Intense
anxiety about being in places or situations from which escape
might be difficult or embarrassing. These situations are
avoided or else are endured with marked distress combined with
anxiety about having a Panic Attack
or panic-like symptoms.
Agoraphobic
fears typically involve characteristic clusters of situations
that include being outside the home alone; being in a crowd
or standing in a line; being on a bridge; and traveling in a
bus, train, or automobile.
The patient has anxiety about being in a place or situation
from which either or both, escape was difficult or embarrassing
or If a panic attack occurred, help might not be available.
The patient:
Avoids
these situations or places (restricting travel )
or;
Endures them, but with material distress (a panic attack might
occur)
or;
Requires a companion when in the situation
Criteria have
never been met for Panic Disorder
The disturbance
is not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition.
The symptoms do
not represent Bereavement.
The anxiety or
phobic avoidance is not better accounted for by another mental
disorder, such as Social Phobia
(avoidance limited to social situations because of fear of embarrassment), Specific
Phobia (avoidance limited to a single situation like elevators), Obsessive-Compulsive
Disorder
(avoidance of dirt in someone with an obsession about contamination),
Posttraumatic
Stress Disorder
(avoidance of stimuli associated with a severe stressor), or
Separation Anxiety
Disorder
(avoidance of leaving home or relatives).
If an associated general medical condition is present, the fear
described is clearly in excess of that usually associated with
the condition.
Associated
Features:
Depressed
Mood
Somatic/Sexual
Dysfunction
Addiction
Anxious or Fearful or Dependent
Personality
Differential
Diagnosis:
Some disorders display similar or sometimes even the same symptom.
The clinician, therefore, in his diagnostic attempt has to differentiate
against the following disorders which one needs to be ruled
out to establish a precise diagnosis
Panic
Disorder with Agoraphobia;
Social Phobia;
Specific Phobia;
Major Depressive Disorder;
Delusional Disorder;
Obsessive-Compulsive
Disorder;
Separation Anxiety
Disorder;
Cause:
Many agoraphobics
develop the disorder after first suffering a series of panic
attacks usually in public places. The attacks seem to
occur randomly and without warning, making it impossible for
a person to predict what situation will trigger such a reaction.
The unpredictability of panic attacks, "trains" the
victims to anticipate future panic attacks and, therefore, to
fear any situation in which an attack may occur. As a result,
they avoid going out in public. Agoraphobia victims also are
likely to develop depression, fatigue, tension, spontaneous
panic and obsessive disorders
Treatment:
Counseling and Psychotherapy [ See
Therapy Section ]:
Treatment
usually involves desensitization or exposure therapy through
which the sufferer is exposed to the source of the phobia and
gradually learns to overcome the fear. Exposure therapy can
significantly reduce or end phobic reactions for at least seven
years. It is based upon having the person relax, then
imagine the components of the phobia, working from the least
fearful to the most fearful. Graded real-life exposure has also
been used with success to help people overcome their fears.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
Therapy
is often combined with medication, such antianxiety and antidepressive
medications are sometimes used to help relieve the symptoms
associated with phobias. Dependency on the medication is a possible
side effect of this treatment.
SSRIs;
TCAs;
Benzodiazepines;
MAOIs
