220 Anxiety Disorders
course and outcome of agoraphobia are associate d with substantially elevated risk of sec-
ondary major depressive disorder, persistent  depressive disorder (dysthymia), and sub-
stance use disorders.
The clinical features of agoraphobia are rela tively consistent across the lifespan, although
the type of agoraphobic situations  triggering fear, anxiety, or avoidance, as well as the type of
cognitions, may vary. For example, in children, being outside of the home alone is the most fre-
quent situation feared, whereas in older adults, being in shops, standing in line, and being in
open spaces are most often feared. Also, cognitio ns often pertain to beco ming lost (in children),
to experiencing panic-like symptoms (in adults), to falling (in older adults).
The low prevalence of agoraphobia in childre n could reflect difficulties in symptom re-
porting, and thus assessments in young child ren may require solicitation of information
from multiple sources, includ ing parents or teachers. Adolescents, particularly males,
may be less willing than adults to openly discuss agoraphobic fears and avoidance; how-
ever, agoraphobia can occur prior to adulthood and should be assessed in children and
adolescents. In older adults, comorbid somatic symptom disord ers, as well as motor dis-
turbances (e.g., sense of fall ing or having medical compli cations), are frequently men-
tioned by individuals as the reason for their fear  and avoidance. In these instances, care is
to be taken in evaluating whether the fear and avoidance are out of proportion to the real
danger involved. 
Risk and Prognostic Factors 
Temperamental. Behavioral inhibition and neurotic disposition (i.e., negative affectivity