Agoraphobia...anyone with experience?

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Specializes in med-surg, psych, ER, school nurse-CRNP.

Greetings! I would like some input on a situation we are dealing with.

Patient X has lately been denied their disability claim, because they refused to attend the court hearing for the continuation of the benefits. The disability claim reason is reportedly agoraphobia. The patient states that they are unable to attend the hearing because the location of the trial requires them to travel over a bridge and into another city. They state that their agoraphobia won't allow them to go to the hearing. They further state that they have tried to speak to the disability board by telephone but, "they hung up on them when they could not stop crying".

Patient repeatedly requests that Doc write them a note that states they cannot attend. Doc's position is that if the patient can stand to leave their house to come to the clinic, then they can go to their hearing.

Some other tidbits...

*The patient was seen by the entire office eating out at restaurant, in no apparent distress.

*The patient has two children that always accompany them to appointments, with various excuses about why they are not in school. (We are currently making inquiries regarding a truancy violation.)

My question:

Is agoraphobia selective? Can it be that the patient is comfortable coming to clinic and eating out, but for some reason can't tolerate a courtroom?

We are of the opinion that the patient simply does not want to put forth the effort, and is using this complaint as a crutch. However, having limited experience with this particular diagnosis, I would be very glad for some other views. Thank you.

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Agoraphobia is fear of having a panic attack where others may see it or where it may be difficult to escape. Maybe they have a specific phobia to bridges. The children may be accompanying them to to restaurants help decrease the patient's anxiety. Need more info.

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Specializes in allergy and asthma, urgent care.

You work in a pain management clinic, correct? So I don't understand why she's asking the doc to verify her disability, if he's not treating her specifically for the agoraphobia? I assume only a psych provider, or her PCP would make that determination. I don't think anyone in your clinic should say anything more than "she presents for appointments at this clinic".

I wouldn't touch this one with a 10 foot pole.

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Specializes in ortho, hospice volunteer, psych,.

A neighbor's daughter has agoraphobia. It apparently began when her husband left for combat duty and she didn't hear from him for about ten days. The national news reported a bridge being blown up near where he supposedly was.

After that, she was afraid to cross one old bridge. It didn't really become a problem until the state closed the other one for three months to repair it. She was so panicky that she refused to leave the house. It helped somewhat when she heard from her husband but her bridge phobia still exists to this day. I haven't seen her outside alone since then.

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Specializes in Home Care.

Does she cross the bridge to get to the clinic?

There are all kinds of phobias and for people that experience them they are very real and can be debilitating for some.

I have a phobia about driving on an open highway, I simply cannot do it without having a massive panic attack. I've had this phobia for a very long time.

I can drive on snow and ice, in a blizzard or pouring rain or on a very busy road. But ask me to drive on an interstate in clear weather and my answer is no.

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No true experience but I did watch a documentary once. The individual featured was able to handle going out to certain places within a limited "comfort zone" and anything beyond that was not possible. So the restaurant and clinic may fall into that zone, while a courtroom not so much.

That said, I have no actual education on this.

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Specializes in med-surg, psych, ER, school nurse-CRNP.
Agoraphobia is fear of having a panic attack where others may see it or where it may be difficult to escape. Maybe they have a specific phobia to bridges. The children may be accompanying them to to restaurants help decrease the patient's anxiety. Need more info.

OK, how else may I clarify? The children are not a comfort aid, this much we do know, because they are allowed to wander all around our clinic and lab area unsupervised, messing with equipment (until I shuffled the little darlings back into the exam room with the patient).

There is a bridge between the patient's house and the clinic.

In short, they seem to have no issue with anything other than attending their hearing.

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Specializes in med-surg, psych, ER, school nurse-CRNP.
You work in a pain management clinic, correct? So I don't understand why she's asking the doc to verify her disability, if he's not treating her specifically for the agoraphobia? I assume only a psych provider, or her PCP would make that determination. I don't think anyone in your clinic should say anything more than "she presents for appointments at this clinic".

I wouldn't touch this one with a 10 foot pole.

Because 'none of their other docs will write an excuse for them'.

I refuse to write an excuse on principle, as we do not treat the patient for this ailment.

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Specializes in med-surg, psych, ER, school nurse-CRNP.

I am no stranger to phobias. I'm terrified of bugs, don't do too well with heights, and I'm probably the jumpiest person you'll ever meet.

And we're talking jump-up-on-the-countertop-to-get-away type scared. That being said, I'll g out and pick a snake up, no problem. I totally get phobias.

But the patient in question is claiming such a debilitating condition that they can barely function, yet all we see is evidence to the contrary.

I think it best, as was said, to not touch this one. Kind of like the gentleman who demanded we treat a non-existing lung condition 'so that he could add it to his disability'. I just don't see aiding and abetting. Better to let the psych doc handle it, if in fact it needs to be handled.

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Because 'none of their other docs will write an excuse for them'.

I refuse to write an excuse on principle, as we do not treat the patient for this ailment.

Your scepticism sounds well-founded. Even if you DID write a letter as the patient is requesting, do you have any documentation that supports such a claim? Do you have any documentation at all regarding this patient's mental health issues and treatment? Likely no, because you aren't their mental health provider!

Stick to your guns.

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Specializes in Psych Nurse.

Agoraphobia and all phobias for that matter can be selective. It is very possible that this patient can be comfortable in a certain "safe area" be it a block or a few miles from her home, and be able to travel no further than that. It is also possible that the children are in fact serving as a "support" if she forces them to miss school just to accompany her to an appointment. The child does not have to be in close proximity to make them a "safe person", they can just be in the hall or in the building or even next door---again, this disorder can be selective in how it manifests itself.

In terms of disability, I would encourage the patient to see a psychiatrist who has some familiarity with anxiety disorders in order to determine if they are eligible for disability and to provide proper documentation. I doubt a GP or NP could reasonably make this call as there are so many variables with this disorder. For example, the patient might be able to attend court if they were prescribed a benzodiazapine and one would have to wonder why they were not able to get an Rx for klonopin before the court date. If a trial of klonopin was not sucessful at controlling the attacks then that would have to be noted in the report as it is also possible that someone can not face their fear even with klonopin in their system. It is not for anyone to judge this patient without the full scope of their symptoms and history. They need to be under the care of a mental health provider that can attend to this issue IMHO.

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Specializes in ER.

What state do you live in? Can NP's in your state even sign disability papers? I am in Michigan, and an NP or PA cannot sign any papers for disabilty claims...you better check before you get yourself involved in this.....there is a great site that has all the states scope of practice summarized, and from what I see, most states restrict an NP's ability to sign these forms. Just my advice....I have seen several patients in our area who went to court with papers filled out by NP's, and their case was thrown out of court. There are physicians and psychiatrists who specialize in evaluating patients for disability...I would refer the patient to one of them.

Good luck!

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