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Agoraphobia in Children and Adolescents

by Josephine Elia, MD

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.

Agoraphobia is uncommon among children, but it may develop in adolescents, particularly those who also have panic attacks (see Panic Disorder in Children and Adolescents).

Patients 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). Patients may have panic attacks when they are exposed to the distressing situation.

Agoraphobia must be distinguished from specific phobias (eg, to a certain situation), social anxiety disorder (see Social Anxiety Disorder in Children and Adolescents), and panic disorder (see Panic Disorder in Children and Adolescents). Also, agoraphobia must be distinguished from depression (see Depressive Disorders in Children and Adolescents), which can cause patients to avoid leaving the house for reasons unrelated to anxiety.

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

* This is a professional Version *