Agoraphobia Without History of Panic Disorder

Diagnostic Features

The essential features of Agoraphobia Without History of Panic Disorder are similar to those of Panic Disorder With Agoraphobia except that the focus of fear is on the occurrence of incapacitating or extremely embarrassing panic-like symptoms or limited-symptom attacks rather than full Panic Attacks. Individuals with this disorder have Agoraphobia (Criterion A). The "panic-like symptoms" include any of the 13 symptoms listed for Panic Attack or other symptoms that may be incapacitating or embarrassing (e.g., loss of bladder control, vomiting in public). For example, an individual may fear having a severe headache or cardiac symptoms and not being able to get help.

To qualify for this diagnosis, the full criteria for Panic Disorder must never have been met (Criterion B) and the symptoms must not be due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (Criterion C). If an associated general medical condition is present (e.g., a cardiac condition), the fear of being incapacitated or embarrassed by the development of symptoms (e.g., fainting) is clearly in excess of that usually associated with the condition (Criterion D). When a diagnosis of Agoraphobia Without History of Panic Disorder is being made, it should be ensured that the avoidance is characteristic of Agoraphobia and cannot be better explained by another Axis I disorder (e.g., Specific Phobia or Social Phobia) or Axis II disorder (e.g., Avoidant Personality Disorder).

Specific Culture and Gender Features

Some cultural or ethnic groups restrict the participation of women in public life, and this must be distinguished from Agoraphobia. This disorder is diagnosed far more often in females than in males.

Prevalence

In clinical settings, almost all individuals (over 95%) who present with Agoraphobia also have a current diagnosis (or history) of Panic Disorder. In contrast, the prevalence of Agoraphobia Without History of Panic Disorder in epidemiological samples has been reported to be higher than that for Panic Disorder With Agoraphobia. However, problems with assessment appear to have inflated the rates reported in epidemiological studies. Recently, individuals who were given a diagnosis of Agoraphobia Without History of Panic Disorder in an epidemiological study were reevaluated by clinicians using standard interview schedules. The majority were found to have Specific Phobias, but not Agoraphobia.

Look also:
Anxiety Disorders: Introduction
Panic Attack
AgoraphobiaRelatively little is known about the course of Agoraphobia Without History of Panic Disorder. Anecdotal evidence suggests that some cases may persist for years and be associated with considerable impairment.