Agoraphobia: Do You Know What It Is?

I can’t work. I can’t go to the supermarket. I can’t go to the mall. I can’t go to the doctor, to my friend’s wedding, to the hospital, on a vacation, to a movie, to see my kid graduate, to dinner with my husband, I can’t, I can’t, I can’t, I can’t, I can’t I can’t.

“What if I can’t go?” “What if I have a panic attack?” “What if I can’t stay?” “What if I have to leave?” “What if I can’t turn back?”

These words are spoken by agoraphobics every day. They live in a world of fear. Fear of almost everything. Fear of fear. Agoraphobia is one the most debilitating, unaccepted, and misunderstood mental illnesses.

We’re in the year 2013 and doctors still don’t know how to pronounce the word and are unaware of its seriousness, and yet 3.2 million people in the United States suffer from this disorder. They range from children to the elderly. The malady is more common in females; however, males also become afflicted. Statistics are unreliable because men tend to be embarrassed and do not seek help.

Notable agoraphobics include: Howard Hughes, the eccentric billionaire; Sigmund Freud, founding father of psychoanalysis; Woody Allen, actor and director; Kim Basinger, well-known actress; and Charles Darwin, British naturalist.

Agoraphobia results from panic disorder, a condition in which a subject experiences attacks of intense fear about loss of control, “going crazy,” or having a heart attack/dying. Agoraphobics go to great lengths to avoid locations where they have experienced panic. Unfortunately, avoidance reinforces irrational fears and can contribute to developing specific phobias.

Many theories suggest panic disorder can stem from a chemical imbalance (such as premenstrual syndrome), genetics, the environment (alcoholism or abuse), or traumatic experiences (sudden death of a loved one or a divorce). Agoraphobia develops when a person subject to such attacks makes the connection between them and the location in which they occurred.

Obsessive Compulsive Disorder (OCD), depression, and Post Traumatic Stress Disorder (PTSD) often accompany agoraphobia. For example, OCD behavior can include fears of food spoilage and allergic reactions to foods, which then develop into a fear of eating.

Researchers have discovered a link between agoraphobia and difficulties with spatial orientation. The vestibular system—which provides us with a sense of balance and contributes to movement —is weak in agoraphobics. Consequently they rely more on visual or tactile signals.

The numerous symptoms of agoraphobia vary from person to person, making it complicated and difficult to understand. The most common fears are of leaving the house, being alone, losing control in a public place, open spaces, anxiety attacks, and inaccessibility of exits. The key word is fear. Conditions like the above can make you feel like a prisoner in your own home and in extreme cases homebound. Other symptoms include: a sense that your body is not real and detached from your environment; feeling helpless and scared; disorientation; a need to run away; overdependence on other people (believing help is necessary to function); or ironically, the need to be alone because of social phobias; and a refusal to leave home even in a medical emergency.

Physical symptoms include hyperventilating, light headedness/dizziness and disequilibrium, palpitations, stomach pains and diarrhea, a sensation of choking, chest pain, blurriness in the eyes, trembling or shaking hands, numbness in hands or legs, difficulty speaking, feeling hot and flushed or else chilled, having a sense that all sound is in the background, and excessive sweating. It is very common for people who experience panic-induced palpitations to rush to an emergency room.

Evidence indicates that the most effective treatment for agoraphobics is a combination of medications (anti-depressants and anti-anxiety drugs) and cognitive behavioral therapy (CBT). However, medications are controversial for several reasons: the side effects of the drugs can be confused with the symptoms of the disorder; symptoms are alleviated, but not cured; and to complicate matters, many agoraphobics fear medications! The fear of ingesting a foreign substance can be so overwhelming, that the anxiety can be worse than any side effect that might occur.

Cognitive behavioral therapy tries to help the patient recognize and replace panic-triggering thoughts through a mix of stress management and relaxation techniques. Support groups, including those found online for housebound individuals, are beneficial. Sharing problems and achievements can relieve symptoms.

Anticipatory anxiety plays a large part in this illness. Every outing must be carefully planned. Parking spaces, seating, and atmosphere are all highly sensitive for affected individuals. The inability to function normally in everyday situations, such as needing to be close to an exit or a car at all times, results in the exclusion of many activities. Often families and friends lack understanding and compassion and don’t “go the extra mile” to help. The future is shaped by loneliness, despair, and deep-rooted hurt. Agoraphobics develop new behaviors and radical lifestyle changes in order to compensate for their losses.

Physical disabilities are visible and receive attention. Agoraphobia is considerably less obvious, but just as debilitating. It is important for people to become educated about this disorder. It shouldn’t be taken lightly or considered imaginary. Agoraphobics are often rejected by their families, physicians, and those around them. They are labeled as outcasts, “black sheep”, and especially strange. Agoraphobics are “special needs” people and deserve empathy and support: acceptance can be a crucial step towards recovery.