Agoraphobia is associated with considerable impairment and disability in terms of role functioning, work productivity, and disability days. Agoraphobia severity is a strong de- terminant of the degree of disability, irrespective of the presence of comorbid panic disor- der, panic attacks, and other comorbid conditions. More than one-third of individuals with agoraphobia are completely homebound and unable to work.
When diagnostic criteria for agoraphobia and another disorder are fully met, both diagnoses should be assigned, unless the fear, anxiety, or avoidance of agoraphobia is attributable to the other disorder. Weighting of criteria and clinical judgment may be helpful in some cases.
Specific phobia, situational type. Differentiating agoraphobia from situational specific phobia can be challenging in some cases, because these conditions share several symptom characteristics and criteria. Specific phobia, situational type, should be diagnosed versus ago- raphobia if the fear, anxiety, or avoidance is limited to one of the agoraphobic situations.
Requiring fears from two or more of the agoraphobic situations is a robust means for differen- tiating agoraphobia from specific phobias, particularly the situational subtype. Additional dif- ferentiating features include the cognitive ideation. Thus, if the situation is feared for reasons other than panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fears of being directly harmed by the situation itself, such as fear of the plane crashing for individ- uals who fear ﬂying), then a diagnosis of specific phobia may be more appropriate.
Separation anxiety disorder. Separation anxiety disorder can be best differentiated from agoraphobia by examining cognitive ideation. In separation anxiety disorder, the thoughts are about detachment from significant others and the home environment (i.e., parents or other attachment figures), whereas in agoraphobia the focus is on panic-like symptoms or other incapacitating or embarrassing symptoms in the feared situations.
Social anxiety disorder (social phobia). Agoraphobia should be differentiated from so- cial anxiety disorder based primarily on the situational clusters that trigger fear, anxiety, or avoidance and the cognitive ideation. In social anxiety disorder, the focus is on fear of being negatively evaluated.
Panic disorder. When criteria for panic disorder are met, agoraphobia should not be di— agnosed if the avoidance behaviors associated with the panic attacks do not extend to avoid- ance of two or more agoraphobic situations.
Acute stress disorder and posttraumatic stress disorder. Acute stress disorder and ing whether the fear, anxiety, or avoidance is related only to situations that remind the individual of a traumatic event. If the fear, anxiety, or avoidance is restricted to trauma re- minders, and if the avoidance behavior does not extend to two or more agoraphobic situ- ations, then a diagnosis of agoraphobia is not warranted.
Major depressive disorder. In major depressive disorder, the individual may avoid leav- ing home because of apathy, loss of energy, low self—esteem, and anhedonia. If the avoid- ance is unrelated to fears of panic-like or other incapacitating or embarrassing symptoms, then agoraphobia should not be diagnosed.