Agoraphobia

• Overview:

  • Anxiety disorder characterised by an excessive fear of situations where escape might be difficult or help might not be readily available
  • Fear that a panic attack or other incapacitating/embarrassing physical symptom may occur
  • Fear is disproportionate to the actual danger posed
• Epidemiology:

  • Often begins in early adulthood
  • Average age of onset 17
  • Twice as common in females
• Risk factors:

  • Female sex
  • Family history of agoraphobia or other anxiety disorder
  • Adverse childhood experiences
  • Overprotection from parents in childhood
  • Experiencing a stressful event
  • Other mental health disorders
  • Comorbid physical condition
• 1. May develop follow a panic attack or other symptoms in a specific situation
  2. Worry so much about having another panic attack, that they feel symptoms returning when they are in a similar situation
  3. Avoids specific situation as a means to control their anxiety
• Both DSM-V and ICD-11 can be used as framework to aid the clinical diagnosis

  Marked fear or anxiety about two or more of the following 5 situations:

  1. Using public transportation (e.g. buses, trains, planes).
  2. Being in open spaces (e.g. bridges, parking lots).
  3. Being in enclosed spaces (e.g. shops, cinema, theatre).
  4. Standing in line or being in a crowd.
  5. Being outside of the home alone.
• The individual fears these situations because, in the event of developing panic-like symptoms or other embarrassing or incapacitating symptoms (e.g. falls, incontinence), they have thoughts that:

  1. Escape might be difficult, OR
  2. Help might not be available

  The fear or anxiety is:

  • Almost always provoked by the situations.
  • Disproportionate to the actual danger posed by the situation.

  This leads to the following situations being:

  • Actively avoided, OR
  • Requiring the presence of a companion, OR
  • Endured with intense fear or anxiety.
• The fear, anxiety, or avoidance behaviours are described as being persistent (i.e. lasting for > 6 months) and causing the affected individual significant distress or functional impairment (i.e. social, occupational, or other important aspects of functioning).
• Management:

  • Mild-moderate functional impairment: low-intensity psychological intervention
  • Severe functional impairment: Medication and high intensity psychological intervention (applied relaxation, CBT)
  • SSRIs are first line - mostly sertraline