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A 35-year-old female presents with a 10-month history of intense fear and avoidance of public transportation, open spaces such as parking lots, enclosed spaces like movie theaters, standing in line, and being in crowds. She has never experienced a panic attack. She reports that her fear is centered on feeling trapped or unable to escape if she became overwhelmed or developed embarrassing symptoms such as dizziness or loss of bowel control. She now requires her husband to accompany her to the grocery store and has stopped using the subway, significantly limiting her employment options.
Explanation
A key DSM-5 change was separating agoraphobia from panic disorder into independent diagnoses. Agoraphobia can be diagnosed without any history of panic attacks. The DSM-5-TR requires marked fear in at least 2 of 5 situation types (public transport, open spaces, enclosed spaces, standing in line/crowds, being outside the home alone), persistent duration of 6+ months, and out-of-proportion fear with functional impairment.
Key Takeaway
Agoraphobia is an independent diagnosis in the DSM-5-TR that does not require a history of panic attacks and is defined by fear or avoidance of at least two of five specified situation types.