The essential feature of agoraphobia is anxiety about being in (or anticipating) situations from which escape might be difficult or in which help may not be available in the event of having a panic attack (or panic-like symptoms). Oftentimes, when in this situation, an individual may have the vague thought that something dreadful may happen. Such concerns must persist for at least 6 months and occur virtually every time an individual encounters the place or situation.
Agoraphobic fears typically involve 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.
More specifically, the diagnostic criteria in the DSM-5 requires that an individual experiences intense fear in response to (or when anticipating entering) at least 2 of the following 5 situations:
1) using public transportation, such as automobiles, buses, trains, ships, or planes
2) being in open spaces, such as parking lots, marketplaces, or bridges
3) being in enclosed spaces, such as shops, theaters, or cinemas
4) standing in line or being in a crowd
5) being outside of the home alone
A person who experiences agoraphobia avoids such situations (e.g., travel is restricted; the person changes daily routines) or else they are endured with significant distress. For example, people with agoraphobia often require the presence of a companion, such as a family member, partner, or friend, to confront the situation.
Anxiety or phobic avoidance in agoraphobia can not be 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 a single situation like elevators), obsessive-compulsive disorder (e.g., avoidance of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), or separation anxiety disorder (e.g., avoidance of leaving home or relatives). As with all mental disorders, the symptoms listed above are not due to the direct physiological effects of a use or abuse of a substance (e.g., alcohol, drugs, medications) or a general medical condition.
As a recent change to its diagnostic criteria (from DSM-IV to the updated 2013 DSM-5) the diagnosis of panic disorder is not required for that of agoraphobia. Now, if an individual meets criteria for panic disorder and for agoraphobia, both diagnoses can be assigned.
This entry has been adapted for 2013 DSM-5 criteria; diagnostic code: 300.22.