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07-SEPTEMBER-2008 03:17:44 - Agoraphobia March 2008 Agoraphobia Classification and external resources ICD-10 F40.00 Without panic disorder, F40.01 With panic disorder ICD-9 300.22 Without panic disorder, 300.21 With panic disorder Agoraphobia is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to their home, experiencing difficulty traveling from this safe place. Contents 1 Definition 2 Prevalence 2.1 Gender differences 3 Causes and contributing factors 4 Alternate theories 4.1 Attachment theory 4.2 Spatial theory 4.3 Feminist theory 5 Diagnosis 5.1 DSM-IV-TR diagnostic criteria 6 Association with panic attacks 7 Treatments 7.1 Cognitive behavioral treatments 7.2 Psychopharmaceutical treatments 7.3 Alternative treatments 8 Notable agoraphobics 9 References 10 External links Definition The word agoraphobia is an English adaptation of the Greek words agora αγοÏ?ά and phobos φόβος, and literally translates to a fear of the marketplace. Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include crowds, wide open spaces or traveling, even short distances. This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public.1 Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. 2 Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack. Prevalence The one-year prevalence of agoraphobia in the United States is about 5 percent.3 According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with panic disorder progress to develop agoraphobia.4 Gender differences Agoraphobia occurs about twice as commonly among women as it does in men.5 The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviors.6 Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia. Causes and contributing factors There are a number of factors that contribute to the development of agoraphobia. These factors include:7unreliable source? Family factors: Having an anxious parent role model. Being abused as a child. Having an overly critical parent. Personality factors: High need for approval. High need for control. Oversensitivity to emotional stimuli. Biological factors: Oversensitivity to hormone changes. Oversensitivity to physical stimuli. High amounts of sodium lactate in the bloodstream. Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.8 9Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces.10 Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data. 11 Alternate theories Attachment theory Main article: Attachment theory Some scholars 12 13 have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Spatial theory In the social sciences there is a perceived clinical bias 14 in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. Feminist theory Main article: Feminist theory Feminist scholars have applied feminist theory in an attempt to construct agoraphobia and other anxiety disorders as gendered issues. One such theory explains agoraphobia as a fear of the hysterical woman, meaning a fear of being perceived by others as overly feminine and out of control.15 Diagnosis Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder American Psychiatric Association, 1998. Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.16 In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used. DSM-IV-TR diagnostic criteria A Anxiety about 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 an unexpected or situationally predisposed 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. B The situations are avoided e.g., travel is restricted or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion. C The anxiety or phobic avoidance is not better accounted for by another 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 a single situation like elevators, Obsessive-Compulsive Disorder e.g., avoidance of dirt in someone with an obsession about contamination, Posttraumatic Stress Disorder e.g., avoidance of stimuli associated with a severe stressor, or Separation Anxiety Disorder e.g., avoidance of leaving home or relatives.17 Association with panic attacks Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. 18 Symptoms of a panic attack include palpitations, a rapid heartbeat, sweating, trembling, dizziness, tightness in the throat and shortness of breath. Many patients report a fear of dying or of losing control of emotions and/or behavior. 18 Treatments Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications.citation needed Treatment options for agoraphobia and panic disorder are similar. Cognitive behavioral treatments Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. 19 Similarly, Systematic desensitization may also be used. Cognitive restructuring has also proved useful in treating agoraphobia. This treatment uses thought replacing with the goal of replacing one's irrational, counter-factual beliefs with more accurate and beneficial ones.citation needed Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.citation needed Psychopharmaceutical treatments Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI selective serotonin reuptake inhibitor class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia.citation needed Alternative treatments Eye movement desensitization and reprogramming EMDR has been studied as a possible treatment for agoraphobia, with poor results.20 As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.21 Alternative treatments of agoraphobia include hypnotherapy, guided imagery mation, music therapy, yoga, religious practice and ayurvedic medicine.citation needed Additionally, many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Stress management techniques and mation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.22 Notable agoraphobics Woody Allen 1935-, American actor, director, musician.23 H.L. Gold 1914-1996, science fiction or; as a result of trauma during his wartime experiences, his agoraphobia became so severe that for more than two decades he was unable to leave his apartment. Towards the end of his life he acquired some control over the condition.24 Daryl Hannah 1960-, American actress.25 Howard Hughes 1905-1976, American aviator, industrialist, film producer and philanthropist.26 BolesÅ‚aw Prus 1847-1912, Polish journalist and novelist.27 Peter Robinson 1962-, British musician known simply as Marilyn.28 Roy Castle 1932-94, entertainer and TV presenter. Suffered from Agorophobia throughout his adult life, see article for details. William Gibson 1948-, science-fiction author.29 Rose McGowan 1973-, American Actress. 30 References ^ Psych Central: Agoraphobia Symptoms ^ Treatment of Panic Disorder, NIH Consens Statement 92: 1-24, September 25-27, 1991, http://consensus.nih.gov/1991/1991PanicDisorder085html.htm ^ 2006 Anxiety Disorders. NIH Publication No. 06-3879. ^ Robins, LN Regier, DN, eds. 1991, Psychiatric Disorders in America: the Epidemiologic Catchment Area Study, New York, NY: The Free Press ^ Magee, W. J., Eaton, W. W. , Wittchen, H. U., McGonagle, K. A., Kessler, R. C. 1996. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey, Archives of General Psychiatry, 53, 159-168. ^ Agoraphobia Research Center. Is agoraphobia more common in men or women?. Retrieved on 2007-11-15. ^ Agoraphobia Resource Center, What causes agoraphobia?, http://www.agoraphobia.ws/causes.htm. Retrieved on 15 November 2007 ^ Relationship between balance system function and agoraphobic avoidance. 1995 May. Behav Res Ther. 33 4: 435-9. PMID : 7755529. ^ Panic, agoraphobia, and vestibular dysfunction 1996. Am J Psychiatry 153: 503-512. ^ Surface dependence: a balance control strategy in panic disorder with agoraphobia 1997 May-Jun. Psychosom Med. 59 3: 323-30. PMID : 9178344. ^ High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality. 2006 Oct. Eur Psychiatry 21 7: 501-8. PMID : 17055951. ^ G. Liotti, 1996. Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, P. Marris Eds.. Attachment Across the Life Cycle. ^ J. Bowlby, 1998. Attachment and Loss Vol. 2: Separation. ^ J. Davidson, 2003. Phobic Geographies ^ La Donna e Mobile: Constructing the irrational woman 2001. Gener, Place and Culture 8 1: 37-54. ^ Barlow, D. H. 1988. Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press. ^ 2000 Diagnostic and Statistical Manual of Mental Disorders, Fourth ion, Text Revision DVM-IV-TR. ^ a b David Satcher etal. 1999. Chapter 4.2, Mental Health: A Report of the Surgeon General. ^ Fava, G. A. 2001. Long-term outcome of panic disorder with agoraphobia treated by exposure. Psychological Medicine 31: 891-898. Cambridge University Press. doi:10.1017/S0033291701003592. ^ Goldstein, Alan J.; Goldstein, Alan J., de Beurs, Edwin, Chambless, Dianne L., Wilson, Kimberly A. 2000. EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions. Journal of Consulting Clinical Psychology 68 6: 947-957. doi:10.1037/0022-006X.68.6.947. ^ Agoraphobia Resource Center, Agoraphobia treatments - Eye movement desensitization and reprogramming, http://www.agoraphobia.ws/treatment-emdr.htm. Retrieved on 18 April 2008 ^ National Institute of Mental Health, How to get help for anxiety disorders, http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml. Retrieved on 18 April 2008 ^ Reconstructing Woody ^ http://en..org/w/index.php?title=H._L._Goldaction=section=4 ^ Biography for Daryl Hannah. Internet Movie Database. Retrieved 28 November 2007. ^ Psychological Autopsy can help understand controversial deaths - The Crime Library on truTV.com ^ StanisÅ‚aw Fita, ed., Wspomnienia o BolesÅ‚awie Prusie Reminiscences about BolesÅ‚aw Prus, Warsaw, PaÅ„stwowy Instytut Wydawniczy State Publishing Institute, 1962, p. 113. ^ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom. ^ I do not want to receive three hundred e-mail messages per week from strangers wanting to communicate with me Josefsson.net ^ Biography for Rose McGowan. Internet Movie Database. Retrieved 15 May 2008. External links Agoraphobia This article incorporates text from the National Institute of Mental Health, which is in the public domain. v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Agoraphobia Categories: PhobiasHidden categories: Articles needing additional references from March 2008 | All pages needing cleanup | Articles with statements since July 2008 | All articles with statements | Articles with statements since January 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Afrikaans العربية Bosanski БългарÑ?ки Català Česky Dansk Deutsch Eesti Ελληνικά Español Euskara Français Galego í•œêµì–´ Hrvatski Italiano עברית ქáƒ?რთული Lietuvių Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий SlovenÄ?ina SlovenÅ¡Ä?ina СрпÑ?ки / Srpski Srpskohrvatski / СрпÑ?кохрватÑ?ки Suomi Svenska Türkçe УкраїнÑ?ька ä¸æ–‡ This page was last modified on 19 August 2008, at 02:56
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