What Makes Someone Vulnerable to Agoraphobia?

I just read an interesting article in the January 2006 issue of American Psychologist on the subject of how anxiety disorders including agoraphobia develop. Allow me to share the mian points.

First, the authors acknowledge that the going theory of how anxiety disorders like agoraphobia develop is through conditioning. They describe two types of conditioning:

Exteroceptive conditioning: learning to associate external cues like sights, sounds, smells, etc. with anxiety and panic.

Interoceptive conditioning: basically learning to fear the fear. Associating lower levels of anxiety sensations with full blown panic. This is when you are conditioned to notice minor sensations and feelings in your body and relate them to high levels of panic - so that these smaller anxiety-related sensations actually start to trigger panic attacks.

Second, the authors pose the question:

"If simple conditioning explains the cause of panic disorder and agoraphobia then why do some people who experience panic attacks go on to develop panic disorder and agoraphobia and some don't?"

In reviewing the literature, the authors answer this question by saying that what is known as "contemporary learning theory" explains why some people are prone to being conditioned into panic disorder and agoraphobia and others are not.

In other words, someone's genetics and prior learning history can make them vulnerable to developing full-on panic disorder or agoraphobia if they experience a single panic attack. Here are the factors that have to do with your genetics and learning history that put you at risk for developing panic disorder and agoraphobia:

1) Genetic personality traits like neuroticism and trait anxiety.

2) History of learning experiences in which you learn to perceive yourself as helpless or lacking control.

3) Being rewarded for engaging in sick role behavior when experiencing anxiety or panic. (The article says that adults who experience panic attacks are more likely to have grown up in households where they witnessed chronic illness and learned to perceive any unusual bodily sensations as dangerous).

To summarize the author's points, initial panic attacks set the stage for internal and external conditioning that could lead to panic disorder and agoraphobia but.......

people with the above risk factors having to do with genetics and learning are more vulnerable to being conditioned into panic disorder or agoraphobia.

Part of the significance of this finding is that by using this "contemporary learning theory" model to understand how panic disorder and agoraphobia develop, it might be possible to identify people who are at risk for these disorders because of their personality and help them unlearn their helplessness and playing the sick role before they get conditioned for panic disorder and agoraphobia.

By the way, the title of the article is "A Contemporary Learning Theory Perspective on the Etiology of Anxiety Disorders." The authors are Susan Mineka and Richard Zinbarg from Northwestern University.

The article covers the development of specific phobias, social phobia, obsessive compulsive disorder, port-traumatic stress disorder, and generalized anxiety disorder in addition to panic disorder and agoraphobia.