Agoraphobia

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Agoraphobia
Agora of the Competaliasts 01 (cropped).jpg
An ancient agora in Delos, Greece—one of the public spaces after which the condition is named.
Pronunciation
Specialty Psychiatry, clinical psychology
Symptoms Anxiety in situations perceived to be unsafe, panic attacks [1] [2]
Complications Depression, substance use disorder [1]
Duration> 6 months [1]
Causes Genetic and environmental factors [1]
Risk factors Family history, stressful event [1]
Differential diagnosis Separation anxiety, post-traumatic stress disorder, major depressive disorder [1]
Treatment Cognitive behavioral therapy [3]
Prognosis Resolution in half with treatment [4]
Frequency1.9% of adults [1]

Agoraphobia [1] is a mental and behavioral disorder, [5] specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. [1] These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own. [1] Being in these situations may result in a panic attack. [2] Those affected will go to great lengths to avoid these situations. [1] In severe cases, people may become completely unable to leave their homes. [2]

Contents

Agoraphobia is believed to be due to a combination of genetic and environmental factors. [1] The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. [1] In the DSM-5, agoraphobia is classified as a phobia along with specific phobias and social phobia. [1] [3] Other conditions that can produce similar symptoms include separation anxiety, post-traumatic stress disorder, and major depressive disorder. [1] The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicide ideation. [6] [7]

    Without treatment, it is uncommon for agoraphobia to resolve. [1] Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT). [3] [8] CBT results in resolution for about half of people. [4] In some instances, those with a diagnosis of agoraphobia have reported taking benzodiazepines and antipsychotics. [6] Agoraphobia affects about 1.7% of adults. [1] Women are affected about twice as often as men. [1] The condition is rare in children, often begins in adolescence or early adulthood, and becomes less common in old age. [1]

    Etymology

    The term agoraphobia was coined in German in 1871 by pioneering German psychologist Karl Friedrich Otto Westphal (1833–1890), in his article "Die Agoraphobie, eine neuropathische Erscheinung." Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1871–72; 3: 138–161. It is derived from Greek ἀγορά (agorā́), meaning ' place of assembly ' or 'market-place' and -φοβία (-phobía), meaning 'fear'. [9] [10]

    Signs and symptoms

    Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of a known, controllable space, usually their home. [1]

    Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks". [11] In these cases, the patient is fearful of a particular place because they have previously experienced a panic attack at the same location. Fearing the onset of another panic attack, the patient is fearful or avoids a location. Some refuse to leave their homes in medical emergencies because the fear of being outside of their comfort areas is too great. [12]

    The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making a diagnosis of panic disorder. Other syndromes like obsessive–compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome. [13]

    People with agoraphobia may experience temporary separation anxiety disorder when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or friends. [14] [15]

    People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia". [16]

    Panic attacks

    Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. [17] Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report a fear of dying, fear of losing control of emotions, or fear of losing control of behaviors. [17]

    Causes

    Agoraphobia is believed to be due to a combination of genetic and environmental factors. [1] The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. [1]

    Research has uncovered a link between agoraphobia and difficulties with spatial orientation. [18] [19] Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system, their visual system, and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds). [20] Likewise, they may be confused by sloping or irregular surfaces. [20] In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with subjects without agoraphobia. [21]

    Substance-induced

    Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia. [22] In 10 patients who had developed agoraphobia during benzodiazepine dependence, symptoms abated within the first year of assisted withdrawal. [23] Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to the long-term effects of alcohol consumption causing a distortion in brain chemistry. [24] Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic. [25]

    Attachment theory

    Some scholars [26] [27] have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. [28] Recent empirical research has also linked attachment and spatial theories of agoraphobia. [29]

    Spatial theory

    In the social sciences, a perceived clinical bias [30] exists in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity. [31] Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating a conflict in the mind of agoraphobic individuals.

    Evolutionary psychology

    An evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred. [32] [33]

    Diagnosis

    Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder. [34] Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur. [35] Early treatment of panic disorder can often prevent agoraphobia. [36] Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other anxiety disorders such as depression. [37]

    Agoraphobia without history of panic disorder

    Agoraphobia without a history of panic disorder (also called primary agoraphobia) is an anxiety disorder where the individual with the diagnosis does not meet the DSM-5 criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks. Agoraphobia can be caused by traumatic experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, generalized anxiety disorder, avoidant personality disorder and social phobia. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic". [38] In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.

    According to the DSM-IV-TR, a widely-used manual for diagnosing mental disorders, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence. [39] The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be diagnosed together. [40]

    Treatments

    Therapy

    Systematic desensitization can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. [41] Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely. [42] [43] In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until the symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise. [43]

    A related exposure treatment is in vivo exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects. [44] This treatment was largely effective with an effect size from d = 0.78 to d = 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment). [44]

    Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals. [44] Further research showed there was no significant effect between using group CBT versus individual CBT. [44]

    Cognitive restructuring has also proved useful in treating agoraphobia.[ citation needed ] This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.

    Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic. [45]

    Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method. [46] Similar to traditional face-to-face interventions, VCP can be used to administer CBT. [47]

    Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street). [48]

    Medications

    Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. Benzodiazepines, monoamine oxidase inhibitor, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia. [49] Antidepressants are important because some have anxiolytic effects. [43] Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy. [43] A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia. [43]

    Benzodiazepines and other anxiolytic medications such as alprazolam and clonazepam are used to treat anxiety and can also help control the symptoms of a panic attack.[ citation needed ]

    Alternative medicine

    Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results. [50] As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma. [51]

    Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. [52]

    Epidemiology

    Agoraphobia occurs about twice as commonly among women as it does in men. It can develop at any age but is much more common in adolescence and early adulthood and occurs more often in people of above average intelligence. [53]

    Panic disorder with or without agoraphobia affects roughly 5.1% of Americans, [44] and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting panic disorders as well. [44]

    Society and culture

    Notable cases

    See also

    Related Research Articles

    <span class="mw-page-title-main">Anxiety</span> Unpleasant state of inner turmoil over anticipated events

    Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one. It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.

    <span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

    A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

    <span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

    A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

    <span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

    Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

    <span class="mw-page-title-main">Panic attack</span> Period of intense fear

    Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing control. Typically, symptoms reach a peak within ten minutes of onset, and last for roughly 30 minutes, but the duration can vary from seconds to hours. Although they can be extremely frightening and distressing, panic attacks themselves are not physically dangerous.

    Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

    <span class="mw-page-title-main">Hypochondriasis</span> Medical condition

    Hypochondriasis or hypochondria also known as syndrome is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

    <span class="mw-page-title-main">Claustrophobia</span> Fear of small spaces

    Claustrophobia is a fear of confined spaces. It is triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

    <span class="mw-page-title-main">Avoidant personality disorder</span> Personality disorder

    Avoidant personality disorder (AvPD) or Anxious personality disorder is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy, severe feelings of inadequacy and inferiority, and an overreliance on avoidance of feared stimuli as a maladaptive coping method. Those affected typically display a pattern of extreme sensitivity to negative evaluation and rejection, a belief that one is socially inept or personally unappealing to others, and avoidance of social interaction despite a strong desire for it. It appears to affect an approximately equal number of men and women.

    Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.

    Mysophobia, also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. It is classified as a type of specific phobia, meaning it is evaluated and diagnosed based on the experience of high levels of fear and anxiety beyond what is reasonable when exposed to or in anticipation of exposure to stimuli related to the particular concept. William A. Hammond first coined the term in 1879 when describing a case of obsessive–compulsive disorder (OCD) exhibited in repeatedly washing one's hands.

    Cynophobia is the fear of dogs and canines in general. Cynophobia is classified as a specific phobia, under the subtype "animal phobias". According to Timothy O. Rentz of the Laboratory for the Study of Anxiety Disorders at the University of Texas, animal phobias are among the most common of the specific phobias and 36% of patients who seek treatment report being afraid of dogs or afraid of cats. Although ophidiophobia or arachnophobia are more common animal phobias, cynophobia is especially debilitating because of the high prevalence of dogs and the general ignorance of dog owners to the phobia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) reports that only 12% to 30% of those with a specific phobia will seek treatment.

    Mental health professionals often distinguish between generalized social phobia and specific social phobia. People with generalized social phobia have great distress in a wide range of social situations. Those with specific social phobia may experience anxiety only in a few situations. The term "specific social phobia" may also refer to specific forms of non-clinical social anxiety.

    Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

    <span class="mw-page-title-main">Thalassophobia</span> Fear of the sea or large open water

    Thalassophobia is the persistent and intense fear of deep bodies of water, such as the ocean, seas, or lakes. Though very closely related, thalassophobia should not be confused with aquaphobia, which is classified as the fear of water itself. Thalassophobia can include fears of being in deep bodies of water, the vastness of the sea, sea waves, aquatic animals, and great distance from land.

    Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

    <span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

    Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.

    <span class="mw-page-title-main">Panic disorder</span> Anxiety disorder characterized by reoccurring unexpected panic attacks

    Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past.

    <span class="mw-page-title-main">Fear of flying</span> Fear of being in a flying vehicle whilst in flight

    Fear of flying is a fear of being on an airplane, or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia, aerophobia, or pteromerhanophobia.

    Autophobia, also called monophobia, isolophobia, or eremophobia, is the specific phobia or a morbid fear or dread of oneself or of being alone, isolated, abandoned, and ignored. This specific phobia is associated with the idea of being alone, often causing severe anxiety.

    References

    PD-icon.svg This article incorporates public domain material from websites or documents of the National Institute of Mental Health .

    1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp.  217–221, 938, ISBN   978-0-89042-555-8
    2. 1 2 3 "Agoraphobia". PubMed Health. Retrieved 11 August 2016.
    3. 1 2 3 Wyatt RJ, Chew RH (2008). Wyatt's Practical Psychiatric Practice: Forms and Protocols for Clinical Use. American Psychiatric Pub. pp. 90–91. ISBN   978-1-58562-687-8. Archived from the original on 21 August 2016.
    4. 1 2 Craske MG, Stein MB (24 June 2016). "Anxiety". Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID   27349358. S2CID   208789585.
    5. ↑ Drs; Sartorius N, Henderson A, Strotzka H, Lipowski Z, Yu-cun S, You-xin X, et al. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). www.who.int World Health Organization . Microsoft Word. bluebook.doc. pp. 110, 112–3. Archived (PDF) from the original on 17 October 2004. Retrieved 23 June 2021– via Microsoft Bing.
    6. 1 2 Shin J, Park DH, Ryu SH, Ha JH, Kim SM, Jeon HJ (24 July 2020). "Clinical implications of agoraphobia in patients with panic disorder". Medicine. 99 (30): e21414. doi:10.1097/MD.0000000000021414. ISSN   0025-7974. PMC   7387026 . PMID   32791758.
    7. ↑ Teismann T, Lukaschek K, Hiller TS, Breitbart J, Brettschneider C, Schumacher U, et al. (24 September 2018). "Suicidal ideation in primary care patients suffering from panic disorder with or without agoraphobia". BMC Psychiatry. 18 (1): 305. doi: 10.1186/s12888-018-1894-5 . ISSN   1471-244X. PMC   6154913 . PMID   30249220.
    8. ↑ Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G (13 April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis". The Cochrane Database of Systematic Reviews. 2016 (4): CD011004. doi:10.1002/14651858.CD011004.pub2. PMC   7104662 . PMID   27071857.
    9. ↑ "Collins dictionary" . Retrieved 17 September 2020.
    10. ↑ Elster CH (2009). Verbal Advantage: Ten Easy Steps to a Powerful Vocabulary. Diversified Publishing. p. PT717. ISBN   978-0-307-56097-1. Archived from the original on 21 August 2016.
    11. ↑ "Agoraphobia – Dictionary of Psychotherapy". Archived from the original on 3 April 2016. Retrieved 23 March 2016.
    12. ↑ "Agoraphobia". betterhealth.vic.gov.au. Archived from the original on 22 March 2017. Retrieved 21 March 2017.
    13. ↑ "Agoraphobia Symptoms". Psych Central.com. 17 May 2016.
    14. ↑ "Agoraphobia – Symptoms and causes". Mayo Clinic. Retrieved 1 July 2019.
    15. ↑ "What Are Anxiety Disorders?". www.psychiatry.org. Retrieved 1 July 2019.
    16. ↑ Adamec C (2010). The Encyclopedia of Phobias, Fears, and Anxieties, Third Edition. Infobase Publishing. p. 328. ISBN   978-1-4381-2098-0.
    17. 1 2 David Satcher, et al. (1999). "Chapter 4.2". Mental Health: A Report of the Surgeon General. Archived from the original on 27 April 2006. Retrieved 7 March 2006.
    18. ↑ Yardley L, Britton J, Lear S, Bird J, Luxon LM (May 1995). "Relationship between balance system function and agoraphobic avoidance". Behav Res Ther. 33 (4): 435–9. doi:10.1016/0005-7967(94)00060-W. PMID   7755529.
    19. ↑ Jacob RG, Furman JM, Durrant JD, Turner SM (1996). "Panic, agoraphobia, and vestibular dysfunction". Am J Psychiatry. 153 (4): 503–512. doi:10.1176/ajp.153.4.503. PMID   8599398.
    20. 1 2 Jacob RG, Furman JM, Durrant JD, Turner SM (1997). "Surface dependence: a balance control strategy in panic disorder with agoraphobia". Psychosom Med. 59 (3): 323–30. doi:10.1097/00006842-199705000-00016. PMID   9178344. S2CID   9789982.
    21. ↑ Viaud-Delmon I, Warusfel O, Seguelas A, Rio E, Jouvent R (October 2006). "High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality" (PDF). Eur. Psychiatry. 21 (7): 501–8. doi:10.1016/j.eurpsy.2004.10.004. PMID   17055951. S2CID   6932961.
    22. ↑ Hammersley D, Beeley L (1996). "The effects of medication on counselling". In Palmer S, Dainow S, Milner P (eds.). Counselling: The BACP Counselling Reader. Vol. 1. Sage. pp. 211–4. ISBN   978-0-8039-7477-7.
    23. ↑ Ashton H (June 1987). "Benzodiazepine withdrawal: outcome in 50 patients". Br J Addict. 82 (6): 665–71. doi:10.1111/j.1360-0443.1987.tb01529.x. PMID   2886145.
    24. ↑ Cosci F, Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry. 68 (6): 874–80. doi:10.4088/JCP.v68n0608. PMID   17592911.
    25. ↑ Cosci F, Knuts IJ, Abrams K, Griez EJ, Schruers KR (May 2010). "Cigarette smoking and panic: a critical review of the literature". J Clin Psychiatry. 71 (5): 606–15. doi:10.4088/JCP.08r04523blu. PMID   19961810.
    26. ↑ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
    27. ↑ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
    28. ↑ Jacobson K (2004). "Agoraphobia and Hypochondria as Disorders of Dwelling". International Studies in Philosophy. 36 (2): 31–44. doi:10.5840/intstudphil2004362165.
    29. ↑ Holmes J (2008). "Space and the secure base in agoraphobia: a qualitative survey". Area. 40 (3): 357–382. Bibcode:2008Area...40..375H. doi:10.1111/j.1475-4762.2008.00820.x.
    30. ↑ J. Davidson, (2003). Phobic Geographies
    31. ↑ Holmes J (2006). "Building Bridges and Breaking Boundaries: Modernity and Agoraphobia". Opticon 1826. 1: 1. doi: 10.5334/opt.010606 (inactive 31 January 2024). Archived from the original on 3 March 2016.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link)
    32. ↑ Bracha HS (2006). "Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder" (PDF). Progress in Neuro-Psychopharmacology and Biological Psychiatry. 30 (5): 827–853. doi:10.1016/j.pnpbp.2006.01.008. PMC   7130737 . PMID   16563589.
    33. ↑ Raffaello S, Alessandra SM, Alessandra S (2011). "[Primary agoraphobia specific symptoms: from natural information to mental representations]" (PDF). Italian Journal of Psychopathology (in Italian). 17 (3): 265–276. Archived from the original (PDF) on 26 April 2012.
    34. ↑ American Psychiatric Association, 1998
    35. ↑ Barlow DH (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press.
    36. ↑ pmhdev. "Agoraphobia – National Library of Medicine". Archived from the original on 30 March 2014. Retrieved 25 January 2017.
    37. ↑ Kenny T, Lawson E. "Agoraphobia". Patient.info. Archived from the original on 7 June 2015. Retrieved 8 December 2014.
    38. ↑ Barlow, D. H. & Waddell, M. T. (1985) Agoraphobia. Ch 1 in Barlow, D. H. (Ed) Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford.
    39. ↑ American Psychiatric Association (2000). "Diagnostic criteria for 300.22 Agoraphobia Without History of Panic Disorder". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN   0-89042-025-4. Archived from the original on 28 August 2021. Retrieved 28 June 2007.
    40. ↑ Administration SA (June 2016). "Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5". www.ncbi.nlm.nih.gov. Retrieved 4 November 2023.
    41. ↑ Fava GA, Rafanelli C, Grandi S, Conti S, Ruini C, Mangelli L, et al. (2001). "Long-term outcome of panic disorder with agoraphobia treated by exposure". Psychological Medicine. 31 (5): 891–898. doi:10.1017/S0033291701003592. PMID   11459386. S2CID   5652068.
    42. ↑ "Agoraphobia – Diagnosis & Treatment". Mayo Clinic. 18 November 2017. Retrieved 15 May 2020.
    43. 1 2 3 4 5 Gelder MG, Mayou R, Geddes J (2005). Psychiatr . New York: Oxford University Press. ISBN   978-0-19-852863-0.
    44. 1 2 3 4 5 6 Sanchez-Meca, Rosa-Alcazar, Marin-Martinez, Gomez-Conesa (11 September 2008). "Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis". Clinical Psychology Review. 30 (1): 37–50. doi:10.1016/j.cpr.2009.08.011. PMID   19775792.
    45. ↑ "Agoraphobia – Diagnosis and treatment – Mayo Clinic". www.mayoclinic.org. Retrieved 1 July 2019.
    46. ↑ Fernández-Álvarez J, Fernández-Álvarez H (2021). "Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects?". Frontiers in Psychology. 12: 589536. doi: 10.3389/fpsyg.2021.589536 . ISSN   1664-1078. PMC   7933024 . PMID   33679513.
    47. ↑ Bouchard S, Allard M, Robillard G, Dumoulin S, Guitard T, Loranger C, et al. (21 August 2020). "Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial". Frontiers in Psychology. 11: 2164. doi: 10.3389/fpsyg.2020.02164 . ISSN   1664-1078. PMC   7472915 . PMID   32973638.
    48. ↑ "Virtual reality could help people with psychosis and agoraphobia". NIHR Evidence. 20 July 2023. doi:10.3310/nihrevidence_59108. S2CID   260053713.
    49. ↑ Lydiard RB, Ballenger JC (16 June 1987). "Antidepressants in panic disorder and agoraphobia". Journal of Affective Disorders. 13 (2): 153–168. doi:10.1016/0165-0327(87)90020-6. PMID   2960710.
    50. ↑ Goldstein, Alan J., de Beurs, Edwin, Chambless, Dianne L., Wilson, Kimberly A. (2000). "EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions". Journal of Consulting and Clinical Psychology. 68 (6): 947–957. CiteSeerX   10.1.1.527.315 . doi:10.1037/0022-006X.68.6.947. PMID   11142547.
    51. ↑ Agoraphobia Resource Center. "Agoraphobia treatments—Eye movement desensitization and reprogramming". Archived from the original on 5 April 2008. Retrieved 18 April 2008.
    52. ↑ National Institute of Mental Health. "How to get help for anxiety disorders". Archived from the original on 4 July 2008. Retrieved 18 April 2008.
    53. ↑ Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC (February 1996). "Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey". Arch Gen Psychiatry. 53 (2): 159–68. doi:10.1001/archpsyc.1996.01830020077009. PMID   8629891.
    54. ↑ Peter Biskind (10 October 2006). "Reconstructing Woody". Vanity Fair. No. December. Archived from the original on 17 October 2012.
    55. ↑ Saul H (2003). Phobias : fighting the fear. New York: Arcade. p. 6. ISBN   978-1-55970-693-3. Archived from the original on 16 October 2015. Retrieved 11 September 2015.
    56. ↑ Murray J (15 August 1991). "Campbell Breaks Free Again". Los Angeles Times. Retrieved 6 January 2023.
    57. ↑ "CNN.com – Transcripts". CNN. 27 May 2004. Archived from the original on 20 July 2009. Retrieved 7 August 2009.
    58. ↑ Julia Moskin (28 February 2007). "From Phobia To Fame: A Southern Cook's Memoir". The New York Times. Archived from the original on 1 February 2017.
    59. ↑ Erik Gregerson (2011). "Horace L. Gold". Britannica. Retrieved 6 January 2023.
    60. ↑ Biography for Daryl Hannah at IMDb. Retrieved 28 November 2007.
    61. ↑ Ellis-Petersen H (26 May 2017). "Miranda Hart: 'I used to think fame would justify my whole existence". The Guardian. Retrieved 14 September 2023.
    62. ↑ "Psychological Autopsy can help understand controversial deaths—The Crime Library on truTV.com". Archived from the original on 14 February 2015. Retrieved 25 January 2017.
    63. ↑ Olivia Hussey—People Magazine—March 16, 1992 Archived March 18, 2012, at the Wayback Machine
    64. ↑ Biography for Olivia Hussey at IMDb
    65. ↑ Churchwell S (10 February 2017). "Shirley Jackson: A Rather Haunted Life by Ruth Franklin review – beyond spooky". The Guardian. Retrieved 9 March 2021.
    66. ↑ essay by Jonathan Lethem Archived April 29, 2012, at the Wayback Machine
    67. ↑ Mike Conklin. (10 December 2004). "Where is Elfriede Jelinek?". Chicago Tribune. Archived from the original on 17 June 2013. Retrieved 8 May 2013.
    68. ↑ Hatfield A (19 July 2022). "Mike Patton discusses agoraphobia diagnosis, canceling Faith No More shows in new interview". Brooklyn Vegan. Retrieved 21 July 2022.
    69. ↑ Stanisław Fita, ed., Wspomnienia o Bolesławie Prusie (Reminiscences about Bolesław Prus), Warsaw, Państwowy Instytut Wydawniczy (State Publishing Institute), 1962, p. 113.
    70. ↑ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.
    71. ↑ V J (21 November 2014). "Famous People With Agoraphobia". Morningside Recovery. Retrieved 26 July 2023.
    72. ↑ McNair J (3 September 2007). "Brian Wilson: Here Comes the Sun". The Independent. Archived from the original on 20 January 2009.
    73. ↑ "Ben Weasel featured on Carson Daly". www.punknews.org. 14 October 2010.

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