraphobia. Female patients were also found to have a higher prevalence of comorbidities.<ref name="pmid27423353">{{cite journal| author=Inoue K, Kaiya H, Hara N, Okazaki Y| title=A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia. | journal=Compr Psychiatry | year= 2016 | volume= 69 | issue=  | pages= 132-5 | pmid=27423353 | doi=10.1016/j.comppsych.2016.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27423353  }} </ref>
*Some studies have suggested that [[panic disorder]] patients with agoraphobia are more likely to be female than patients who have [[panic disorder]] but not agoraphobia. Female patients were also found to have a higher prevalence of [[comorbidities]].<ref name="pmid27423353">{{cite journal| author=Inoue K, Kaiya H, Hara N, Okazaki Y| title=A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia. | journal=Compr Psychiatry | year= 2016 | volume= 69 | issue=  | pages= 132-5 | pmid=27423353 | doi=10.1016/j.comppsych.2016.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27423353  }} </ref>


===Race===
===Race===
No racial predilection has been established for agoraphobia.<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref>
*No racial predilection has been established for agoraphobia.<ref name="pmid15939837">{{cite journal| author=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE| title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. | journal=Arch Gen Psychiatry | year= 2005 | volume= 62 | issue= 6 | pages= 593-602 | pmid=15939837 | doi=10.1001/archpsyc.62.6.593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15939837  }} </ref>


==Risk Factors==
==Risk Factors==
Risk factors for agoraphobia include:<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*The exact cause of agoraphobia is unknown. In some instances, someone who has a panic attack may begin to exhibit signs of agoraphobia out of fear that another panic attack will occur.<ref name="#8">NIH: U.S. National Library of Medicine. (2016). Agoraphobia. https://medlineplus.gov/ency/article/000923.htm Retrieved 29 September 2016.</ref>
*Anxiety sensitivity
*Risk factors for agoraphobia include:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Behavioral inhibition
**[[Anxiety]] sensitivity
*Genetic predisposition
**Behavioral inhibition
*Neurotic disposition (neuroticism)
**[[Genetic predisposition]]
*Negative events in childhood
**Neurotic disposition ([[neuroticism]])
:*Separation
**Negative events in childhood
:*Death of parent
***Separation/divorce of parents
:*Bullying
***Death of parent
*Stressful or traumatic events (e.g., being attacked or mugged)
***Bullying
 
**Stressful or traumatic events (e.g., being attacked or mugged)
==Screening==


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
People with agoraphobia may experience [[panic attack]]s in situations in which they feel trapped, insecure, out of control, or too far from their personal [[comfort zone]]. In severe cases, an agoraphobic person may be completely confined to his or her home.<ref name="NIH91">{{Citation | title=Treatment of Panic Disorder | journal=NIH Consens Statement | date=Sep 25-27, 1991 | volume=9 | issue=2 | pages=1-24 |url=http://consensus.nih.gov/1991/1991PanicDisorder085html.htm}}</ref>
*People with agoraphobia may experience [[panic attack]]s in situations in which they feel trapped, insecure, out of control, or too far from their personal comfort zone. In severe cases, an agoraphobic person may be completely confined to his or her home.<ref name="NIH91">{{Citation | title=Treatment of Panic Disorder | journal=NIH Consens Statement | date=Sep 25-27, 1991 | volume=9 | issue=2 | pages=1-24 |url=http://consensus.nih.gov/1991/1991PanicDisorder085html.htm}}</ref>
*Some people with agoraphobia are comfortable seeing visitors, but only in a defined space in which they feel in control.
**Some people with agoraphobia are comfortable seeing visitors, but only in a defined space in which they feel in control.
**Such people may live for years without leaving their homes, while happily seeing visitors and working, as long as they can stay within their safety zones.
***Such people may live for years without leaving their homes, while happily seeing visitors and working, as long as they can stay within their safety zones.
**If someone suffering from agoraphobia leaves his or her "safety zone," an anxiety attack may occur.
***If someone suffering from agoraphobia leaves his or her "safety zone," an [[anxiety]] attack may occur.
*Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, adrenaline is released in large amounts for several minutes causing the classical "fight or flight" condition.
**Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, [[adrenaline]] is released in large amounts for several minutes causing the classical "fight or flight" condition.
**The 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 | year=1999 | chapter=Chapter 4.2| author=David Satcher etal.| title='''Mental Health: A Report of the Surgeon General'''| url=http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html}}</ref> These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. <ref name="NIH4.2"/>
***The 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 | year=1999 | chapter=Chapter 4.2| author=David Satcher etal.| title='''Mental Health: A Report of the Surgeon General'''| url=http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html}}</ref>
***These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. <ref name="NIH4.2" />


===Complications===
===Complications===
Complications associated with agoraphobia may encompass physical, behavioral, or lifestyle changes.
*Complications associated with agoraphobia may encompass physical, behavioral, or lifestyle changes.
*The avoidance behaviors associated with agoraphobia are established correlates of treatment discontinuation.<ref name="pmid27385412">{{cite journal| author=Bélanger C, Courchesne C, Leduc AG, Dugal C, El-Baalbaki G, Marchand A et al.| title=Predictors of Dropout From Cognitive-Behavioral Group Treatment for Panic Disorder With Agoraphobia: An Exploratory Study. | journal=Behav Modif | year= 2016 | volume=  | issue=  | pages=  | pmid=27385412 | doi=10.1177/0145445516656614 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27385412  }} </ref>
**The avoidance behaviors associated with agoraphobia are established correlates of treatment discontinuation.<ref name="pmid27385412">{{cite journal| author=Bélanger C, Courchesne C, Leduc AG, Dugal C, El-Baalbaki G, Marchand A et al.| title=Predictors of Dropout From Cognitive-Behavioral Group Treatment for Panic Disorder With Agoraphobia: An Exploratory Study. | journal=Behav Modif | year= 2016 | volume=  | issue=  | pages=  | pmid=27385412 | doi=10.1177/0145445516656614 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27385412  }} </ref>
*Individuals with agoraphobia are more likely to show signs of decreased assertiveness, perhaps because their illness cultivates feelings of helplessness and insecurity.<ref name="pmid26915016">{{cite journal| author=Levitan MN, Simoes P, Sardinha AG, Nardi AE| title=Agoraphobia Related to Unassertiveness in Panic Disorder. | journal=J Nerv Ment Dis | year= 2016 | volume= 204 | issue= 5 | pages= 396-9 | pmid=26915016 | doi=10.1097/NMD.0000000000000486 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26915016  }} </ref>
**Individuals with agoraphobia are more likely to show signs of decreased assertiveness, perhaps because their illness cultivates feelings of helplessness and insecurity.<ref name="pmid26915016">{{cite journal| author=Levitan MN, Simoes P, Sardinha AG, Nardi AE| title=Agoraphobia Related to Unassertiveness in Panic Disorder. | journal=J Nerv Ment Dis | year= 2016 | volume= 204 | issue= 5 | pages= 396-9 | pmid=26915016 | doi=10.1097/NMD.0000000000000486 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26915016  }} </ref>
*The avoidance of places or structures in which panic attacks with occurred may limit a patient’s job prospects or proximity to desirable facilities or services.<ref name="#9">NIH: U.S. National Library of Medicine. (2016). About Panic and Agoraphobia. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024921/ Retrieved 29 September 2016.</ref>
**The avoidance of places or structures in which panic attacks have occurred may limit a patient’s job prospects or proximity to desirable facilities or services.<ref name="#9">NIH: U.S. National Library of Medicine. (2016). About Panic and Agoraphobia. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024921/ Retrieved 29 September 2016.</ref>


===Prognosis===
===Prognosis===
The prognosis of agoraphobia depends upon the severity of the disease. The prognosis is generally good with early medical intervention; if left untreated, the disorder may become more difficult for healthcare providers to effectively manage.<ref name="#8"></ref>
*The prognosis of agoraphobia depends upon the severity of the disease.
*The prognosis is generally good with early medical intervention; if left untreated, the disorder may become more difficult for healthcare providers to effectively manage.<ref name="#8" />


==Diagnosis==
==Diagnosis==
Line 113: Line 116:
====DSM-V Diagnostic Criteria for Agoraphobia====
====DSM-V Diagnostic Criteria for Agoraphobia====


The fifth version of the DSM, released in 2013, sets forth the following as diagnostic criteria for agoraphobia:<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
The fifth version of the DSM, released in 2013, sets forth the following as diagnostic criteria for agoraphobia:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
{{cquote|
{{cquote|


Line 158: Line 161:
}}
}}


===Symptoms===
===History and Symptoms===
Symptoms of agoraphobia may include the following:<ref name="#8"></ref>
Symptoms of agoraphobia may include the following:<ref name="#8" />
*Fear of crowds, bridges, and/or being outside alone
*Fear of crowds, bridges, and/or being outside alone
*Fear of losing control of oneself in a public place
*Fear of losing control of oneself in a public place
Line 171: Line 174:
*[[Depression]] or suicidal ideation
*[[Depression]] or suicidal ideation


If agoraphobic patients find themselves in a situation that triggers their anxiety, symptoms may include the following:<ref name="#8"></ref>
If agoraphobic patients find themselves in a situation that triggers their anxiety, symptoms may include the following:<ref name="#8" />
*Powerful sensations of [[panic]] and [[distress]]
*Powerful sensations of [[panic]] and [[distress]]
*[[Tachycardia]]
*[[Tachycardia]]
Line 182: Line 185:


===Physical Examination===
===Physical Examination===
Health care providers will examine a patient who is exhibiting signs of agoraphobia for a history of panic disorders. The clinician will also get a description of the relevant symptoms and behaviors from the patient and, if possible, from any family members or friends who might have knowledge of relevant behaviors.<ref name="#8"></ref>
*Healthcare providers will examine a patient who is exhibiting signs of agoraphobia for a history of panic disorders.
*The clinician will also get a description of the relevant symptoms and behaviors of the patient and, if possible, from any family members or friends who might have knowledge of relevant behaviors.<ref name="#8" />


==Treatment==
==Treatment==


===Medical Therapy===
===Medical Therapy===
The mainstay of therapy for agoraphobia is a combination of [[CBT]], or [[talk therapy]], and medicine. Certain drugs that are regularly used to treat depression, such as [[SSRI|SSRIs]] and [[SNRI|SNRIs]] may also be helpful in the treatment of agoraphobia. Such drugs must be taken every day in order to be effective.<ref name="#8"></ref>
*The mainstay of therapy for agoraphobia is a combination of [[CBT]], [[talk therapy]], and [[medicine]]. Certain drugs that are regularly used to treat [[depression]], such as [[SSRI|SSRIs]] and [[SNRI|SNRIs]], may also be helpful in the treatment of agoraphobia.<ref name="#8" />
*Treatment delivery factors, particularly therapist adherence, are important indicators of the potential for successful CBT.<ref name="pmid27235836">{{cite journal| author=Weck F, Grikscheit F, Höfling V, Kordt A, Hamm AO, Gerlach AL et al.| title=The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia. | journal=J Anxiety Disord | year= 2016 | volume= 42 | issue=  | pages= 10-8 | pmid=27235836 | doi=10.1016/j.janxdis.2016.05.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27235836  }} </ref>
**Treatment delivery factors, particularly therapist adherence, are important indicators of the potential for successful [[CBT]].<ref name="pmid27235836">{{cite journal| author=Weck F, Grikscheit F, Höfling V, Kordt A, Hamm AO, Gerlach AL et al.| title=The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia. | journal=J Anxiety Disord | year= 2016 | volume= 42 | issue=  | pages= 10-8 | pmid=27235836 | doi=10.1016/j.janxdis.2016.05.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27235836  }} </ref>
*Studies have shown that therapist-directed cognitive behavioral therapy has a more significant impact on agoraphobic psychopathology in the short-term than do SSRIs/SNRIs.<ref name="pmid26837851">{{cite journal| author=Liebscher C, Wittmann A, Gechter J, Schlagenhauf F, Lueken U, Plag J et al.| title=Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia. | journal=Eur Neuropsychopharmacol | year= 2016 | volume= 26 | issue= 3 | pages= 431-44 | pmid=26837851 | doi=10.1016/j.euroneuro.2016.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26837851  }} </ref>
**Studies have shown that therapist-directed [[CBT]] has a more significant impact on agoraphobic [[psychopathology]] in the short-term than do [[SSRIs]]/[[SNRIs]].<ref name="pmid26837851">{{cite journal| author=Liebscher C, Wittmann A, Gechter J, Schlagenhauf F, Lueken U, Plag J et al.| title=Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia. | journal=Eur Neuropsychopharmacol | year= 2016 | volume= 26 | issue= 3 | pages= 431-44 | pmid=26837851 | doi=10.1016/j.euroneuro.2016.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26837851  }} </ref>
*At a physician’s discretion, sedatives or hypnotics may also be prescribed. A physician may advise his/her patient to take such drugs when the symptoms of agoraphobia are particularly severe or as a preventive measure, when one expects to be exposed to a triggering situation.<ref name="#8"></ref>
**At a physician’s discretion, [[sedatives]] or [[hypnotics]] may also be prescribed. A physician may advise an agoraphobic patient to take such drugs when the symptoms of agoraphobia are particularly severe or as a preventive measure, when one expects to be exposed to a triggering situation.<ref name="#8" />


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of agoraphobia.
*Surgical intervention is not recommended for the management of agoraphobia.
 
===Prevention===


====Primary Prevention====
===Primary Prevention===
There is no established method for the primary prevention of agoraphobia.
*There is no established method for the primary prevention of agoraphobia.


====Secondary Prevention====
===Secondary Prevention===
Maintenance of a healthy lifestyle, which includes eating a balanced diet, exercising regularly, and getting a sufficient amount of sleep, may be helpful in the secondary prevention of agoraphobia.<ref name="#8"></ref>
*Maintenance of a healthy lifestyle may be helpful in the secondary prevention of agoraphobia. This includes:<ref name="#8" />
**Eating a balanced diet
**Exercising regularly
**Getting a sufficient amount of sleep


==References==
==References==

Latest revision as of 16:23, 20 August 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2], Haleigh Williams, B.S., Irfan Dotani

Overview

Agoraphobia is an anxiety disorder characterized by intense terror and anxiety over any place or situation from which one might not easily be able to escape. This often leads sufferers to avoid leaving their homes, using public transportation or air travel, or being in crowded spaces. The average age of onset of agoraphobia is 20 years. Agoraphobia is closely associated with panic disorder; the two are commonly comorbid. Patients with agoraphobia often exhibit depressive symptoms, as well as social or specific phobias, which can make the disorder difficult to diagnose. Patients with severe agoraphobia may become confined to their homes. The word "agoraphobia" is an English adoption of the Greek words agora (αγορά) and phobos (φόβος), literally translated as "a fear of the marketplace." This etymology is the reason for the common misconception that agoraphobia is a fear of open spaces.

Historical Perspective

  • In 1871, Agoraphobia was first described by Karl Friedrich Otto Westphal, a German psychiatrist.
  • Westphal coined the term after observing three of his patients, who exhibited severe anxiety and dread upon traveling to certain public areas of Berlin, in the city where he worked.

Classification

  • Though some experts have argued that agoraphobia can reasonably be thought of as a severe consequence of panic disorder, a comparison of the multivariate comorbidity patterns of agoraphobia and panic disorder supports the independent classification of these disorders.[3]

Pathophysiology

Relationship to Balance Disorders

  • Agoraphobia may be related to defects in balance. Researchers who noticed a similarity between the situations commonly avoided by sufferers of agoraphobia and the types of environments that trigger disorientation in people with balance disorders administered a battery of audiovestibular tests, coupled with moving platform posturography, to 36 subjects with agoraphobic symptoms and 20 normal, healthy controls.
    • Over 60% of the former group were destabilized by these disorienting conditions, compared to a mere 10% of the control group.
    • Postural instability was found to be highly related to agoraphobic avoidance (r = 0.63, P < 0.01), event after the researchers controlled for symptoms, anxiety, and agoraphobic cognitions.[4]

Attachment Theory

  • Some scholars (e.g., Liotti 1996, Bowlby 1998) have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.[5][6]

Spatial Theory

  • In the social sciences, there is a perceived clinical bias (e.g., Davidson 2003) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.[7]

Associated Conditions

Differential Diagnosis

Epidemiology and Demographics

Prevalence

  • The prevalence of agoraphobia is 1,700 per 100,000 (1.7%) of the overall population.[1]

Age

  • Among children, ages 13 to 18, there is a lifetime prevalence of 2,400 per 100,000 (2.4%) for agoraphobia.[9]
  • Among adults in the United States, agoraphobia has a 12-month prevalence of 800 per 100,000 (0.8%). 40.6% of these cases are classified as "severe."[10]

Gender

  • No gender disparity in the incidence of agoraphobia has been widely established.[10]
  • Some studies have suggested that panic disorder patients with agoraphobia are more likely to be female than patients who have panic disorder but not agoraphobia. Female patients were also found to have a higher prevalence of comorbidities.[11]

Race

  • No racial predilection has been established for agoraphobia.[10]

Risk Factors

  • The exact cause of agoraphobia is unknown. In some instances, someone who has a panic attack may begin to exhibit signs of agoraphobia out of fear that another panic attack will occur.[12]
  • Risk factors for agoraphobia include:[1]
    • Anxiety sensitivity
    • Behavioral inhibition
    • Genetic predisposition
    • Neurotic disposition (neuroticism)
    • Negative events in childhood
      • Separation/divorce of parents
      • Death of parent
      • Bullying
    • Stressful or traumatic events (e.g., being attacked or mugged)

Natural History, Complications, and Prognosis

Natural History

  • People with agoraphobia may experience panic attacks in situations in which they feel trapped, insecure, out of control, or too far from their personal comfort zone. In severe cases, an agoraphobic person may be completely confined to his or her home.[13]
    • Some people with agoraphobia are comfortable seeing visitors, but only in a defined space in which they feel in control.
      • Such people may live for years without leaving their homes, while happily seeing visitors and working, as long as they can stay within their safety zones.
      • If someone suffering from agoraphobia leaves his or her "safety zone," an anxiety attack may occur.
    • Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, adrenaline is released in large amounts for several minutes causing the classical "fight or flight" condition.
      • The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. [14]
      • These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. [14]

Complications

  • Complications associated with agoraphobia may encompass physical, behavioral, or lifestyle changes.
    • The avoidance behaviors associated with agoraphobia are established correlates of treatment discontinuation.[15]
    • Individuals with agoraphobia are more likely to show signs of decreased assertiveness, perhaps because their illness cultivates feelings of helplessness and insecurity.[16]
    • The avoidance of places or structures in which panic attacks have occurred may limit a patient’s job prospects or proximity to desirable facilities or services.[17]

Prognosis

  • The prognosis of agoraphobia depends upon the severity of the disease.
  • The prognosis is generally good with early medical intervention; if left untreated, the disorder may become more difficult for healthcare providers to effectively manage.[12]

Diagnosis

Diagnostic Criteria

DSM-V Diagnostic Criteria for Agoraphobia

The fifth version of the DSM, released in 2013, sets forth the following as diagnostic criteria for agoraphobia:[1]

  • A. Marked fear or anxiety about two (or more) of the following five situations:
  • 1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
  • 2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
  • 3. Being in enclosed places (e.g., shops, theaters, cinemas).
  • 4. Standing in line or being in a crowd.
  • 5. Being outside of the home alone.

AND

  • B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

AND

  • C. The agoraphobic situations almost always provoke fear or anxiety.

AND

  • D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

AND

  • E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the socio cultural context.

AND

  • F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

AND

  • G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

AND

  • I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder): and are not related exclusively to obsessions (as in obsessive-compulsive disorder),perceived defects or flaws in physical appearance (as in body dysmorhic disorder), reminders of traumatic events (as in post traumatic stress disorder), or fear of separation (as in separation anxiety disorder).

Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

History and Symptoms

Symptoms of agoraphobia may include the following:[12]

  • Fear of crowds, bridges, and/or being outside alone
  • Fear of losing control of oneself in a public place
  • Feeling dependent upon others
  • Feeling helpless
  • Feeling that one’s body or surroundings are not real
  • Being easily agitated or angered
  • Staying in one’s house for long periods of time
  • Self-medication with drugs or alcohol
  • Inability to function at work or other inherently social settings
  • Depression or suicidal ideation

If agoraphobic patients find themselves in a situation that triggers their anxiety, symptoms may include the following:[12]

Physical Examination

  • Healthcare providers will examine a patient who is exhibiting signs of agoraphobia for a history of panic disorders.
  • The clinician will also get a description of the relevant symptoms and behaviors of the patient and, if possible, from any family members or friends who might have knowledge of relevant behaviors.[12]

Treatment

Medical Therapy

  • The mainstay of therapy for agoraphobia is a combination of CBT, talk therapy, and medicine. Certain drugs that are regularly used to treat depression, such as SSRIs and SNRIs, may also be helpful in the treatment of agoraphobia.[12]
    • Treatment delivery factors, particularly therapist adherence, are important indicators of the potential for successful CBT.[18]
    • Studies have shown that therapist-directed CBT has a more significant impact on agoraphobic psychopathology in the short-term than do SSRIs/SNRIs.[19]
    • At a physician’s discretion, sedatives or hypnotics may also be prescribed. A physician may advise an agoraphobic patient to take such drugs when the symptoms of agoraphobia are particularly severe or as a preventive measure, when one expects to be exposed to a triggering situation.[12]

Surgery

  • Surgical intervention is not recommended for the management of agoraphobia.

Primary Prevention

  • There is no established method for the primary prevention of agoraphobia.

Secondary Prevention

  • Maintenance of a healthy lifestyle may be helpful in the secondary prevention of agoraphobia. This includes:[12]
    • Eating a balanced diet
    • Exercising regularly
    • Getting a sufficient amount of sleep

References

  1. 1.0 1.1 1.2 1.3 1.4 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  2. 2.0 2.1 World Heart Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10). Geneva, Switzerland. Retrieved 29 September 2016.
  3. Greene AL, Eaton NR (2016). "Panic disorder and agoraphobia: A direct comparison of their multivariate comorbidity patterns". J Affect Disord. 190: 75–83. doi:10.1016/j.jad.2015.09.060. PMID 26480214.
  4. Yardley L, Britton J, Lear S, Bird J, Luxon LM (1995). "Relationship between balance system function and agoraphobic avoidance". Behav Res Ther. 33 (4): 435–9. PMID 7755529.
  5. G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
  6. J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
  7. J. Davidson, (2003). Phobic Geographies
  8. Bandelow B, Michaelis S (2015). "Epidemiology of anxiety disorders in the 21st century". Dialogues Clin Neurosci. 17 (3): 327–35. PMC 4610617. PMID 26487813.
  9. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L; et al. (2010). "Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A)". J Am Acad Child Adolesc Psychiatry. 49 (10): 980–9. doi:10.1016/j.jaac.2010.05.017. PMC 2946114. PMID 20855043.
  10. 10.0 10.1 10.2 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005). "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication". Arch Gen Psychiatry. 62 (6): 593–602. doi:10.1001/archpsyc.62.6.593. PMID 15939837.
  11. Inoue K, Kaiya H, Hara N, Okazaki Y (2016). "A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia". Compr Psychiatry. 69: 132–5. doi:10.1016/j.comppsych.2016.05.014. PMID 27423353.
  12. 12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 NIH: U.S. National Library of Medicine. (2016). Agoraphobia. https://medlineplus.gov/ency/article/000923.htm Retrieved 29 September 2016.
  13. "Treatment of Panic Disorder", NIH Consens Statement, 9 (2): 1–24, Sep 25–27, 1991
  14. 14.0 14.1 David Satcher; et al. (1999). "Chapter 4.2". Mental Health: A Report of the Surgeon General.
  15. Bélanger C, Courchesne C, Leduc AG, Dugal C, El-Baalbaki G, Marchand A; et al. (2016). "Predictors of Dropout From Cognitive-Behavioral Group Treatment for Panic Disorder With Agoraphobia: An Exploratory Study". Behav Modif. doi:10.1177/0145445516656614. PMID 27385412.
  16. Levitan MN, Simoes P, Sardinha AG, Nardi AE (2016). "Agoraphobia Related to Unassertiveness in Panic Disorder". J Nerv Ment Dis. 204 (5): 396–9. doi:10.1097/NMD.0000000000000486. PMID 26915016.
  17. NIH: U.S. National Library of Medicine. (2016). About Panic and Agoraphobia. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024921/ Retrieved 29 September 2016.
  18. Weck F, Grikscheit F, Höfling V, Kordt A, Hamm AO, Gerlach AL; et al. (2016). "The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia". J Anxiety Disord. 42: 10–8. doi:10.1016/j.janxdis.2016.05.007. PMID 27235836.
  19. Liebscher C, Wittmann A, Gechter J, Schlagenhauf F, Lueken U, Plag J; et al. (2016). "Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia". Eur Neuropsychopharmacol. 26 (3): 431–44. doi:10.1016/j.euroneuro.2016.01.004. PMID 26837851.


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