Among the anxiety disorders, agoraphobia without panic disorder, or AWPD, is classified in the Diagnostic and Statistical Manual of Mental Disorders as "Agoraphobia Without History of Panic Disorder." Many mental health professionals think that agoraphobia is always related to panic. It is difficult to find information about agoraphobia without panic because it appears that panic and agoraphobia are usually lumped together into the same category in mental health information and writing.
Identification
Panic disorder is characterized by severe anxiety, often commencing without warning, that produces sometimes alarming symptoms like heart palpitations, shortness of breath, chest pain, fear of dying and numbness. A textbook panic attack lasts about 10 to 20 minutes or less.
In contrast, agoraphobia alone is characterized by fear and anxiety about being in situations where escape is difficult. It need not give rise to such severe symptoms found with panic, but is pervasive. Panic disorder can occur with agoraphobia, but agoraphobia does not require that panic symptoms be present. The level of anxiety occurring with agoraphobia that leads people to curtail or avoid activities is viewed by many in mental health as attempts to avoid feared panic attacks.
Characteristics
Agoraphobia with no history of panic occurs when a person experiences intense anxiety about being somewhere or doing something somewhere when escape would be difficult. Part of the agoraphobic fear is that if the person would panic, no help would be there for him. If a person has an intense fear about only one thing, like fear of spiders, it would be classified as a specific phobia. Agoraphobia is a generalized fear that affects the person in more than one situation. For example, some agoraphobics suffer so badly, they cannot leave their dwelling. Others experience fear of situations such as being in crowds or out of a certain neighborhood, fear of driving, fear of flying, and fear of bridges. These fears are clusters of fears or phobias.
Behaviors
A person with agoraphobia will do her best to avoid the feared situations, even if it means sharply restricting her life, which may include social and work activity. He may want to be able to do more, but even thinking about doing so produces marked distress and anxiety---a type of mental paralysis. Sometimes she may be able to enter feared situations if she is with another person. His self-esteem may drop, especially if he attempts to explain his limits to others who devalue him because of his restrictions. If one person in a relationship or family is severely agoraphobic, the issue may cause great strain on the relationship(s).
Physical Symptoms
An agoraphobic person may experience any or all of many physical symptoms, such as lightheadedness, trouble breathing, dizziness, excessive sweating, rapid heart rate, flushing, nausea, upset stomach, diarrhea, chest pain and trouble swallowing, according to the Mayo Clinic's listing of symptoms. Many of these symptoms may occur with other illnesses and disorders. What associates these symptoms with agoraphobia is that they only occur when a feared situation is experienced or contemplated.
Case Example
Agoraphobia may be attached to fears and situations of many types and is resistant to logical thought. One man in his 30s developed agoraphobia because he was afraid of having a spontaneous bowel movement whenever he would not have a restroom nearby. His doctors determined he had no physical problem. He had, in fact, only had one such experience, when he was home. He curtailed his activities by avoiding walking in the park, boating, riding in a car with anyone not in his family and attending business meetings. He spent about 10 percent of his day attempting to have bowel movements to preempt having one if he could not be by a restroom, and was preoccupied with locating restrooms. It is easy to imagine how his agoraphobia must have negatively affected his business and family life.
References
- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; American Psychiatric Association; 2000
- "Synopsis of Psychiatry, Ninth Edition"; Benjamin J. Sadock, Virginia A. Sadock; 2003
- "The Journal of Nervous and Mental Disease"; Agoraphobia Without Panic: Case Illustrations of an Overlooked Syndrome; Alec C. Pollard, Ph.D., Raymond C. Tait, Ph.D., Donald Meldrum, Psy.D., Ira H. Dubinsky, Ph.D., and Jeffrey S. Gall, Ph.D.; January 1996
- Mayo Clinic: Agoraphobia Symptoms
