266 CHAPTER 7
What Is Agoraphobia?
After Campbell’s fi rst panic attack, he refused to go out:... I knew I could not set foot outside my house. Until I learned what was wrong
with me, the only place I would go was to a doctor’s offi ce or a hospital.... Reuna
thought that was part of my problem. I was shutting myself off from the world. I was
going to sleep very late, waking up at noon, spending the whole day in bed. She said
I needed to pull my life back together or I would never get well.... The thing she
failed to understand was the predicament I would be placing myself in if I did go out.
What if I had another attack? What if it happened while I was in church? Or while
I was walking down the aisle of a crowded grocery store? What would I do? How
could I deal with the humiliation that such a loss of control would bring?
(Campbell & Ruane, 1999, pp. 93–94)
Campbell had developed agoraphobia.
Agoraphobia(which literally means “fear of the marketplace”) refers to the
persistent avoidance of situations that might trigger panic symptoms or from which
escape would be diffi cult. Moreover, many patients with agoraphobia may avoid
places in which it would be embarrassing or hard to obtain help in case of a panic
attack. For these reasons, tunnels, bridges, crowded theaters, and highways are typ-
ically avoided or entered with diffi culty by people with agoraphobia.
Some people have agoraphobia without having panic attacks, but it is not
common. These people avoid situations where they fear they might lose control
of themselves for some other reason (such as incontinence) or where they fear they
may experience symptoms that are less severe or numerous than the criteria for a
panic attack (listed in Table 7.3). For instance, they might avoid types of situations
that have, in the past, triggered palpatations and nausea (but experience less than
the minimum of four symptoms necessary for a panic attack). However, people who
only avoid particular kinds of stimuli (only bridges or only parties) are not diag-
nosed with agoraphobia, which is a more general pattern of avoiding many kinds
of environments or situations. Table 7.6 lists the criteria for agoraphobia, but note
that it is not a separate DSM-IV-TR diagnosis. A patient with agoraphobia will be
Agoraphobia
The persistent avoidance of situations that
might trigger panic symptoms or from which
escape would be diffi cult.
Table 7.6 • DSM-IV-TR Criteria for Agoraphobia
A. Anxiety about being in places or situations from which escape might be diffi cult (or embarrass-
ing) 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 characteris-
tic 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.
Note: Consider the diagnosis of Specifi c Phobia [discussed later in this chapter] if the avoidance is
limited to one or only a few specifi c situations, or Social Phobia [discussed later in this chapter] if the
avoidance is limited to social situations.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),
Specifi c 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
[all disorders discussed later in this chapter], or separation anxiety disorder (e.g., avoidance of
leaving home or relatives [discussed in Chapter 14]).
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,
Fourth Edition, (Copyright 2000) American Psychiatric Association.Agoraphobia is not a separate DSM-IV-TR disorder. Patients who meet the criteria for agoraphobia
are diagnosed with either panic disorder with agoraphobia or agoraphobia without history of panic
disorder, depending on the presence or absence of panic disorder.