Agarofobia oxford handbook of psychiatry Agoraphobia1 Essence Symptoms of anxiety (psychological and/or autonomic) are not secondary delusional

or obsessive thoughts and are restricted to places or situations where escape may be difficult or embarrassing, leading to avoidance (e.g. of crowds, public places, travelling away from home or alone). Epidemiology Prevalence (6 month) 2.85.8% (ECA); : = 1:3; as for panic disorder, there is a bimodal distribution with the first being somewhat broader (1535 yrs). In later life agoraphobic symptoms may develop secondary to physical frailty, with the associated fear of exacerbating medical problems or having an accident. Aetiology Genetic Both genetic and environmental factors appear to play a role. The predisposition towards overly interpreting situations as dangerous may be genetic, and some commentators suggest an ethological factor involving an evolutionarily determined vulnerability to unfamiliar territory2. First-degree relatives also have an increased prevalence of other anxiety and related disorders (e.g. social phobia), alcohol misuse, and depressive disorders. Psychoanalytical Unconscious conflicts are repressed and may be transformed by displacement into phobic symptoms. Learning theory Conditioned fear responses lead to learned avoidance. Comorbidity Panic disorder, depressive disorder, other anxiety and related disorders (e.g. 55% also have social phobia), alcohol and substance misuse Differential diagnosis Other anxiety and related disorders (esp. generalised anxiety disorder, social phobia, OCD), depressive disorders, secondary avoidance due to delusional ideas in psychotic disorders. Management

Pharmacological Antidepressants As for panic disorder. BDZs short-term use only (may reinforce avoidance)most evidence for alprazolam/clonazepam. Psychological Behavioural methods Exposure techniques (focused on particular situations or places), relaxation training, and anxiety management. Cognitive methods Teaching about bodily responses associated with anxiety/education about panic attacks, modification of thinking errors.

References 1 Literally fear of the market place (Greek.)

2 Lelliott P, Marks I, McNamee G, Tobena A (1989) Onset of panic disorder with agoraphobia. Toward an integrated model. Archives of General Psychiatry 46, 10004.