Day: April 15, 2015

AGORAPHOBIA

Posted on by fightorflights

  

Diagnostic Features

Agoraphobia is a cluster of phobias embracing fears of using public transportation, being in open spaces (e.g., parking lots, marketplaces, bridges), being in enclosed places (e.g., shops, theaters), standing in line or being in a crowd, or being outside of the home alone. The fear is clearly excessive. Avoidance of the phobic situation is prominent, and some agoraphobics experience little anxiety because they are able to avoid their phobic situations. 


Complications

Fear and its avoidance are the core features of all anxiety disorders. Agoraphobia can be thought of as “generalized phobic disorder” in which individuals develop many phobias that cause significant distress or disability. More than one-third of individuals with agoraphobia are homebound and unable to work; thus they are dependent on others to provide for their basic needs. 

Comorbidity

Commonly has Panic Disorder, Specific Phobia, Social Phobia, Posttraumatic Stress Disorder and Major Depressive Disorder. Often these individuals may inappropriately self-medicate their anxiety with alcohol or sedatives, and thus may develop addiction as a consequence. 

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder. 

Prevalence

The 1-year prevalence rate in adolescents and adults is 1.7%, but this drops to 0.4% after age 65. Agoraphobia is rare in childhood, but its incidence peaks in late adolescence and early adulthood. Women are twice as likely as men to develop agoraphobia. 

Course

Agoraphobia and panic disorder are closely associated. The majority of individuals with panic disorder have signs of agoraphobia before the onset of panic disorder. Likewise, 30% or more of individuals with agoraphobia have panic disorder before the onset of their agoraphobia. Onset of agoraphobia is before age 35 in two-thirds of individuals. The mean age of onset is 17 years. The course of agoraphobia is chronic and persistent. Complete recovery is rare (10%), unless treated.  

Familial Pattern

Heritability for Agoraphobia is 61% (the strongest for all phobias). 

Effective Therapies

There is very little research on the treatment of Agoraphobia Without Panic Disorder. Research on the treatment of Agoraphobia With Panic Disorder has found that cognitive behavioral therapy (CBT) [given by a therapist or by a computer], SSRI antidepressants, and clonazepam (an antianxiety medication) are all equally effective. It now appears that exposure therapy is more effective for Agoraphobia, and cognitive behavioral therapy (CBT) is more effective for Panic Disorder.