Acting Against Agoraphobia
You avoid shopping malls and driving on freeways because of panic attacks. Grocery shopping is brutal. You probably have agoraphobia.
Agoraphobia means “fear of the marketplace” but the meaning has been expanded to fear of open spaces. It consists of panic attacks that occur when the person is outside the home and in a crowd, a mall, a supermarket, a busy street or other public arenas where many people congregate.
When an attack happens—and it can do so without warning—people’s hearts race. They might become dizzy and tremble. Often they have chest pain or believe they are choking. They are convinced that they’re on death’s door.
There is a glitch in the way these people’s brains produce chemical messengers. The brain alerts the body to imminent danger when there is no real threat.
People with agoraphobia may suffer symptoms of severe anxiety when they leave home or when they are in crowded places. At home they anticipate being anxious. As a result, they typically try to avoid situations that trigger anxiety.
One reason that people with agoraphobia stay close to home is the fear of developing panic symptoms, such as a racing heart, difficulty breathing, sweaty palms and shakiness. Other possible symptoms include the fear of losing control in a public place, feeling helpless or detached from others (even perceiving that one’s own body is not real) and unusual agitation.
In the most severe cases, people with agoraphobia become afraid to leave home at all. Agoraphobia is more common among women than men. Most of the time, the illness first shows symptoms in late adolescence or early adulthood.
Physical complaints are a common problem of agoraphobics for several reasons. Sometimes they focus their anxiety on their bodies. They know the symptoms of fear are real so they may see a physician because of increased heart rate and hyperventilation. Another reason for many physical complaints may be because they find it easier to see a physician for a physical problem than an emotional one. The astute physician may hear the unvoiced problem, one of anxiety, and treat it instead of the perceived physical problem.
Agoraphobia can turn a person into a social hermit, but it is not a hopeless condition. Phobias are common and people can achieve mastery over them with the help of a professional.
Treatment depends on the particular symptoms and their severity, but usually involves some combination of talk therapy and medicine.
In cognitive behavioral therapy, for example, a clinician helps the patient to recognize distorted feelings about particular situations that are adding to the anxiety. During therapy, the patient also learns to find individualized techniques to counter the stress and fear that is evoked. Often cognitive behavioral therapy is combined with exposure therapy and relaxation techniques. This approach might begin with visualization exercises, in which the clinician helps the patient relax and then asks him or her to imagine a fear-provoking situation (e.g. riding the subway or going to a crowded mall). In some cases a clinician might actually accompany the patient as he or she ventures into these situations. The goal is to desensitize the patient to the situation so that it is no longer so scary.
Although relaxation, stress reduction and other techniques can help many people with agoraphobia learn how to manage their fear, some will also need medication. Options include antidepressants and anti-anxiety medications.
The most important part of therapy involves gently exposing the agoraphobic patient to situations that are frightening while offering support. Best results are achieved when a family member or spouse is included in therapy.
