Agoraphobia

We know traveling can be anxiety-provoking, but come with us to a faraway land—just for a minute.

The Agora, in Ancient Greece, was the center of the action. It hosted political and civic events, the arts, and sports. Eventually, it also became the major marketplace where all sorts of things were sold and traded. It was, in other words, the place to be. And yes, it is where we get the word agoraphobia (fear of the marketplace).

I take some comfort in imagining that the ancient Greeks recognized and acknowledged that some of us struggle with fully participating in the marketplace. I definitely would have been the one who couldn’t attend marketplace activities due to anxiety-induced dizziness and nausea. (Abs would have begged off because of her fear of germs.)

Perhaps one of the best ways to illuminate the disorder known as agoraphobia is to talk about what it isn’t. Since we are already hanging out in Ancient Greece, we might as well bring up some of the myths (get it?) around agoraphobia:

Myth #1: Agoraphobia is the fear of leaving home.

Actually, agoraphobia is the fear of being trapped or not being able to access help in a public place. For many Anxiety Sisters, agoraphobia is the fear of having a panic attack in a public place and not being able to get help or get to a “safe zone.” It’s not about being afraid to leave the house—it’s the fear of dealing with our phobias, panic, or physical illness when we do. My own agoraphobia stemmed from my worry that my panic attacks would cause me to pass out or vomit (or both) in the subway. I didn’t need to stay home as much as I needed to avoid the subway and a long list of places that might make me feel trapped.

Myth #2: Agoraphobics never leave home.

In all but the most severe cases, people with agoraphobia do leave home—as long as they are in a safe zone where they feel relatively comfortable. For some Anxiety Sisters, this means they will go anywhere in their own town, but will be too fearful to venture further away. For others, the safe zone can be even wider (or smaller).

Myth #3: People with agoraphobia are loners.

Many people with agoraphobia dislike being alone and are quite dependent on friends or family members, especially when venturing out of their safe zones. In fact, agoraphobics often have trouble going places alone because they are scared that, if something happens to them, nobody will be there to help them. When agoraphobics withdraw from loved ones, it may be because they feel that they are a “burden” to family and friends, which can cause profound loneliness and bouts of isolation.

Myth #4: You must have panic disorder or many irrational fears in order to develop agoraphobia.

Many people with agoraphobia do have panic disorder and/or phobias, such as driving. However, this is not the case for everyone. Some older folks may worry about doing something embarrassing in public (e.g., becoming incontinent or falling down) which is neither irrational nor panic-inducing. Children can get agoraphobia as well. When a child is extremely fearful about getting lost, [s]he may try to avoid big or crowded places.

So how do you know if you have agoraphobia?  

We are not doctors, and we would never feel comfortable diagnosing anyone; however, we do know that people with agoraphobia tend to avoid at least 2 of the following for at least 6 months:

1) Trains, buses, planes (public transport)

2) Open spaces like malls or parking lots

3) Enclosed spaces like movies, smaller stores, restaurants, meeting rooms

4) Waiting in lines or being in crowds

5) Leaving home alone

Although most people start to experience agoraphobia in their 20’s, people of any age can become agoraphobic. As is true of anxiety disorders in general, women are twice as likely to become agoraphobic as men. Also, feel free to blame it on your parents—in about 60 percent of cases, agoraphobia has a genetic component.

What is the treatment?

Whether or not you have a formal diagnosis of agoraphobia, if your world is shrinking because of avoidant behaviors, you probably need some type of help. Most often, unfortunately, standard “talk” therapy is not helpful. Experts will point you toward Cognitive Behavior Therapy (CBT), which involves analyzing and interrupting thought patterns, and Exposure Therapy, which involves exposing the sufferer to the source of her anxiety in progressively larger doses, as the most effective treatments for agoraphobia. For most of us, however, it is hard to find local practitioners of these exact therapies. We are limited by real-life challenges like our agoraphobia, our insurance coverage (or lack of it), and the limited resources in our area. If you cannot find anyone trained specifically in treatments for agoraphobia, you may want to consider some of the online programs and apps in order to find help.

One final note: we know that it is possible to deal with agoraphobia without medication, but we think it is very hard. We liken it to running a marathon with a fifteen-pound weight on your back. Yes, it can be done, but the situation is just so much more difficult. Unless you have a medical reason for avoiding medication, we strongly encourage you to consider it—at least until you are on your way to recovery.