Reflections on the New Agoraphobia Diagnosis

What constitutes a “mental disorder” and what doesn’t, is officially determined by an official clinical manual called the Diagnostic and Statistical Manual, or the DSM. Mental health clinicians have been using the DSM-IV since around 2000. But now, at long last, the next addition of the DSM is set to be published in 2013. Of particular relevance to psychologists and others who treat people struggling with panic attacks, the DSM-V will reportedly feature major changes to the diagnostic criteria for panic disorder and agoraphobia. Specifically, Panic Disorder and Agoraphobia will be separated into two distinct mental health disorders.

The diagnostic criteria for Panic Disorder will largely stay the same, except that all mention of Agoraphobia will be excised from it. As a separate codable diagnosis, the first two proposed criteria for Agoraphobia will be the following:

Criterion A: Extreme fear or anxiety concerning two or more following agoraphobic situations: 1) being outside the home alone, 2) public transportation, such as airplanes, buses, subways, etc., 3) open spaces, including large parking lots or markets, 4) being in stores, theaters, or cinemas, or 5) standing in a line with other people or being in a crowd of people.

Criterion B: The person has become afraid of and may additionally be avoiding these situations because they feel it would be difficult to escape or help would not be available if they were to experience a panic attack or pass out.

You can read all the proposed criteria here. It’s difficult to know how the set changes in the DSM-V will affect treatment and insurance compensation over the long term, but it does seem to me to be the case with various agoraphobic people I have worked with that their phobic avoidance of venturing outside or into populated space sometimes seems to evolve in a way that they have certain focal fears–such as heart stopping or spontaneous suffocation–that are related but not the exact same thing as having a panic attack. In other words, people struggling with agoraphobia do not always necessarily say that they are afraid of having a panic attack, per se, but rather, after some exploration, they voice whatever their focal fear is, along with the imagined shame and embarrassment of having it happen in public.

So, for the time being I will remain provisionally supportive of this change to the DSM-V, which may result in a more accurate characterization of the distinct struggles faced by those suffering from Agoraphobia.