Anxiety Disorders 267
diagnosed with either panic disorder with agoraphobia (if he or she also has panic
disorder) or agoraphobia without history of panic disorder (if he or she had never
had panic disorder). Between one third and one half of those with panic disorder
also have agoraphobia. Some researchers suggest that agoraphobia—with no refer-
ence to panic disorder—should be a disorder in future diagnostic manuals (Bienvenu
et al., 2006). Shirley B., in Case 7.3, suffered from symptoms of agoraphobia.
CASE 7.3 • FROM THE INSIDE: Agoraphobia
“The Story of an Agoraphobic” by Shirley B.
As I am writing this I am a 46-year-old recovering agoraphobic. Whew! I never thought I could
say that, let alone write it. But three weeks after I fi rst admitted it in therapy, I crossed the
street eight times on my own. Some people would say “That is no big deal.” No, it’s not a big
deal—it’s a MIRACLE! I wanted to shout, “Hello again world, I’m back. It’s me, Shirley B.!!!” Liv-
ing is what I do now. Not as fully as I plan to, but it is so much more than just being....
There isn’t much I can say about how I became agoraphobic. I just slipped a little day by
day.... My daughter Nadeen was always by my side on those rare occasions when I ventured
outside, forced to leave my home when I needed medical attention. In the past my fear kept
me at home with all sorts of physical pains and ailments, as horrifi c as the pain was, the pain
of facing the outside world was greater. When I had two abscessed teeth and my jaw was
swollen to twice its normal size I was in such excruciating pain that I had to go to the dentist.
So with my legs wobbling, my heart pounding, my hands sweating, and my throat choking,
to the dentist I went. After examining my x-rays, the dentist said he wouldn’t be able to do
anything with my teeth because they were so infected, he prescribed medication for the pain
and infection and said that I must return in ten days, not in two years. I felt as though those
ten days were a countdown to my own execution. Each day passed at lightning speed—like a
clock ticking away. The fear grew stronger and stronger. I had to walk around with my hand
on my heart to keep it from jumping so hard, as if I were pledging allegiance, which I was—to
my fears and phobia. I asked God to please give me strength to go back to the dentist. When
the day came, I knew that my preparations would take me a little over four hours. I had to
leave time, not just to bathe and dress, but to debate with myself about going.
Source: Anxiety Disorders Association of America.People with extreme agoraphobia cannot function normally in daily life. Theyare totally housebound, too crippled by panic and fear to go to work, the super-
market, or the doctor. Others with agoraphobia are able to function better than
Shirley B. and can enter many situations without triggering a panic attack. Relying
on a friend or family member (often referred to as a “safe” person), such as Shirley’s
daughter Nadeen, can help the sufferer enter feared situations that otherwise might
be avoided.
When agoraphobia develops, it usually does so within the fi rst year of recur-rent panic attacks (American Psychiatric Association, 2000). For some individuals,
as panic attacks decrease, agoraphobia decreases; for others, there is no such rela-
tionship. Because people with agoraphobia avoid situations that are associated with
past panic attacks, they do not learn that they can be in such situations and not have
a panic attack.
Understanding Panic Disorder and Agoraphobia
“I still don’t know what triggers a panic attack, but I can tell anyone reading this
who has never experienced one that it is a devastating experience. I don’t have many
attacks these days, but when they come, they come hard and bring me to my knees.
An attack may hit me on a day when I’m feeling relaxed and happy. That’s when
I think, ‘Why me?’ ‘Why today?’” (Campbell & Ruane, 1999, p. 151). Let’s use
the neuropsychosocial approach to address Campbell’s question about why panic
disorder and agoraphobia arise and are maintained. Each type of factor makes an
important and unique contribution.