Agoraphobia and Specific Phobias

Agoraphobia is described as severe and pervasive anxiety being in situations from which escape might be difficult or avoidance of situations such as being alone outside of the home, traveling in a car, bus, or airplane, or being in a crowded area.

Most people who present to mental health specialists develop agoraphobia after the onset of a panic disorder. Agoraphobia is best known as an adverse behavioral outcome of repeated panic attacks and the subsequent worry, preoccupation, and avoidance.

Agoraphobia happens about two times more commonly among women than men. The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women, although other explanations are also possible.

Specific Phobias

These common conditions are characterized by marked fear of specific objects or situations. Exposure to the object of the phobia, either in real life or via imagination pr video, invariably elicits intense anxiety, which may include a panic attack. Adults generally know that this intense fear is irrational. Nevertheless, they typically avoid the phobic stimulus or endure exposure with great difficulty.

The most common specific phobias include the following feared stimuli or situations: animals, insects, heights, elevators, flying, automobile driving, water, storms, and blood, injections or social phobia. Approximately 8 percent of the adult population suffers from one or more specific phobias in 1 year. Much higher rates would be recorded if less rigorous diagnostic requirements for avoidance or functional impairment were employed.

Typically, the specific phobias begin in childhood, although there is a second “peak” of onset in the middle 20s of adulthood. Most phobias persist for many years or even decades, and relatively few remit spontaneously or without treatment.

The specific phobias generally do not derive from exposure to a single traumatic event (i.e. being bitten by a dog or nearly drowning). Rather, there is evidence of phobia in other family members and social or vicarious learning of phobias. Spontaneous, unexpected panic attacks also appear to play a part in the development of specific phobias, although the particular pattern of avoidance is much more focal and circumscribed.

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Obsessive Compulsive Disorder (OCD)

Obsessions are recurrent, intrusive thoughts, impulses, or images which are perceived as inappropriate, grotesque, or forbidden. The obsessions, which elicit anxiety and marked distress, are termed “ego-alien” or “ego-dystonic” as their content is quite unlike the thoughts that the person usually has. Obsessions are perceived as uncontrollable, and the sufferer often fears that he or she will lose control and act upon such thoughts or impulses. Common themes include contamination with germs or body fluids, doubts, order or symmetry, or loss of control of violent or sexual impulses.

Compulsions are repetitive behaviors or mental acts that reduce the anxiety that accompanies an obsession or “prevent” some dreaded event from ocurring. Compulsions include both overt behaviors, such as hand washing or checking, and mental acts such as counting or praying. Not uncommonly, compulsive rituals take up long periods of time, even hours, to complete.

Obsessive compulsive disorder typically begins in adolescence to young adult life (males) or in young adult life (females). For most, the course is fluctuating and, like generalized anxiety disorder, symptom exacerbations are usually associated with life stress. Common comorbidities include major depressive disorder and other anxiety disorders. Approximately 20 to 30 percent of people in clinical samples with obsessive compulsive disorder report a past history of tics, and about one-quarter of these people meet the full criteria for Tourette’s disorder. Conversely, up to 50% of people with Tourette’s disorder develop obsessive compulsive disorder.

Obsessive compulsive disorder has a clear familial pattern and somewhat greater familial specificity than many other anxiety disorders. Furthermore, there is an increased risk of obsessive compulsive disorder among first-degree relatives with Tourette’s disorder. Other mental disorders that may fall within the spectrum of obsessive compulsive disorder include trichotillomania, compulsive shoplifting, gambling, and sexual behavior disorders. The latter conditions are somewhat discrepant because the compulsive behaviors are less ritualistic and yield some outcomes that are pleasurable or gratifying. Body dysmorphic disorder is a more circumscribed condition in which the compulsive and obsessive behavior centers around a preoccupation with an individual's appearance. Find out more on the treatments for obsessive compulsive disorder.

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Anxiety disorder and Panic Attacks

Anxiety disorder is the most common, or frequently occurring, mental disorder. They consist a group of conditions that share extreme or pathological anxiety as the principal disturbance of mood or emotional tone. Anxiety, which may be known as the pathological counterpart of normal fear, is manifest by disturbances of mood, as well as thoughts, behavior, and physiological activity.

Anxiety disorders include panic disorder, agoraphobia, generalized anxiety disorder, specific phobia, social phobia, obsessive compulsive disorder, acute stress disorder, and post traumatic stress disorder. In addition, there are adjustment disorders with anxious features, anxiety disorders due to general medical conditions, substance-induced anxiety disorders, and the residual category of anxiety disorder not otherwise specified.

A panic attack is a discrete period of intense fear or discomfort that is associated with numerous somatic and cognitive symptoms. These symptoms include palpitations, sweating, trembling, shortness of breath, sensations of choking or smothering, chest pain, nausea or gastrointestinal distress, dizziness or lightheadedness, tingling sensations, and chills or blushing and “hot flashes.” The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes. Most people report a fear of dying, “going crazy,” or losing control of emotions or behavior. The experiences generally provoke a strong urge to escape or flee the place where the attack begins and, when associated with chest pain or shortness of breath, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance. Yet an attack rarely lasts longer than 30 minutes. The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks may be further characterized by the relationship between the onset of the attack and the presence or absence of situational factors.

Panic attacks are not always indicative of a mental disorder, and up to 10 percent of otherwise healthy people experience an isolated panic attack per year. Panic attacks also are not limited to panic disorder. They commonly occur in the course of social phobia generalized anxiety disorder, and major depressive disorder. Panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and develops persistent concern or worry about having further attacks or changes his or her behavior to avoid or minimize such attacks. Whereas the number and severity of the attacks varies widely, the concern and avoidance behavior are essential features. The diagnosis is inapplicable when the attacks are presumed to be caused by a drug or medication or a general medical disorder, such as hyperthyroidism.

Panic disorder is about twice as common among women as men. Age of onset is most common between late adolescence and midadult life, with onset relatively uncommon past age 50.

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