Agoraphobia without History of Panic Disorder
Agoraphobia refers to a particular type of anxiety that occurs when someone is faced with a situation that is difficult or embarrassing to leave, or where help would not be available if they were to experience panic symptoms (e.g., becoming dizzy or disoriented). Some examples of agoraphobia include fear of leaving home, fear of riding in elevators or on escalators, fear of being home alone, fear of being outdoors, and fear of being in a crowd. People with Agoraphobia will avoid these types of situations, and this avoidance interferes with their general functioning. For instance, someone who fears elevators may refuse to accept any job where their office is located beyond the fifth floor. People with Agoraphobia often learn to cope with these anxiety-provoking situations by being accompanied by another person, often referred to as a "safety person." While a safety person may help to limit the magnitude of dysfunction, it also serves to maintain the disorder.
Agoraphobia without panic attacks is not that common. To meet the criteria for Agoraphobia without Panic Disorder, there cannot be a prior history of Panic Disorder. Most individuals who experience agoraphobia would be correctly diagnosed as having Panic Disorder with Agoraphobia (see below), because they experience panic attacks in response to the agoraphobic situations they fear. However, Agoraphobia can occur without Panic Disorder (thus, the reason for this separate diagnosis). However, people with Agoraphobia may have limited-symptom panic attacks.
Panic Disorder, with or without Agoraphobia
Panic disorder is characterized by uncued (unexpected) panic attacks. Panic Disorder is diagnosed only when the panic attacks are not better accounted for by some other anxiety disorder such as Social or Specific Phobias, Posttraumatic Stress Disorder, or Obsessive-Compulsive Disorder: Cued panic attacks are most common with these disorders. Panic Disorder can occur with, or without, Agoraphobia. In order to be diagnosed with Panic Disorder, a person must experience repeated, unexpected (uncued) panic attacks, and the attacks must be followed by constant concerns about having more attacks; worrying about the consequences of the attacks; or significantly changing behavior to avoid the attacks. Once those criteria are met, the clinician must decide whether Panic Disorder includes agoraphobia. Thus, the diagnosis of Panic Disorder will be stated as "with Agoraphobia," or "without Agoraphobia." The frequency and severity of panic attacks varies considerably. Some people report moderately frequent attacks that occur regularly (such as once per week) every month, for many months. Others report a cluster of very frequent attacks (perhaps one per day) that occur for a several weeks, followed by a dormant period of several months, without any attacks. Treatment for Panic Disorder is found in the treatment section.