Here comes another
section in the anxiety disorders chapter of DSM-5. It's
agoraphobia. (Memorization clue: Agora is Greek for a public open
space. Fear of that, more or less.) Agoraphobia is a new dx in
DSM-5. Criteria look like this:
A. Marked fear or anxiety about two or more of
1. Public transportation
2. Open spaces (e.g., parking lots,
3. Enclosed places (e.g., shops,
4. Standing in line or being in a
5. Being outside of the home alone
B. These situations are feared or avoided due to thoughts of
being unable to escape when and if panic-like symptoms (or other
incapacitating or embarrassing symptoms) develop.
C. These situations almost always provoke
D. These situations are actively avoided, require the
presence of a companion, or are endured with intense
E. Reaction is out of proportion to actual danger.
F. Symptoms present for 6 months or more
G. Symptoms cause clinically significant distress
H. If another medical condition (e.g., IBS) is present,
fear/anxiety/avoidance are clearly excessive.
I. Symptoms not better explained by another
The list of other disorders that agoraphobia might be better
explained by is useful, especially for narrowing down answers on
the ASWB exam. On that list: specific phobia, social anxiety
disorder, OCD, body dysmorphic disorder, PTSD, and separation
The most difficult distinctions there may be the first two.
Imagine a question like this:
A client tells a social worker she hates leaving her
apartment on her own. She says she's terrified of having a panic
attack and not being able to escape from wherever she is when it
hits. "I had to quit my job because the elevators in the
building freaked me out so much," she says. She hasn't worked in
over six months. What is the MOST likely diagnosis for this
A. Specific Phobia, Situational
B. Social Anxiety Disorder
C. Panic Disorder with Agoraphobia
You know the answer because it's the subject of the blog post.
But on a test, without that giant clue, do you think you might've
been tempted by the other possibilities? Specific phobia
doesn't really fit. The client's anxiety is situational, but the
situation isn't just elevator or just shopping--it's more
widespread. She's afraid to leave the apartment. Social anxiety
isn't a great fit either--it's places and her own panic the client
seems to fear, not other people and their judgment. How about
panic disorder with agoraphobia? The client may meet criteria for
panic disorder--she reports recurrent, unpredictable panic attacks.
But there's this: panic disorder with agoraphobia is a DSM-IV-TR
diagnosis. It doesn't appear in DSM-5. DSM-5 separates panic
disorder and agoraphobia; clients can be diagnosed with either or
both. So, narrowed down thusly, you have your answer: D)
If this comes up on the exam, consider yourself ready for
To read up on agoraphobia, try:
Now that you're prepped for an agoraphobia-related question on
the big test, get more practice on the topic and others by signing up with SWTP.
Good luck on the exam!