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Agoraphobia

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

Agoraphobia is characterized by an intense fear or anxiety that occurs when someone is faced with a situation that is difficult or embarrassing to leave, or where help would be unavailable if they were to experience panic-like symptoms (e.g., becoming dizzy or disoriented). To meet the diagnostic criteria these reactions must occur in at least two of the following five situations:

1. Using public transportation (cars, buses, trains, ships, airplanes).
2. Being in open spaces (parking lot, marketplaces, bridges).
3. Being in enclosed places (movie theatre, shops).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.

The fearful or anxious response almost always occurs when exposed to these situations. People with Agoraphobia will strive to avoid these types of situations at all costs. This avoidance interferes with their general functioning. For instance, someone who fears elevators may refuse to accept any job where their office is located beyond the fifth floor. People with Agoraphobia often learn to cope with these anxiety-provoking situations by being accompanied by another person, often referred to as a "safety person." While a safety person may help to limit the magnitude of dysfunction, it also serves to maintain the disorder. 

Many people with Agoraphobia will experience cued (expected) panic attacks when exposed to these situations or anticipate the possibility of exposure. However, a person with agoraphobia may also experience uncued (unexpected) panic attacks. In this case, a person may also meet the criteria for Panic Disorder and they would receive both diagnoses.

To meet diagnostic criteria, the symptoms must be persistent, usually lasting at least 6 months or more. Treatment for Agoraphobia is discussed in another section.