Agoraphobia

What is agoraphobia?

Marked fear of anxiety about at least 2 of the following situations

• using public transportation (bus, train, plane)

• being in open spaces (parking lots, marketplaces)

• being in enclosed spaces (shops, theater)

• standing in a line/being in a crowd

• being outside home alone

Why are “agoraphobic” situations avoided?

Avoided because of thoughts that it would be difficult to escape/receive help in the events of incapacitation/embarassment due to panic like symptoms

• These situations consistently provoke fear/anxiety

• Situations actively avoided, require companion presence, or endured with intense fear/anxiety

How long do agoraphobia symptoms last?

At least 6 months

Agoraphobia comorbidity w/ panic disorder

• Comorbid in ~30-50% of cases

• ~3% Lifetime Prevalence

• Special instance of classical & operant conditioning gone wrong

Differential diagnosis (comorbidity)

Agoraphobia: MULTIPLE agoraphobic situations; fear is ABOUT panic-like sxs or other incapacitating sxs

Specific Phobia: limited to ONE agoraphobic situation; fear is about something else or being hurt by the situation (Plane crash for people scared of flying)

What is differential diagnosis

The process of distinguishing between 2 or more disorders that share similar sxs

• Ex. SAD v. Agoraphobia v. Specific phobia (situational): all may engage in avoidance of situations but for DIFFERENT reasons

Differential Diagnosis (SAD, AGO, SP)

SAD: fearful for scrutiny by others; calm when alone

AGO: fearful of situations where they can’t escapee in event of panic like sxs; multiple fear evoking symptoms; not calm when alone

SP: some other reasons (fear of being hurt by a situation) specific to ONE situation, not calm when alone

Comorbidity in Anxiety Disorders

80% of people with anxiety disorders meet criteria for another anxiety disorder

• subthreshold sxs (don’t meet full DSM), very common

70% of people w/ anxiety disorder meet criteria for another psychological disorder

• 60% w/ anxiety also have depression (esp. w/high GAD and MDD)

• Substance abuse

• Personality disorders

• Medical disorders

Causes of comorbidity

• sxs to diagnose various anxiety disorders overlap (ex. SAD & AGO might both involve fear of crowds)

• common etiological factors increase risk for more than ONE anxiety disorder (hyperactivity of fear circuit)

Depression and Anxiety Comorbidity

• 42% of specific phobia pt’s have depression

• 58% of GAD pt’s have depression

• 56% of PD pt’s have depression

• 48% of PTSD pt’s have depression

• 37% of SAD pt’s have depression

• 37% of OCD pt’s have depression