Agoraphobia

Agoraphobia is an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape.

Agoraphobics may experience severe 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 not only to their home, but to one or two rooms, and they may even become bed-bound, or a recluse.

Agoraphobics are often extremely sensitized to their own bodily sensations, subconsciously over-reacting to perfectly normal events. For example, the exertion involved in climbing a flight of stairs may trigger a full-blown panic attack, because it increases the heartbeat and breathing rate, which the agoraphobic interprets as the start of a panic attack instead of a normal fluctuation.

Misconceptions

The word agoraphobia is an English adoption of the Greek words agora (αγορά) and phobos (φόβος), literally translated as “a fear of the marketplace”. This translation is the reason for the common misconception that agoraphobia is a fear of open spaces. This is not exactly the case, since agoraphobics are not afraid of open spaces themselves, but of having panic attacks as a result of being in certain locations.

Another misconception is that agoraphobia is a fear of “crowded spaces”. Once again, an agoraphobic does not fear people: he or she rather fears an embarrassing/dangerous situation with no escape. Some people with agoraphobia are comfortable seeing visitors, but only in a defined space they feel in control of. Such people may live for years without leaving their homes, while happily seeing visitors and working, as long as they can stay within their safety zones. The safety zones can vary, from not being able to leave home, or not being able to make eye contact. If the person ‘leaves their safety zone’ they can have an anxiety attack.

Prevalence
The one-year prevalence of agoraphobia is about 5 percent. Agoraphobia occurs about twice as commonly among women than men (Magee et al., 1996 [1]). The gender difference may be attributable to social/cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women (DSM-IV), although other explanations are possible.

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 the subsequent worry, preoccupation, and avoidance. [2] Thus, the formal diagnosis of panic disorder with agoraphobia was established. However, for those people in communities or clinical settings who do not meet full criteria for panic disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used (DSM-IV).

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. Anti-anxiety medications include benzodiazepines such as alprazolam. Anti-depressant medications which are used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class such as sertraline, paroxetine and fluoxetine.

Treatment options for agoraphobia and panic disorder are similar.

Alternate academic theories

Attachment theory and agoraphobia
GA FAVA, C RAFANELLI, S GRANDI, S CONTI, C RUINI (2001), Long-term outcome of panic disorder with agoraphobia treated by exposure. Psychological Medicine. Vol. 31, pp 891-898 Cambridge: University Press. Conclusions The findings suggest that 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.

Some scholars (e.g., Liotti 1996 [3], Bowlby 1998 [4]) have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.

Spatial theory and agoraphobia
In the social sciences there is a perceived clinical bias (e.g., Davidson 2003 [5]) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.

Agoraphobics
See also Category:Agoraphobic celebrities

Real

Paula Deen had agoraphobia at one point in her life
Philip K. Dick, American science fiction writer
Woody Allen, American film director
Kim Basinger, American actress
Roy Castle, British TV presenter
Ronald Jones (musician), American musician, guitarist for Flaming Lips
Elfriede Jelinek, Nobel laureate for Literature, 2004
Emily Dickinson, American poet of the 19th century
Fictional

Howie from The Benchwarmers
Matthew Malone from Game On
Arthur “Boo” Radley from the novel To Kill A Mockingbird
Ambrose Monk the brother of Adrian Monk from the television series Monk. Despite his agoraphobia he has made a decent living writing manuals for electronics.
Dr. Helen Hudson from Copycat, played by Sigourney Weaver
Auric Goldfinger, in Ian Fleming’s Goldfinger (James Bond Novel)
Pearl Burton from Family Guy episode Brian Wallows and Peter’s Swallows
Father Jack Hackett from Father Ted was claimed agoraphobic by Ted in the episode ‘Are you Right There, Father Ted?’
Wanda from Corner Gas
In Stark Raving Dad, Homer Simpson meets an agoraphobe in a mental institution
Harold Smith in the television series Twin Peaks
Ken Rosenberg in the video game Grand Theft Auto: Vice City
Sheila Jackson from Channel 4 drama Shameless
Harper Pitt from Angels in America
Elijah Baley from Isaac Asimov’s Robot Series
Annie from I am Sam, played by Dianne Wiest
Susan Jagger from False Memory, written by Dean Koontz
Laura Wingfield from the play The Glass Menagerie, written by Tennessee Williams

See also
Agoraphobia Without History of Panic Disorder

References
^ 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.
^ Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press.
^ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
^ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
^ J. Davidson, (2003). Phobic Geographies

Sources
Yahoo Health

Footnotes
Materials for this topic are obtained from the public domain source:

David Satcher etal. (1999). “Chapter 4.2”, Mental Health: A Report of the Surgeon General.