Agoraphobia 219
daily routines, choosing a job nearby to avoi d using public transportation, arranging for
food delivery to avoid entering shops and su permarkets) as well as cognitive (e.g., using
distraction to get through agoraphobic situations) in nature. The avoidance can become so
severe that the person is completely homebound. Often, an individual is better able to con-
front a feared situation when accompanied by a companion, such as a partner, friend, or
health professional.
The fear, anxiety, or avoidance must be out of proportion to the actual danger posed by
the agoraphobic situations and to the sociocul tural context (Criterion E). Differentiating
clinically significant agoraphobic fears from  reasonable fears (e.g., leaving the house dur-
ing a bad storm) or from situations that ar e deemed dangerous (e.g ., walking in a parking
lot or using public transportation in a high-cri me area) is important for a number of reasons.
First, what constitutes av oidance may be difficul t to judge across cult ures and sociocultural
contexts (e.g., it is sociocultu rally appropriate for orthodox Muslim women in certain parts
of the world to avoid leaving the house alone,  and thus such avoidance would not be con-
sidered indicative of agoraphobia). Second, older adults are likely to overattribute their
fears to age-related constraints and are less likely to judge their fears as being out of pro-
portion to the actual risk. Th ird, individuals with agoraphobia are likely to overestimate
danger in relation to panic-like or other bodily symptoms. Agora phobia should be diag-
nosed only if the fear, anxiety, or avoidance pers ists (Criterion F) and if it causes clinically