Agoraphobia Without History of Panic Disorder

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.

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Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks. Historically, there has been debate over whether Agoraphobia Without Panic genuinely existed, or whether it was simply a manifestation of other disorders such as Panic Disorder, General anxiety disorder, Avoidant personality disorder and Social Phobia. Said one researcher: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic" (Barlow & Waddell, 1985) . In spite of this earlier skepticism, current thinking is that Agoraphobia Without Panic Disorder is indeed a valid, unique illness which has gone largely unnoticed, since its sufferers are far less likely to seek clinical treatment.

Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines Agoraphobia Without a History of Panic Disorder as:

A. The presence of Agoraphobia related to fear of developing panic-like symptoms (e.g., dizziness or diarrhea):

1. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) 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 involved characteristic 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.
2. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
3. 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), specific phobia (e.g., avoidance limited to single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Post-traumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation anxiety disorder (e.g., avoidance of leaving home or relatives).

B. Criteria have never been met for Panic Disorder.

C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

D. If an associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition.

See also

• Panic disorder
• Agoraphobia
• Anxiety Disorders Association of America

References

• Agoraphobia Without a History or Panic Disorder May Be Part of the Panic Disorder Syndrome. Journal of Nervous & Mental Disease, 190(9):624-630, September 2002.
• Agoraphobia Without Panic: An Under-Treated Population.
• The Relationship of Agoraphobia and Panic in a Community Sample of Adolescents and Young Adults.
• Barlow, D. H. & Waddell, M. T. (1985) Agoraphobia. Ch 1 in Barlow, D. H. (Ed) Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford.