Wednesday, 19 May 2010

Definition of Agoraphobia

Following my last post Diver brought a website to my attention. For those who don't read my comments I thought I would make a post about it as I found it interesting.

This is from the American Psychiatric Association who are re-writing the current diagnosis of Agoraphobia.
Agoraphobia is a codable disorder.
A. Marked fear or anxiety about more than one situation from a characteristic cluster of agoraphobic situations typically include: being outside the home alone; public transportation (e.g., travelling on a bus, ship, train, plane); open spaces (e.g., parking lots, market place); being in shops, the theater, or cinemas; standing in line of being in a crowd.
B. The individual fears and/or avoids these situations because escape might be difficult or help might not be available in the event of incapacitation or panic-like symptoms.
C. The agoraphobic situations consistently provoke fear or anxiety.
D. The agoraphobic situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations. NOTE: Out of proportion refers to the sociocultural context
F. The duration is at least xxx months*
G. The fear, anxiety, and avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning**
H. The fear, anxiety, and avoidance are not restricted to the direct psychological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., cardiopulmonary disorders).
I. The fear, anxiety,and avoidance are not restricted to the symptoms of another mental disorder, such as Specific Phobia (e.g., if limited to one of a few circumscribed phobic objects or situations), Social Phobia (e.g.,in response to feared social situations), Obsessive-Compulsive Disorder (e.g., in response to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g, in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
*Need to examine a potential duration requirement in secondary data analyses and field trials
**An option that will be tested in the field trial is the possibility or deleting criterion G
Agoraphobia: Alternation Option that is under discussion
A. Anxiety about being, or anticipating being, in places or situations from which escape might be difficult or embarrassing, or in which help may not be available, in the event of having a panic attack, being suddenly incapacitated, or having sudden physical symptoms (including panic-like symptoms or other somatic events such as dizziness, vomiting or diarrhea).
Agoraphobic fears typically involves characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being in the centre of a theatre row or on a bridge; travelling in a bus, train, car, or plane; or being in open spaces (e.g., parking lots, market place).
B. Situations from which escape might be difficult are avoided (e.g., travel is restricted); endured with marked distress or with anxiety about having a Panic Attack, panic-like or other symptoms; or require the presence of a companion.
C. The fear, anxiety, or avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The anxiety or phobic avoidance is not restricted to the symptoms of other mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to one or only a few specific situations like dogs or elevators), Social Phobia (e.g., avoidance limited to social situations), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).


Richard said...

What most clinicians fail to realize is that one's personality actually contributes to the panic/anxiety or agoraphobia reaction. Specifically how one deals with disappointment.
The result is that most approaches for panic and anxiety or agoraphobia result in a success rate of around 30% which is generally equal to placebo results.
This is because all approaches that I've seen utilize inward focus techniques which focus on breathing skills and body relaxation skills. Unfortunately it is these very skills that can trigger a panic attack.
Instead an effective technique that has produced 80% success rate utilizes outward focus techniques.
Other programs generally ignore the contribution of personality traits of the individual feeding into the panic reaction. An effective program focuses on handling and dealing with life disappointments which invariably yield uncomfortable emotions and feelings. For a progressive approach to dealing with anxiety and panic attack that has resulted in a documented 80% success rate please visit

Lynn said...

hmmm interesting. I definately think personality plays a part, especially in recovery. Thanks Richard

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Louis said...

Hello Lynn,
I am wondering if what Richard says has more than a little merit. I am thinking of how many anxious people get hyper sensitive about how others may react to a panic attack. If you were taught that you were always being watched and evaluated it could make you more likely to be subject to aviod stressful situations and therefore become more likely to be someone that could get to the point of being agoraphobia.

Fi said...

Hi Lynn,

I've just read your blog and it really moved me.

I was looking for information about Agoraphobia, when I came across it, for my boyfriend Paul. He's been suffering for years and for the last year and a half he's been pretty much housebound; we were doing night time walks but they have suddenly come to an abrupt end, he won't tell me why, he just can't.

I try to be supportive and to understand but we are both 26 and it's so hard to watch him suffer.

It's sometimes really hard because he's so intelligent and he knows why this is happening to him but he's unable to stop it which is frustrating for him.

What really shocks me is the lack of help out there for people! Especially for you being pregnant, I'd love to help raise awareness, because this is such a debilitating illness and people just turn up their noses and ignore it!

Your blog is such an insight, it really is fantastic.