Shutting Out the World

More than 3,500,000 Americans suffer from agoraphobia. For some, fear of the world beyond their houses keeps them shut in and alone. But with help, they can come out.

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One in 20 Americans suffers from a crippling anxiety of being in public spaces. They worry that they will have a panic attack with no way to get help. The term comes from the Greek word for the marketplace, agora. To people who suffer from it, the condition keeps them from driving in cars, going to the shopping malls and grocery stores, and, in the most extreme cases, from leaving their homes.

If you, or someone you love, has ever avoided going out in public for fear they would have a panic attack, read on. There are concrete signs and effective treatments for this debilitating condition.

What Are the Symptoms of Agoraphobia?

  • Severe anxiety or panic attacks
  • Fear of being alone
  • Fear of losing control in public
  • Becoming housebound
  • Being overly dependent on other people in your life
  • Physical symptoms such as abdominal and chest pain, dizziness, nausea, sweating

What Puts You at Risk?

The most significant risk factor is recurrent unexpected panic attacks. People with a family history of anxiety or mood disorders and people going through life transitions (good or bad) are also at greater risk, and women are more likely to suffer from agoraphobia than men; in fact, they are diagnosed 4 times more often.

Most people are not born with agoraphobia. It develops over time, often beginning in the mid-20s and peaking in middle age.

What Is Happening?

Sensing a threat, our bodies secrete hormones that tell our system to be on alert. Our hearts race, our lungs inflate to suck in more air, which causes us to hyperventilate; we sweat and feel anxious. For people with panic disorder, this sequence of events can happen often and with very little stimulation. Soon the fear of a panic attack becomes its own phobia that keeps people from living their lives as they normally would.

How Do I Know If I Have It?

We all go through times when we don't want to leave the house, face the office or stand in a long line at the grocery store. But, for people with agoraphobia, the critical difference is the reason they want to stay away.

Ask yourself if you avoid:

  • Crowded places that are hard to get out of, such as the supermarket, a movie theater, or a shopping mall
  • Public transportation such as buses and subways
  • Driving or riding in a car or traveling via airplane
  • Getting in long lines
  • Being far away from your home, or outside an established safety zone around your house

If you answered yes to any one of those and the reason is that you are afraid of experiencing a panic attack, you may suffer from agoraphobia. If that fear and avoidance is impacting your ability to live a normal and comfortable life, you may need help managing it. Reach out for help as soon as possible; agoraphobia can feed on itself and worsen over time.

How Is It Treated?

The goal in treating agoraphobia is to slowly expose the person to the settings and places that scare them. Exposure therapy involves taking baby steps, each a little further outside your comfort zone. For people who are afraid of leaving their homes, those steps are literal - slowly widening the area around your house that you feel safe operating within. Gradually, the person with agoraphobia realizes that they can go places without experiencing panic, and that discovery reinforces their comfort with the activity.

In the most extreme cases, people can begin treatment over the phone with a psychotherapist. Antidepressants and anti-anxiety medication are sometimes used to treat the disorder. 

How Can I Help A Loved One With Agoraphobia?

For people with agoraphobia, the people who live with them become a critical support system. That means spouses can often end up enabling the agoraphobic behavior. Since no one likes to see their partner in pain, it can be easier to shield them from what is frightening than to witness the anxiety felt by trying to face it.

What people with agoraphobia need instead is support that encourages them to go outside their safety zone, to consistently push the envelope, and, if necessary, get aggressive professional treatment to prevent becoming disabled by the disorder. Experts usually recommend that a patient bring their spouse into treatment, so that the spouse learns how to effectively help their partner overcome their fear.