agoraphobia

agoraphobia, type of anxiety disorder characterized by avoidance of situations that induce intense fear and panic. The term is derived from the Greek word agora, meaning “place of assembly,” “open space,” or “marketplace,” and from the English word phobia, meaning “fear.” Many patients with agoraphobia are uncomfortable in unfamiliar places or in crowded or open areas, such as shops, markets, restaurants, and theatres, where they may inadvertently enter into situations that they perceive to be beyond their control. Although the relationship between agoraphobia and panic disorder is unclear, many agoraphobic patients also experience panic attacks. These individuals often are afraid of having a panic attack in a public place, which they perceive as embarrassing, or of having a panic attack in a location distant from their physician or medical clinic or where effecting medical care might be difficult. As a result, many have difficulty driving long distances, crossing bridges, and driving through tunnels. At its most severe, agoraphobia can cause the sufferer to become housebound.

Agoraphobia generally is treated with a combination of specific medication and individual psychotherapy. Cognitive behavioral therapy (CBT), a form of individual psychotherapy, also appears to be effective in the treatment of panic disorder; its combination with medication may be even more powerful. CBT usually involves distraction and breathing exercises along with education to help the patient make more appropriate attributions for distressing somatic symptoms. Exposure to desensitize patients to their fears is the most-effective intervention, and in its most basic form it may consist of gentle encouragement for patients to enter feared situations, such as shopping in a grocery store.