A. The presence of Agoraphobia related to fear of developing panic-like symptoms (e.g., dizziness or diarrhea).
B. Criteria have never been met for Panic Disorder.
C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
D. If an associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition.
Panic Disorder With Agoraphobia
Agoraphobia Without History of Panic Disorder is distinguished from Panic Disorder With Agoraphobia by the absence of a history of recurrent unexpected Panic Attacks. The avoidance in Agoraphobia Without History of Panic Disorder results from fear of incapacitation or humiliation due to unpredictable, sudden, panic-like symptoms rather than from fear of a full Panic Attack as in Panic Disorder With Agoraphobia. The diagnosis of Panic Disorder With Agoraphobia remains appropriate in cases in which Panic Attacks go into remission but Agoraphobia continues to be experienced.
Other mental disorders
Other reasons for avoidance must also be distinguished from Agoraphobia Without History of Panic Disorder. In Social Phobia, individuals avoid social or performance situations in which they fear that they might act in a way that is humiliating or embarrassing. In Specific Phobia, the individual avoids a specific feared object or situation. In Major Depressive Disorder, the individual may avoid leaving home due to apathy, loss of energy, and anhedonia. Persecutory fears (as in Delusional Disorder) and fears of contamination (as in Obsessive-Compulsive Disorder) can also lead to widespread avoidance. In Separation Anxiety Disorder, children avoid situations that take them away from home or close relatives.
Individuals with certain general medical conditions may avoid situations due to realistic concerns about being incapacitated (e.g., fainting in an individual with transient ischemic attacks) or being embarrassed (e.g., diarrhea in an individual with Crohn's disease). The diagnosis of Agoraphobia Without History of Panic Disorder should be given only if the fear or avoidance is clearly in excess of that usually associated with the general medical condition.