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
