Is there an anxiety so severe that it locks us out of the house? It turns out that yes – it is experienced by people with agoraphobia, which is one of the disorders belonging to the group of anxiety disorders. For these people, walking in the park, traversing the city center or entering a shopping mall is unattainable. What is agoraphobia and where does it come from? What are its symptoms? Can it be dealt with somehow? These questions will be answered later in the article.
Agoraphobia – what is this disorder?
Anna never liked crowds, but over time her anxiety began to intensify. She increasingly avoided leaving the house, fearing panic and dizziness. Shopping at the mall, walking through the city center, going to the movies… What used to be a pleasure now became a nightmare. And worst of all, Anna felt completely helpless about it. She couldn’t explain how it was that as the apartment door closed behind her, she began to feel worse and worse.
Does Anna’s case seem familiar to you? This is what agoraphobia looks like. It’s a fear of places that are difficult to get out of. It also appears in situations where it is hard for us to get help if we feel worse. Agoraphobia is most often encountered in large stores, shopping malls, public transportation, cinemas, theaters , clubs, elevators and offices.
Agoraphobia can also affect open spaces. Usually then we notice that there are certain elements of the landscape that cause us strong fear. Such objects can be streets, the surface of water or the visible horizon. People experiencing this type of agoraphobia may avoid bridges, beaches, parks and even their own balconies, feeling extremely uncomfortable in these places. The fear of being out in the open is one of the main symptoms of this disorder.
What are we afraid of when we have agoraphobia?
A person with agoraphobia is most often afraid of space, and its symptoms include:
- open (large parking lots, beaches, parks),
- very confined (elevators, tunnels, bridges),
- where there is a crowd of people (queue at the post office or checkout at a store),
- where medical assistance is difficult (airplane, streetcar),
- from where it is impossible to get out quickly in case of ill health (hypermarket, theater, lecture hall).
Agoraphobia, is also a fear of:
- the occurrence of a panic attack – the fear of another attack prompts us to avoid places that can trigger it,
- loss of control – we are accompanied by fears of not being able to control our anxiety,
- evaluation of others – we fear that we will be the center of attention and our behavior will be judged.
Where can agoraphobia occur?
To list all the places where agoraphobia can occur is impossible. Sometimes the fear affects all stores, and sometimes only large-format stores. Some people experience it in all establishments that are so vast that the front door cannot be constantly in sight. Others, on the other hand, are afraid of open spaces – and this is true regardless of whether there are people there or not.
Anxiety can also occur:
- in a lecture hall,
- at a meeting at work,
- during a mass at church,
- during a family celebration,
- while driving a car,
- while standing at a red light,
- while traveling to a completely new and unfamiliar place.
Agoraphobia has more than one face and it is impossible to list all the places where it can occur. Each patient has a slightly different experience. What’s more – spaces that at first didn’t evoke bad associations can cause fear over time. Even if at first we fear only huge airports and trade fair halls, there is no guarantee that this will always be the case. Perhaps after a few months we will notice that the symptoms of agoraphobia appear in more types of facilities.
How far can the anxiety disorder develop?
Agoraphobia can run a mild course, or lead to a situation where we are no longer able to leave the house. So what can it look like? Agoraphobia is a type of anxiety disorder that can vary in severity and affect daily life.
We can distinguish three types of agoraphobia based on its severity:
- mild agoraphobia – we feel uncomfortable in certain places, but are unlikely to avoid them,
- moderate agoraphobia – the discomfort is strong enough that we avoid certain places (for example, we stop going to the movies, take the stairs instead of taking the elevator),
- severe agoraphobia – we don’t want to leave the house alone for fear of experiencing increased anxiety.
Agoraphobia – symptoms of agoraphobia
Let us now look at the symptoms characteristic of agoraphobia. Then, in turn, we will turn to the symptoms of panic attacks, which very often occur in the course of the disorder in question.
The most common symptoms of agoraphobia are:
- feeling intense fear of different types of spaces,
- experiencing anxiety that becomes problematic when it begins to paralyze and impede daily functioning,
- avoidance of specific places and situations for fear of developing anxiety,
- panic attacks (but they do not have to occur – we distinguish between agoraphobia with panic attacks and agoraphobia without such attacks),
- careful planning of the route before leaving home – some people show a tendency to devise routes in detail to avoid specific places,
- avoiding public places at certain times – fear of crowded spaces often leads to avoiding them during rush hour,
- catastrophic thinking – a tendency to anticipate the worst possible scenarios.
What does a panic attack look like in agoraphobia?
In a situation that fills us with anxiety (for example, after entering a supermarket or finding ourselves in a large park), we may experience a panic attack. It is most simply described as a sudden and unexpected attack of severe anxiety, occurring for no apparent reason. It usually lasts for up to a few minutes and then slowly subsides – however, time seems to “stretch out” at that point, so we get the feeling that the attack has no end. Panic attacks are characterized by intense anxiety and can be managed with therapy and relaxation techniques.
Panic attacks are often accompanied by depersonalization (the feeling of not being yourself) or derealization (the feeling that the world around you is unreal). It also seems to us that something very bad is about to happen. However, we are unable to specify what it will be. All this makes us feel completely helpless – as if we are stuck in a nightmare from which it is impossible to wake up.
The symptoms we experience during a panic attack are:
- nausea,
- a feeling of shortness of breath,
- trembling of the hands,
- dizziness, headaches
- palpitations, accelerated heartbeat,
- dry mouth,
- accelerated heart rate,
- fear of death,
- feeling of a “gulp” in the throat,
- accelerated breathing,
- excessive sweating,
- increased muscle tension,
- pain and tightness in the chest,
- a feeling of not being yourself,
- redness or fading,
- a desire to flee immediately,
- an intense sense of danger,
- a feeling of detachment from reality.
Agoraphobia – causes of agoraphobia
There are many different factors that are involved in the development of agoraphobia. Usually it is a combination of several of them that leads to the appearance of unpleasant symptoms of the disorder in question. A genetic predisposition to the anxiety disorder can increase the likelihood of developing agoraphobia.
Among the most common causes of agoraphobia are:
- genetic predisposition – the presence of anxiety disorders in the family,
- the presence of other disorders – specific phobias, depression and obsessive-compulsive disorder, among others,
- very strong experience of stress – individual sensitivity to stress combined with unskillful ways of coping with tension,
- traumatic past experiences – for example, experiencing an assault, a car accident,
- experience of a panic attack in a public place – the anxiety disorder develops in us because we fear that the situation will happen again.
What disorders can co-occur with agoraphobia?
Agoraphobia is a type of anxiety disorder that often coexists with other mental problems. Various mental disorders can co-occur with agoraphobia, which increases the severity of the symptoms and hinders our functioning. That’s why it becomes crucial to have a comprehensive diagnosis of the mental disorder, followed by tailored treatment in accordance with the diagnostic criteria for agoraphobia in the DSM-V system.
Disorders often co-occurring with agoraphobia are:
- depression,
- epilepsy,
- schizophrenia,
- claustrophobia,
- social phobia,
- specific phobias,
- generalized anxiety syndrome,
- obsessive-compulsive disorder,
- bipolar affective disorder.
What does agoraphobia lead to?
Agoraphobia makes our daily life much more difficult. We are constantly afraid that when we leave the house again, a panic attack will appear and thwart all our plans. Not wanting to expose ourselves to unpleasant ailments, we prefer to let go and stay where we feel safe. We avoid the outside world, isolating ourselves from other people and limiting our options. The death of a loved one can be one of the key stressful or traumatic events that contribute to the development of agoraphobia. These situations can worsen an individual’s mental condition and lead to symptoms of anxiety disorders.
Consequences of agoraphobia include:
- withdrawal from professional activities,
- avoiding friends and refusing to go out together,
- moving away from family and breaking off contact with loved ones,
- inability to keep a steady job or find a new one,
- difficulty in establishing new relationships (including romanticones ),
- restriction of daily physical activity and deterioration of health,
- loss of independence (when someone has to bail us out to go to the store or post office because we are unable to do it ourselves).
How does agoraphobia affect relationships?
Agoraphobia can be the cause of relationship breakdown. This happens primarily because we try to get our partner to be with us everywhere. This is because having him by our side makes us feel more comfortable – it is often the only way we can “normally” go shopping or go for a walk. However, the desire to take your beloved with you everywhere is not good for the relationship. We then try to limit our partner and always have him at arm’s length. Over time, this begins to overwhelm him – he feels as if he is no longer a partner, but a full-time employed caregiver. It is not uncommon then to make the decision to leave.
Moreover, suffering from agoraphobia, we can also:
- excessively fear abandonment or betrayal,
- fail to cope when conflicts arise,
- constantly feel guilty for burdening a partner with their problems,
- have difficulty communicating and expressing our needs honestly.
Agoraphobia – test
Fill out this quick test and see if you can measure yourself with agoraphobia. Remember, however, that this is not a specialized tool, and the results obtained in it should not be considered a diagnosis.
Answer the following questions by answering “YES” or “NO”:
- Are you afraid of leaving your home? YES/NO
- Do you avoid public places such as shopping malls? YES/NO
- Do you experience anxiety on public transportation? YES/NO
- Are you panicky about being alone in public places? YES/NO
- Are you accompanied by anxiety when you are in a place from which there is no possibility of getting out quickly? YES/NO
- Do you fear that you may experience a panic attack after leaving home? YES/NO
- Does avoiding certain places or situations significantly limit your daily life? YES/NO
The more “YES” answers, the greater the likelihood of agoraphobia. If you suspect this disorder in yourself, see a specialist – get a professional diagnosis from him.
Is agoraphobia treatable?
Despite the presence of severe symptoms, few people choose to consult a specialist. They are accompanied by the feeling that no one will really understand the problem they face. Moreover, they also think that their case is incurable. So they suffer in solitude, losing hope that things can get better. Meanwhile, there are effective methods to help us deal with agoraphobia. Various therapeutic methods are used to treat agoraphobia, including pharmacotherapy and psychological therapy. It is not worth living in limbo and expecting the anxiety to disappear on its own. Modern treatment methods offer a chance to quickly return to normalcy!
Agoraphobia – how to overcome anxiety at home?
Treatment of agoraphobia can be greatly assisted by breathing exercises, meditation and yoga. Deep, conscious breathing helps regulate the heart rhythm and reduce the level of the stress hormone cortisol. As a result, we regain a sense of control over our own bodies.
Meditation, on the other hand, allows us to quiet the mind and learn to notice our own thoughts. We then let them flow through our head, but avoid “going into them” and judging their content. We also notice the emotions that arise within us and allow them to persist and then fade away. Regular practice of meditation reduces anxiety, improves concentration and increases resistance to stress.
Yoga, on the other hand, is a way to combine movement, breathing and concentration. It strengthens the body, improves its flexibility, and at the same time increases our awareness. Practicing yoga helps deal with the muscular tension that often accompanies anxiety attacks. However, remember regularity – it is the key to success here.
The combination of all three forms of practice can be very beneficial, but it cannot completely cure our phobia. Overcoming the disorder will only be possible with the implementation of professional interventions, such as psychotherapy.
Help in the treatment of agoraphobia
Agoraphobia is a type of anxiety disorder that requires a comprehensive treatment approach. While there is no one-size-fits-all way to overcome this anxiety, psychotherapy and, in some cases, pharmacotherapy play a key role.
Typically, a psychiatrist will prescribe antidepressants, anti-anxiety medications and tranquilizers. The most common are serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) along with benzodiazepines. Pharmacotherapy is especially useful when, by the intensity of anxiety symptoms, daily functioning is virtually impossible. Taking medications allows for quick improvement – but for long-term effects, they should be combined with psychotherapy.
Treatment of agoraphobia – cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT) is considered the most effective treatment for agoraphobia. It focuses on getting to the negative thought patterns through which our functioning is worsened. When we notice what beliefs make us feel fear when we leave the house, we can go a step further – and modify them. During therapy, we are also concerned with learning the mechanisms of anxiety and mastering effective methods of coping with difficult situations.
CBT helps us:
- understand the mechanisms of anxiety,
- recognize negative thinking patterns,
- change deeply ingrained beliefs,
- gradually expose ourselves to anxiety-producing situations.
It is important to remember that therapy is a process that takes time and commitment. The effects do not appear immediately, but consistent work on ourselves will allow us to regain control of our lives.
Bibliography
Adamczyk, K., Adamczyk, D., Wojcik, R., Fałkowska, U., Soroka, E. (2018). Rare specific phobias – types and treatment, Varia Medica, 2(5), pp. 423-429.
Kacprzyk-Straszak, A., Pawlak, A., Kucharczyk, K. (2017). Anxiety disorders – the reality next to us, Beskid Heritage V, pp. 95-114.
Nitka-Siemińska, A. (2014). Anxiety disorders – characteristics and principles of treatment, Forum of Family Medicine, 8(1), pp. 37-43.