A middle aged person reported to Psychiatric OPD with the complaints of fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and sweating if he is in these situations. He often avoids public transport to go his place of work. The most likely diagnosis is –
**Core Concept**
The patient's symptoms describe a pattern of avoidance behavior, marked anxiety, and physiological symptoms such as palpitations and sweating, which are characteristic of anxiety disorders. Specifically, the patient's fear of places and situations, and avoidance of these situations, point towards a diagnosis of a phobic disorder.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with Agoraphobia, which is a type of anxiety disorder characterized by an intense fear of being in public places or situations where escape might be difficult or embarrassing, or where help may not be available in the event of having an unexpected panic attack or panic-like symptoms. The patient's avoidance of public transport to go to work is a classic symptom of Agoraphobia. This disorder often co-occurs with Panic Disorder, which is characterized by recurrent panic attacks. In this case, the patient's physiological symptoms such as palpitations and sweating are consistent with a panic attack.
**Why Each Wrong Option is Incorrect**
**Option A:** Avoidant Personality Disorder is characterized by pervasive feelings of social inadequacy and hypersensitivity to criticism, but it does not involve the specific fear of places and situations that is characteristic of Agoraphobia.
**Option B:** Social Phobia (also known as Social Anxiety Disorder) involves a fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. While it can involve some avoidance behavior, it is not typically characterized by the fear of places and situations that is seen in Agoraphobia.
**Option C:** Panic Disorder is characterized by recurrent panic attacks, but it does not necessarily involve the avoidance of specific places and situations that is seen in Agoraphobia.
**Option D:** Generalized Anxiety Disorder (GAD) is characterized by excessive and persistent worry about everyday things, but it does not involve the specific fear of places and situations that is characteristic of Agoraphobia.
**Clinical Pearl / High-Yield Fact**
A key feature of Agoraphobia is the avoidance of places and situations where the person feels like they might have a panic attack and not be able to escape or get help. This avoidance can become so severe that it interferes with the person's daily life, such as avoiding public transport or going to work.
**Correct Answer: C. Panic Disorder.**