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* This is the Professional Version. *

Agoraphobia in Children and Adolescents

By Josephine Elia, MD, Professor of Psychiatry and Human Behavior, Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Nemours Alfred I. duPont Hospital for Children

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Agoraphobia is a persistent fear of being trapped in situations or places without a way to escape easily and without help. Diagnosis is by history. Treatment is with benzodiazepines or SSRIs and behavioral therapy.

(See also Agoraphobia in adults.)

During a typical agoraphobic situation (eg, standing in line, sitting in the middle of a long row in a classroom), some people have panic attacks; others simply feel uncomfortable. Agoraphobia is uncommon among children, but it may develop in adolescents, particularly those who also have panic attacks.

Agoraphobia often interferes with function and, if severe enough, can cause people to become housebound.

Diagnosis

  • Clinical criteria

For agoraphobia to be diagnosed, patients must consistently have fear or anxiety about ≥ 2 of the following for ≥ 6 mo:

  • Using public transportation

  • Being in open spaces

  • Being in enclosed spaces

  • Standing in line or being in a crowd

  • Being outside the home alone

Also, the fear must cause patients to avoid the distressing situation to the extent that they have difficulty functioning normally (eg, going to school, visiting the mall, doing other typical activities).

Agoraphobia must be distinguished from the following:

Treatment

  • Behavioral therapy

Behavioral therapy is especially useful for agoraphobia symptoms. Drugs are rarely useful except to control any associated panic attacks.

* This is the Professional Version. *