agoraphobia

Agoraphobia
Classification & external resources
ICD-10F40.00 Without panic disorder, F40.01 With panic disorder
ICD-9300.22 Without panic disorder, 300.21 With panic disorder
Agoraphobia is an anxiety disorder which primarily consists of the fear of certain settings that may present unexpected challenges or demands. These could include parking lots, shoppings malls or restaurants. The social consequences of having a panic attack or losing control in public often becomes an additional source of fear in its own right. As a result, severe sufferers of agoraphobia may become confined to their homes, experiencing difficulty traveling from this "safe place."

Definition

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, and is not clinically accurate.

Agoraphobia describes a condition where the sufferer becomes uneasy in environments that are unfamiliar or where he/she perceives that he or she has little control. Triggers may include crowds, wide open spaces or traveling alone even for short distances. The anxiety is often compounded by a fear of social embarrassment in case of panic attacks or appearing distraught in public.[1]

People with agoraphobia may experience 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 to his home. [2] 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 his 'safety zone,' he can have an anxiety attack.

Prevalence

The one-year prevalence of agoraphobia is about 5 percent. [3] About one third of people with Panic Disorder progress to develop Agoraphobia. [4] Agoraphobia occurs about twice as commonly among women as it does in men (Magee et al., 1996[5]).

Causes and contributing factors

Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation.[6] [7]Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces.[8] Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data. [9]

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.[10] 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).

Association with panic attacks

Main article: Panic attack
Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear, where help would be difficult to obtain. During a panic attack, adrenaline is released in large amounts for several minutes causing the classical "fight or flight" condition. The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. [11] These symptoms include palpitations, sweating, trembling, and shortness of breath. Many patients report a fear of dying, or losing control of emotions or behavior. [11]

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. Treatment options for agoraphobia and panic disorder are similar.

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. [12]

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. Hypnosis is a possible alternative treatment.

Alternate theories

Attachment theory

Main article: Attachment Theory
Some scholars (e.g., Liotti 1996,[13] Bowlby 1998[14]) 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

In the social sciences there is a perceived clinical bias (e.g., Davidson 2003[15]) 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

References

1. ^ [1]
2. ^ "Treatment of Panic Disorder", NIH Consens Statement 9 (2): 1-24, Sep 25-27, 1991, <[2]
3. ^ (2006) Anxiety Disorders. NIH Publication No. 06-3879. 
4. ^ Robins, LN & DN Regier, eds. (1991), Psychiatric Disorders in America: the Epidemiologic Catchment Area Study, New York, NY: The Free Press
5. ^ 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.
6. ^ (1995 May) "Relationship between balance system function and agoraphobic avoidance.". Behav Res Ther. 33 (4): 435-9. PMID: 7755529. 
7. ^ (1996) "Panic, agoraphobia, and vestibular dysfunction". Am J Psychiatry 153: 503-512. 
8. ^ (1997 May-Jun) "Surface dependence: a balance control strategy in panic disorder with agoraphobia". Psychosom Med. 59 (3): 323-30. PMID: 9178344. 
9. ^ (2006 Oct) "High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.". Eur Psychiatry 21 (7): 501-8. PMID: 17055951. 
10. ^ Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press. 
11. ^ David Satcher etal. (1999). "Chapter 4.2", Mental Health: A Report of the Surgeon General. 
12. ^ "Long-term outcome of panic disorder with agoraphobia treated by exposure". Psychological Medicine 31: 891-898. 
13. ^ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
14. ^ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
15. ^ J. Davidson, (2003). Phobic Geographies
16. ^ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.

Footnotes

This article incorporates text from the National Institute of Mental Health, which is in the public domain.


The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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List of ICD-10 codes. The version for 2007 is available online at [1]

Chapter Blocks Title
I Certain infectious and parasitic diseases
II Neoplasms
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
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The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.

See also


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misleading. Please see the discussion on the talk page.
Anxiety disorders
Classification & external resources

ICD-10 F40-F42
ICD-9 300

Anxiety disorder
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Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger.
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Greek}}} 
Writing system: Greek alphabet 
Official status
Official language of:  Greece
 Cyprus
 European Union
recognised as minority language in parts of:
 European Union
 Italy
 Turkey
Regulated by:
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An agora (αγορά), translatable as , was a public space and an essential part of an ancient Greek polis or city-state. An agora acted as a marketplace and a forum to the citizens of the polis.
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Phobos, Greek for "fear", is the root word of phobia. It may also refer to:
  • Phobos (mythology), one of the sons of Ares and Aphrodite in Greek mythology.
  • Phobos (moon), the larger and innermost of Mars' two moons.

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Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger.
..... Click the link for more information.
Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger.
..... Click the link for more information.
Comfort Zone is the first studio album by Sector Seven. It was released in 1999 by Raw Energy.

Track listing

  1. "Comfort Zone"
  2. "Think Twice"
  3. "SRM"
  4. "Right Away"
  5. "What Went Wrong?"
  6. "Back And Forth"
  7. "Land Of Confusion"
  8. "Head First"

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Panic disorder
Classification & external resources

ICD-10 F41.0
ICD-9 300.01 , 300.21

DiseasesDB 30913

Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or
..... Click the link for more information.
The vestibular system, or balance system, is the sensory system that provides the dominant input about our movement and orientation in space. Together with the cochlea, the auditory organ, it is situated in the vestibulum in the inner ear (Figure 1).
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The visual system is the part of the nervous system which allows organisms to see. It interprets the information from visible light to build a representation of the world surrounding the body.
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Proprioception (PRO-pree-o-SEP-shun (IPA pronunciation: [ˈpɹopɹiːoˌsɛpʃən]); from Latin proprius
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Virtual reality (VR) is a technology which allows a user to interact with a computer-simulated environment, be it a real or imagined one. Most current virtual reality environments are primarily visual experiences, displayed either on a computer screen or through special
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Panic disorder
Classification & external resources

ICD-10 F41.0
ICD-9 300.01 , 300.21

DiseasesDB 30913

Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or
..... Click the link for more information.
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international.
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Panic disorder
Classification & external resources

ICD-10 F41.0
ICD-9 300.01 , 300.21

DiseasesDB 30913

Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or
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Agoraphobia Without a History of Panic Disorder is an anxiety disorder characterized by extreme fear of experiencing panic symptoms, but with an absence of any underlying history of panic attacks.

Agoraphobia typically develops as a result of having panic disorder.
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Panic attacks are sudden, discrete periods of intense anxiety, fear and discomfort that are associated with a variety of somatic and cognitive symptoms[1]. The onset of these episodes is typically abrupt, and may have no obvious trigger.
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Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy developed by a South African psychiatrist, Joseph Wolpe.
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Cognitive Therapy (CT) is a type of psychotherapy developed by psychiatrist Aaron T. Beck in the 1960s. Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which
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Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). These components combine to create the feelings that we typically recognize as fear, apprehension, or worry.
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antidepressant, is a psychiatric medication or other substance (nutrient or herb) used for alleviating depression or dysthymia ('milder' depression). Drug groups known as MAOIs, tricyclics and SSRIs are particularly associated with the term.
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Panic disorder
Classification & external resources

ICD-10 F41.0
ICD-9 300.01 , 300.21

DiseasesDB 30913

Panic Disorder is a psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or
..... Click the link for more information.
Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy developed by a South African psychiatrist, Joseph Wolpe.
..... Click the link for more information.
The benzodiazepines (pronounced [ˌbɛnzəʊdaɪˈæzəpiːnz], or "benzos" for short) are a class of psychoactive drugs considered minor tranquilizers with varying hypnotic, sedative, anxiolytic,
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Alprazolam, also known under the trade names Xanax and Niravam, is a short-acting drug in the benzodiazepine class used to treat severe anxiety disorders and as an adjunctive treatment for anxiety associated with clinical depression.
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