Symptoms of Agoraphobia

The translational value of the open field test has been validated in humans with agoraphobia. In this study, individuals with agoraphobia (AP), along with age-matched healthy controls (HC), were instructed to first walk freely around a soccer field. AP participants spent significantly more time closer to the edges of the soccer field than the HC group. Additionally, all participants were given a specific destination within the city, and their routes were remotely monitored. The GPS data shows that most AP participants avoided crossing the market square, which in this study is considered the open field. HC participants crossed the market square, as this provided the shortest route to the destination. This data provides evidence that thigmotaxis can be demonstrated in humans and is related to anxiety disorders such as agoraphobia.

Applications of the open field test

Patients must have fear for at least 6 months with at least 2 of the following situations:

- Using public transport
- Being in open spaces 
- Being in an enclosed place (eg, shop, theater)
- Standing in line or being in a crowd
- Being alone outside the home

The fear must involve thoughts around the fact that escaping and getting help would be difficult. In addition:

- The situation must always trigger anxiety
- The situation must always be avoided or require a companion
- The fear is unreasonable
- The fear causes significant distress and interference

DSM-5 Criteria for Agoraphobia

Perlmutter, Richard A. "Psychopharmacology of Attachment: Effects of Successful Agoraphobia Treatment on Marital Relationships." Family Systems Medicine 8.3 (1990): 279-84. ProQuest. Web. 15 Aug. 2024.

Reference for Role of Spouse in Agoraphobia Treatment

Within the United States, the lifetime prevalence of agoraphobia is estimated to be about 1.4%, meaning this percentage of the population will experience the disorder at some point.

Prevalence of Agoraphobia

An individual experiences intense anxiety about being in situations like crowded shopping malls or on public buses. Their primary concern is the thought of having a panic attack and being unable to escape or find help. Consequently, they have started to avoid these situations entirely. This specific pattern of fear and avoidance, centered on the difficulty of escape during panic, is the central feature of:

Derived from the Greek for 'fear of the marketplace,' agoraphobia is an anxiety disorder defined by intense fear and avoidance of situations where escape might be difficult or help unavailable if panic symptoms arise. Such situations often include using public transportation, being in open areas like parking lots, enclosed spaces like stores, crowded places, or being outside the home alone.

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The term 'phobia' originates from the Greek word for fear. A phobic disorder is defined by an intense, persistent, and irrational fear of a particular object, activity, or situation. This overwhelming fear compels the individual to actively avoid the source of their phobia. Exposure to the phobic stimulus results in significant distress and dysfunction, even when the person intellectually understands that their fear is excessive. Phobic disorders are generally categorized into three types: specific phobias, agoraphobia, and social phobia.

Phobic Disorder

The DSM-5-TR separates anxiety disorders into the following specific disorders:
-	Separation Anxiety Disorder
-	Selective Mutism
-	Specific Phobia
-	Social Anxiety Disorder
-	Panic Disorder
-	Panic Attack Specifier
-	Agoraphobia
-	Generalized Anxiety Disorder (GAD)
-	Substance / Medication-Induced Anxiety Disorder
-	Anxiety Disorder Due to Another Medical Condition
-	Other Specified Anxiety Disorder
-	Unspecified Anxiety Disorder


[DSM-5-TR] List of Anxiety Disorders

Brazier, Y. (2020, November 26). Phobias: Symptoms, types, causes, and treatment. Medical News Today. https://www.medicalnewstoday.com/articles/249347. 

Phobias Article

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Agoraphobia

Social anxiety disorder (SAD) affects about 4% of the worldwide population and is slightly more common in women. Also known as social phobia, it is defined as a persistent,and potentially debilitating fear of meeting new people, being watched, or criticized by others. Some with social anxiety may attempt to avoid anxiety-triggering situations by self-isolating or cancelling plans. It is a profound fear of the judgement of peers, particularly public humiliation. It is NOT shyness or introversion but can sprout from childhood shyness. In a social sense, social anxiety is not just feeling nervous or shy in certain social situations like starting a new job or the first day of school. Social anxiety disorder is a disorder that interferes with everyday life and relationships due to fearing situations where you can be embarrassed or viewed negatively and intense fear of situations where a person with SAD expects the worst. 

Social Anxiety Disorder (Social Phobia)

Coelho, C. M., & Purkis, H. (2009). The Origins of Specific Phobias: Influential Theories and Current Perspectives. Review of General Psychology, 13(4), 335–348. https://doi.org/10.1037/a0017759

The Origins of Specific Phobias: Influential Theories and Current Perspectives, 2009

A specific phobia, formerly known as a simple phobia, is an anxiety disorder characterized by excessive, distressing, and persistent fear or anxiety centered on a specific object or situation. Individuals with a specific phobia often recognize that their level of fear is irrational, yet they may go to great lengths to avoid the phobic stimulus. The anxiety and avoidance behaviors associated with the phobia are typically disruptive to the person's daily life and functioning.

Specific Phobia

Based on the provided scenario, explain why Maria's condition is best described as a phobic disorder rather than a simple fear. In your answer, identify specific examples from the text that align with the defining characteristics of a phobic disorder.

Differentiating Fear from Phobia

Separation anxiety in children seems intense or prolonged and interferes with school or other daily activities. It can also includes panic attacks. Most frequently separation anxiety disorder is linked to the child's anxiety about his or her parents, but it could relate to another close caregiver.

Less common separation anxiety disorder can occur in teenagers and adults, causing significant problems leaving home or going to work.

Separation Anxiety Disorder

A severe anxiety disorder, where a person is unable to speak in certain social situations, for example with classmates or distant relatives. Usually, selective mutism starts during childhood, if left untreated, it can continue to adulthood. Individuals with selective mutism are not choosing to not speak but are unable to speak. The expectation to talk to certain people triggers a freeze response with feelings of panic making talking impossible. 



Selective Mutism 

This disorder is hallmarked by the experience of multiple, unexpected panic attacks. These attacks are often associated with intense fear that occurs quickly. Generally, this diagnosis is applied if you have had four or more panic attacks, and fear their reocurrence. Having one panic attack, is not a panic disorder. Worry over panic attacks and avoidance of situations, places, etc. that are associated with panic attacks can lead to further problems. 

Recurrent panic attacks may show temporal lobe abnormalities. Those who suffer from panic disorder typically have lower temporal lobe volumes. These attacks can occur unexpectedly or by a trigger. 



Panic Disorder

Generalized Anxiety Disorder (GAD) is characterized by a persistent and relatively continuous state of excessive, uncontrollable, and often pointless worry and apprehension. Individuals with this disorder typically worry about routine, everyday matters, such as health, finances, or the safety of family members, without any justified reason. For a diagnosis, this diffuse worrying must occur more days than not for a period of at least six months, not be attributable to another disorder, and be accompanied by at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep difficulties.

Generalized Anxiety Disorder

Very Well Mind. Retrieved June 30th, 2023 from https://www.verywellmind.com/

Very Well Mind

This disorder refers to an increased amount of anxiety that stems from alcohol, drug, or medication usage. This diagnosis would go beyond the anxiousness or panic during intoxication/withdrawal. The anxiety causes distress and impariment.

Substance / Medication-Induced Anxiety Disorder

When someone's physical health condition is the direct cause for symptoms of anxiety or panic.

Anxiety Disorder Due to Another Medical Condition

MSD Manual, Professional Version. Retrieved July 2nd, 2023 from https://www.msdmanuals.com/professional

MSD Manual, Professional Version

For the past eight months, David has experienced a near-constant state of worry. He feels anxious about his performance at work, the health of his parents, and his financial situation, despite there being no specific or immediate threats in these areas. He reports feeling restless, easily fatigued, and has significant muscle tension in his neck and shoulders. His condition is best described by which of the following?

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