During a telehealth session, a 32-year-old single woman reports being home during the quarantine for a period of 4 months with no outside contact. She says she knows several people who died from COVID-19, and although she never became ill, she has become extremely nervous about leaving her house. She tried leaving her house once during the Phase 1 reopening, but she says it felt like "an elephant" was sitting on her chest and went back home. She is terrified to use public transportation or go to any stores and stand in line, in case she has another episode of chest pain and "cannot escape." She is too terrified to go out again but misses seeing her friends and family. Which diagnosis is most correct?

Choice A reason: Specific phobia involves intense fear of a specific object or situation, often leading to avoidance. While situational fears exist here, the patient’s avoidance is broad and involves multiple public environments, exceeding a single situational phobia. Choice B reason: Adjustment disorder is characterized by emotional or behavioral symptoms in response to an identifiable stressor, typically appearing within 3 months. While COVID-19 is a stressor, the patient’s persistent, specific avoidance pattern fits a more defined anxiety disorder. Choice C reason: PTSD involves re-experiencing trauma, avoidance of trauma-related stimuli, hyperarousal, and negative mood. The patient does not have re-experiencing or trauma-related cues in this scenario. Choice D reason: This is correct. Agoraphobia is characterized by fear and avoidance of situations where escape may be difficult, often involving public spaces, transportation, or crowds. The patient’s inability to leave home, avoidance of stores, and fear of public situations align with the diagnostic criteria for agoraphobia.