Trapped in Open Space: Dealing with Agoraphobia
Meaning
Agoraphobia literally means fear of the market.
At first.
Along the line, you begin to fear the laundry too. And then you fear being on the bus and before long, even being in a private car in the middle of traffic becomes torture. In the end, you become completely housebound.
This is no way to live.
I know it makes no sense. I ask myself, what’s the danger in just going to the mall that I’ve been to a hundred times in the past? But just the thought of standing in the aisle with cabinets stacked around me for what feels like miles; people — God, the people! — moving, flowing like a stream around me, thrashing like harsh currents that threaten to sweep me away.
I do not fear death. I’m not afraid of what they’ll do to me. My fear is me. That I’ll flip out, run mad, do something fatally embarrassing. I fear that at any moment, I’m going to explode, and everything dirty inside of me will come spilling out. The thought of it all overwhelms me, leaves me already gasping for air, feeling that ominous cloud sliding over me, like I am face to face with a dementor, and I can’t breathe, I can’t think, I just want to escape. I want a hole to open up in the ground and swallow me…
Agoraphobia is a mental condition in which your brain gets wrongly wired to perceive danger in public places, especially where crowds gather and in locations that are not familiar. You may feel that you need a companion, such as a family member or friend, to go with you to public places. The stress is stirred up by fear that something big and overwhelming could happen at any time when you’re out in the open, and there’s no easy way to escape or get help. For example, you may fear using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.
Some quick things to note:
Agoraphobia is sometimes mistaken as a fear of leaving the house, but it is more complex. It’s a peculiar anxiety that makes you avoid situations where you might feel panicked, trapped, helpless, or embarrassed.
It is more common in women.
Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack. They then avoid the places where it may happen again.
The most striking feature of agoraphobia is avoidance: it is unrelenting and debilitating, eventually getting to bizarre extents.
Fear is now familiar, my abnormal normal. I develop a new game. It is called What If? I can’t stop playing it. What if the panic happens again, somewhere where there is no escape? Motorways, open roads. No houses, no barns, no shelter. What if is a never-ending question. Anticipatory anxiety, the textbooks call it. A record stuck in its groove.
And then it does happen again. In a shopping precinct. And again, on a bus into town. And again, during a lecture. What if? is replaced by Where Next?
Symptoms
Typical agoraphobia symptoms include fear of:
· Leaving home alone.
· Crowds or waiting in line.
· Enclosed spaces, such as cinemas, elevators or small stores.
· Open spaces, such as parking lots, bridges or malls.
· Using public transportation, such as a bus, plane or train.
These situations cause anxiety because you fear you won’t be able to escape or find help if you start to feel panicked. Or you may fear having other disabling or embarrassing symptoms, such as dizziness, fainting, falling or diarrhoea.
It feeds on Panic
Some people have panic disorder in addition to agoraphobia. A panic attack is a sudden feeling of extreme fear that reaches a peak within a few minutes and triggers a variety of intense physical symptoms. You might think that you’re totally losing control, having a heart attack or even dying. If you haven’t checked it out yet, we talked extensively about panic disorder here. The fear can be so overwhelming that you may feel you can’t leave your home.
The avoidance behaviours present in agoraphobia may mimic other specific phobias, but on close scrutiny, they may be worlds apart. For instance:
A person with agoraphobia may avoid traveling by airplane due to a fear of having a panic attack on a plane and not necessarily due to aerophobia, or the fear of flying.
A person with agoraphobia may avoid crowds, fearing the embarrassment of having a panic attack in front of a lot of people. Such a fear is not the same as social anxiety disorder, which is a separate mental health condition that involves anxiety about being negatively evaluated by others.
It gets worse
Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands. You find that you’re stuck in a vicious cycle of fearing a situation and avoiding it, which only feeds your fear of that situation. Even in milder forms, this anxiety disorder can create a web of limitations. You might become fixed in daily routines, taking the same route to work or school every day, fearing any deviation. Public transportation can feel stressful, leading to the need for “safety behaviors” like always sitting near an exit. The pressure of social situations can be so intense that important events like weddings, funerals, or reunions are avoided altogether. The longer this fear rules over your life, you find yourself missing out on valuable opportunities like job interviews or romantic connections.
This can lead to depression, paranoia, perpetual anxiety that mimics GAD or PTSD, and suicidal thoughts. Some people abuse drugs and alcohol in order to deal with these and then fall into the trap of substance addiction and related problems.
But why are you this way?
Hard to pin down. It’s an unlucky coincidence of genetic makeup and overwhelming stress at times when your mind is particularly vulnerable. Some researchers believe that the triggers in the brain are similar to those for panic disorder.
Risk factors for agoraphobia include:
· Having panic disorder or other excessive fear reactions, called phobias.
· Responding to panic attacks with too much fear and avoidance.
· Experiencing stressful life events, such as abuse, the death of a parent or being attacked.
· Having an anxious or nervous personality.
· Having a blood relative with agoraphobia.
Isolation Can Fuel Fears of Open Spaces! Spending long stretches alone might raise the chances of developing agoraphobia. The COVID-19 pandemic exemplifies this. Lockdowns and social distancing, while necessary for public health, also caused fear and isolation. This combination is believed by mental health professionals to have increased agoraphobia rates, potentially causing long-term effects on mental well-being for many.
Treatment
Psychotherapy: a trained and experienced therapist guides you to override your anxiety mechanisms by employing simple but effective relaxation techniques while you slowly expose yourself to the situations you fear. It’s called systematic desensitization.
When I begin to feel ‘weird’ in public now, I breathe in for four seconds (through my stomach, not my chest). I pause for four seconds. Then I exhale (pulling my stomach back in) for four seconds. This kind of breathing is hard to master, but it’s the same kind of breathing we do when we are sleeping.
Medications: there are effective medicines that help the chemicals in your brain normalise to reduce fear and worrying. These take time to work and are best used in combination with talking therapy.
How to help a loved one with Agoraphobia
Just to reiterate what we said when discussing panic, what you do around someone with agoraphobia can make you their saving grace — or just another source of anxiety. Get this: your understanding and empathy are powerful tools. Recognize the challenges they face and avoid judgmental comments. Dismissive remarks like “get over it” or “toughen up” are unhelpful and can discourage them from seeking professional help.
I know you care, and really want to help. So here are a few tips to guide you to be truly helpful to someone with this condition.
Learn as much as you can. Read books, listen to podcasts, talk to mental health experts. The more you know, the better positioned you’ll be to provide help. If possible, expand your knowledge beyond agoraphobia and learn about anxiety disorders in general. If you’re reading this right now, kudos! You’re already off to a great start.
Practice Patience. No one wants to experience an anxiety disorder like agoraphobia. It’s often traumatic and overwhelming. As a friend or loved one, you can learn how to practice a sense of patience. You may not be able to relate to what a person is feeling, but you can still show them a sense of understanding.
Don’t set a timeline to their recovery. Each person’s journey can differ based on factors like the severity of their condition and the types of setbacks they experience. Your loved one might seem to be doing better one week, only to be housebound again the next.
You don’t really know what they’re passing through, but someone else might. Hearing about how other people cope with agoraphobia or panic disorder can inspire and boost morale — for you and them. Along with providing motivation, support groups can also make them feel understood and less alone in their struggles. Online support groups might be easier to find simply due to the nature of agoraphobia. Anyway, you may also find groups that work their way up to in-person sessions, or groups that encourage bringing a support person.
Help with the practical stuff. Your role is to support them in their recovery, not take responsibility for their recovery. While taking care not to enable their avoidance instincts, small acts of assistance would really go a long way. This could involve anything from helping them find a therapist or support group to driving them to doctor’s appointments or merely escorting them outside. Sometimes, you need to help them speak to their employer about arranging a safe and comfortable work environment such as a remote working solution.
Don’t forget the panic attacks. It’s likely that your loved one may have experienced panic attacks at some point. It’s also a distinct possibility that it will happen again. In this story, we talked in detail about practical steps to support someone experiencing a panic attack.
Help them create an Anxiety Plan. Many people with anxiety disorders benefit from creating a personalized “MAP” (Management Action Plan) for coping with symptoms. This plan outlines specific steps and strategies to manage anxiety as it arises. Would your friend or loved one be interested in working with you to create a similar plan tailored to their specific struggles with agoraphobia? You could be a valuable partner in brainstorming strategies and offering support as they develop a toolbox for managing their anxiety.
Check-In regularly. Even when your friend or someone you care about isn’t in a situation where they’re fearful, or they aren’t experiencing acute symptoms of agoraphobia, it can be helpful for them to know you care. Regularly check-in, even if it’s just a quick text or phone call and see how your friend’s doing. This reinforces the idea that you are a support system.
Guide Them Towards Help. Agoraphobia can be a significant obstacle for many. While you can’t force someone into treatment, offering your support can be incredibly helpful. Many people with agoraphobia find relief through professional therapy, medication, or a combination of approaches. If your loved one is open to it, you could help them find a therapist specializing in anxiety disorders. Even offering to drive them to the first appointment demonstrates your willingness to be there for them on their journey to recovery.
Facing Agoraphobia Together: Patience and Resilience
Agoraphobia can affect you or someone you care about. Remember, patience is key. We all experience anxiety, and it’s normal. Don’t view setbacks as failures. Instead, focus on building your resilience. Learn to manage those uncomfortable feelings. With this newfound confidence, agoraphobia’s grip on your life will loosen, allowing you to live to the fullest.
Are you secretly battling a similar anxiety? Do you have a friend who popped up in your mind while reading this story? Feel free to reach out to me. In the comments or in my inbox (nnajioforpeter@gmail.com). You can also share your own story. I guarantee someone would find inspiration in it.
