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Encyclopedia > Agoraphobia
Agoraphobia
Classification & 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 precipitated by the fear of having a symptom attack or 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." The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Anxiety disorder is a blanket term covering several different forms of abnormal, pathological anxiety, fears, phobias. ... Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ...

Contents

Definition

The word "agoraphobia" is an English adaptation of the Greek words agora (αγορά) and phobos (φόβος), and literally translates to "a fear of the marketplace." Stoa of the ancient agora de Thessaloniki An agora (αγορά), translatable as marketplace, was a public space and an essential part of an ancient Greek polis or city-state. ... In Greek mythology, Phobos is one of the sons of Ares (Mars) and Aphrodite (Venus). ...


Agoraphobia is a condition where the sufferer becomes spooky 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] Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ...


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 that they feel in control of. 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. Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ... Comfort Zone is the first studio album by Sector Seven. ... Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ...


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] Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or at least a month of ongoing worry about the implications or concern about having other attacks. ...


Gender Differences

Agoraphobia occurs about twice as commonly among women as it does in men (Magee et al., 1996[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 is no one single cause associated with agoraphobia. Instead, there are a number of factors that contribute to the development of agoraphobia. These factors include:

  • 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 control.
    • Oversensitivity to emotional stimuli.
  • Biological Factors:
    • Oversensitivity to hormone changes.
    • Oversensitivity to physical stimuli.
    • High amounts of sodium lactate in the bloodstream.[7]

Additionally, research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.[8] [9]Normal 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] It has been suggested that Equilibrioception be merged into this article or section. ... The visual system is the part of the nervous system which allows organisms to see. ... Proprioception (from Latin proprius, meaning ones own) is the sense of the position of parts of the body, relative to other neighbouring parts of the body. ... This article is about the simulation technology. ...


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.[12] 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. Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or at least a month of ongoing worry about the implications or concern about having other attacks. ... Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ... Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or at least a month of ongoing worry about the implications or concern about having other attacks. ... Agoraphobia Without a History of Panic Disorder is a mental illness characterized by extreme fear of public spaces but with an absence of any underlying history of panic attacks. ...


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. Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ...


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).[13] Social anxiety, sometimes known as social phobia or social anxiety disorder (SAD), is a common form of anxiety disorder that causes sufferers to experience intense anxiety in some or all of the social interactions and public events of everyday life. ... Posttraumatic stress disorder (PTSD), is a term for the psychological consequences of exposure to or confrontation with stressful experiences, which involve actual or threatened death, serious physical injury or a threat to physical integrity and which the person found highly traumatic. ... Separation Anxiety redirects here. ...


Association with Panic Attacks

Main article: Panic attack

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. [14] 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. [14] Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger. ... Adrenaline redirects here. ... This article or section should include material from Fight-or-flight The flight or fight response, also called the acute stress response, was first described by Walter Cannon in the 1920s as a theory that animals react to threats with a general discharge of the sympathetic nervous system. ...


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. Treatment options for agoraphobia and panic disorder are similar. A highly effective treatment which involves slowly and incrementally increasing a patients exposure to a feared situation. ... This article is about Becks Cognitive Therapy. ... Anxiety is a complex combination of the feeling of fear, apprehension and worry often accompanied by physical sensations such as palpitations, chest pain and/or shortness of breath. ... Prozac, a selective serotonin reuptake inhibitor (SSRI) Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant, is a psychiatric medication or other substance (nutrient or herb) used for alleviating depression or dysthymia (milder depression). ... Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or at least a month of ongoing worry about the implications or concern about having other attacks. ...


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. [15] Similarly, Systematic desensitization may also be used. A highly effective treatment which involves slowly and incrementally increasing a patients exposure to a feared situation. ... Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. ...


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. This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ...


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. Relaxation techniques are used by people who wish to relax, for a wide variety of reasons. ...


Psychopharmaceutical Treatments

Anti-depressant medications used are 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. SSRI redirects here; for other uses, see SSRI (disambiguation). ... Zoloft bottles, with blue and green tablets Sertraline hydrochloride (also sold under brand names Zoloft, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. ... Paroxetine (Paxil, Seroxat, Pexeva) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Prozac redirects here. ... Alprazolam 2 mg tablets The benzodiazepines (pronounced , or benzos for short) are a class of psychoactive drugs considered minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are mediated by slowing down the central nervous system. ... Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs prescribed for the treatment of depression. ...


Alternative Treatments

Alternative treatments of agoraphobia include hypnotherapy, guided imagery meditation, music therapy, yoga, religious practice and ayurvedic medicine. Hypnotherapy is therapy that is undertaken with a subject in hypnosis. ... For other senses of this word, see Meditation (disambiguation). ... Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a qualified professional who has completed an approved music therapy program. ... For other uses, see Yoga (disambiguation). ... Ayurveda (आयुर्वेद Sanskrit: ayu—life; veda—knowledge of) or ayurvedic medicine is a more than 2,000 year old comprehensive system of medicine based on a holistic approach rooted in Vedic culture. ...


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 meditation 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.


Alternate Theories

Attachment Theory

Main article: Attachment Theory

Some scholars (e.g., Liotti 1996,[16] Bowlby 1998[17]) have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Mother and child Attachment theory is a psychological, evolutionary and ethological theory that provides a descriptive and explanatory framework for discussion of interpersonal relationships between human beings. ... John Bowlby (1907-1990) was a British developmental psychologist of the psychoanalytic tradition. ...


Spatial Theory

In the social sciences there is a perceived clinical bias (e.g., Davidson 2003[18]) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. The word space has many meanings, including: Physics The definition of space in physics is contentious. ...


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.[19] Feminism is a social theory and political movement primarily informed and motivated by the experience of women. ... Feminist theory is the extension of feminism into theoretical, or philosophical, ground. ... Water massages as a treatment for hysteria c. ...


Notable Agoraphobics

Jesús Navas González (born in Seville on November 21, 1985) is a Spanish footballer. ... Philip Kindred Dick (December 16, 1928 – March 2, 1982) was an American writer, mostly known for his works of science fiction. ... Emily Dickinson (December 10, 1830 – May 15, 1886) was an American poet. ... Kimila Ann Basinger (born December 8, 1953) is an Academy Award-winning American film actress and former fashion model. ... Roy Castle OBE (born August 31, 1932 in Scholes, near Holmfirth; died September 2, 1994) was a British dancer, singer, comedian, actor and musician. ... Ronald Jones(born 1970?) was a guitarist in the Oklahoma indie-rock band The Flaming Lips from 1991 to 1996. ... Elfriede Jelinek (born 20 October 1946) is an Austrian feminist playwright and novelist. ... The Nobel Prize (Swedish: ) was established in Alfred Nobels will in 1895, and it was first awarded in Physics, Chemistry, Physiology or Medicine, Literature, and Peace in 1901. ... Paula Hiers Deen, (born Paula Ann Hiers on January 19, 1947), is an American cook, restaurateur, writer, and Emmy Award-winning TV personality. ... Rose Arianna McGowan (born September 5, 1973) is an American actress best known for her role as Paige Matthews in The WB television series Charmed and the cult-classic The Doom Generation. ... Steven James Williams (born Steven Anderson on December 18, 1964)[2] better known by his ring name Stone Cold Steve Austin, is an American actor and former professional wrestler. ... Ben Weasel (born Ben Foster in Chicago, Illinois) was the lead singer of punk rock bands Screeching Weasel and The Riverdales. ... Screeching Weasel was an American punk band from Chicago, Illinois. ... The Scream. ... The Scream by Edvard Munch (1893) which inspired 20th century Expressionists Portrait of Eduard Kosmack by Egon Schiele Rehe im Walde by Franz Marc Elbe Bridge I by Rolf Nesch On White II by Wassily Kandinsky, 1923. ... Alessandro Manzoni (Francesco Hayez, 1841, Brera Art Gallery). ... Jason Statham (born on 12 September 1972, in Sydenham, Lewisham, London) is an English actor, known for his roles in the Guy Ritchie crime films Lock, Stock and Two Smoking Barrels, Revolver and Snatch. ... Marilyn Peter Robinson (born November 3, 1962), better known as Marilyn, is a famous cross-dressing singer and musician who reached fame with his song Calling Your Name in the 1980s. ... Christopher David Patton (born March 15, 1971 in Houston, Texas) has been acting since early childhood, and voice acting for FUNimation Entertainment and ADV Films for eight years. ...

Agoraphobics in Fiction

Hairspray is a 2007 musical film produced by Zadan/Meron Productions and distributed by New Line Cinema. ... Alice, a fictional character based on a real character from the work of Lewis Carroll. ... This article is about the 1988 film. ... The Sentry (Robert Bob Reynolds) is a fictional character, a comic book superhero who lives in the Marvel Comics universe. ... This article is about the comic book company. ... Alice, a fictional character based on a real character from the work of Lewis Carroll. ... Sigourney Weaver (born Susan Alexandra Weaver on October 8, 1949 in New York City) is an Oscar-nominated American actress. ... The term copycat (also written as copy-cat or copy cat) refers to the tendency of humans to duplicate the behavior of others, as expressed in the saying, monkey see, monkey do. ... Alice, a fictional character based on a real character from the work of Lewis Carroll. ... Tony Kushner (born July 16, 1956) is an award-winning American playwright most famous for his play Angels in America, for which he was awarded the Pulitzer Prize. ... Angels in America: A Gay Fantasia on National Themes is an award winning play in two parts by American playwright Tony Kushner. ...

See also

Agoraphobia Without a History of Panic Disorder is a mental illness characterized by extreme fear of public spaces but with an absence of any underlying history of panic attacks. ...

References

  1. ^ http://psychcentral.com/disorders/sx29.htm
  2. ^ "Treatment of Panic Disorder", NIH Consens Statement 9 (2): 1-24, Sep 25-27, 1991, <http://consensus.nih.gov/1991/1991PanicDisorder085html.htm>
  3. ^ (2006) Anxiety Disorders. NIH Publication No. 06-3879. 
  4. ^ Robins, LN & Regier, DN, eds. (1991), Psychiatric Disorders in America: the Epidemiologic Catchment Area Study, New York, NY: The Free Press
  5. ^ 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.
  6. ^ Agoraphobia Research Center. Is agoraphobia more common in men or women?. Retrieved on 2007-11-15.
  7. ^ Agoraphobia Resource Center, What causes agoraphobia?, <http://www.agoraphobia.ws/causes.htm>. Retrieved on 2007-11-15
  8. ^ (1995 May) "Relationship between balance system function and agoraphobic avoidance.". Behav Res Ther. 33 (4): 435-9. PMID: 7755529. 
  9. ^ (1996) "Panic, agoraphobia, and vestibular dysfunction". Am J Psychiatry 153: 503-512. 
  10. ^ (1997 May-Jun) "Surface dependence: a balance control strategy in panic disorder with agoraphobia". Psychosom Med. 59 (3): 323-30. PMID: 9178344. 
  11. ^ (2006 Oct) "High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.". Eur Psychiatry 21 (7): 501-8. PMID: 17055951. 
  12. ^ Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press. 
  13. ^ (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DVM-IV-TR). 
  14. ^ a b David Satcher etal. (1999). "Chapter 4.2", Mental Health: A Report of the Surgeon General. 
  15. ^ "Long-term outcome of panic disorder with agoraphobia treated by exposure". Psychological Medicine 31: 891-898. Cambridge University Press. 
  16. ^ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
  17. ^ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
  18. ^ J. Davidson, (2003). Phobic Geographies
  19. ^ (2001) "La Donna e Mobile: Constructing the irrational woman". Gener, Place and Culture 8 (1): 37-54. 
  20. ^ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 319th day of the year (320th in leap years) in the Gregorian calendar. ...

Footnotes

This article incorporates text from the National Institute of Mental Health, which is in the public domain. The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness. ... The public domain comprises the body of all creative works and other knowledge&#8212;writing, artwork, music, science, inventions, and others&#8212;in which no person or organization has any proprietary interest. ...


  Results from FactBites:
 
Agoraphobia - Wikipedia, the free encyclopedia (767 words)
This is most often not the case since people suffering from agoraphobia usually are not afraid of the open spaces themselves, but of public spaces or of situations often associated with these spaces.
Agoraphobia today describes severe and pervasive anxiety about being in situations from which escape might be difficult or avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area (DSM-IV).
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.
Agoraphobia | Principal Health News (698 words)
Agoraphobia is twice as common in women as in men and usually strikes between the ages of 15-35.
The symptoms of the panic attacks which may accompany agoraphobia vary from person to person, and may include trembling, sweating, heart palpitations (a feeling of the heart pounding against the chest), jitters, fatigue, tingling in the hands and feet, nausea, a rapid pulse or breathing rate, and a sense of impending doom.
Agoraphobia and other phobias are thought to be the result of a number of physical and environmental factors.
  More results at FactBites »

 
 

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