Understanding Agoraphobia, a fear of crowds & helplessness in the outdoors

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Agoraphobia is characterized by a feeling of panic in reaction to the idea of an uncontrollable situation. This phobia is linked to anxiety disorders, and affects nearly 3% of the population.

HOW DO YOU BETTER UNDERSTAND AGORAPHOBIA?

Fear of overcrowded or confined places, but also vast and open places is known as agoraphobia. An agoraphobe fears the possibility of losing control over a situation, and not being able to escape easily in case of danger.

Agoraphobia may only concern certain places (e.g. public spaces, or busy places such as at demonstrations or in public transport), or it can extend to anything outside the home. The resulting physical responses – flailing legs, dizziness, sweating, palpitations and abdominal pain – can be equated with real panic attacks. Agoraphobia is a common source of social isolation, and can be effectively treated by monitoring cognitive-behavioral therapy.

“I started by avoiding public transport at rush hour, and then avoided it altogether,” recalls Kim, 39. “I also stopped driving because of traffic jams. Today I shop only at the opening times of shops to finish faster, and I do not leave my neighborhood very often.”

Like Kim, 3 to 4% of the population suffers from agoraphobia at some point in their lives, and to varying degrees. Difficulties often begin between the ages of 20 and 30, but older people can also be affected. Women are twice as likely to be affected by agoraphobia as men.

Summary

  • Agoraphobia: Not Just a Phobia of The Crowd
  • Frequent But Safe Panic Attacks
  • Treating Agoraphobia: Cognitive and Behavioral Therapies
  • Other Possible Treatments for Agoraphobia?

Agoraphobia: Not Just a Phobia of The Crowd

Agoraphobia is often equated with a fear of public places, and by extension of crowds. In reality an agoraphobic person is not afraid of crowds, but afraid in crowds. More broadly, an agoraphobe is afraid of what could happen to him or her if they were suddenly in danger within a crowd, or any other place without a means of escape or rescue.

Situations that crystallize fears related to agoraphobia are therefore extremely varied. They correspond to highly frequented and/or closed places such as traffic jams, elevators, department stores, public transport and meetings in tight spaces. Interestingly, while it may seem paradoxical, agoraphobes are also afraid of large spaces without human presence, such as desert plains, snowy tundras or winding bridges and tunnels.

Claustrophobia, or the fear of confined spaces, is a form of agoraphobia. Agoraphobia must be distinguished from social phobias which, although able to generate the same type of behaviors (e.g. avoidance of crowds, seldom leaving home) corresponds to a fear of the other.

When it starts, agoraphobia is limited to certain circumstances: long trips in a New York subway, an extended queue at supermarket checkouts et cetera. However, dreaded situations can multiply and agoraphobia can become truly debilitating, forcing agoraphobes to isolate themselves socially.

Frequent But Safe Panic Attacks

Agoraphobic symptoms commonly manifest themselves as a choking sensation. Other agoraphobes have flailing legs, dizziness, sweating, palpitations or abdominal pains. They are afraid of any situation that heightens the possibility of falling, having a heart attack, a stroke, or even a nervous breakdown. In short, their fear is primarily rooted in the prospect of losing control.

When physical agoraphobic reactions are aggravated, they can give rise to actual panic attacks. Put simply, agoraphobes who suffer from panic attacks are “afraid of being afraid.” Fear of crisis itself, and afraid of conditions that could aggravate this fear. It’s usually in overcrowded or closed places where agoraphobes feel the most stifled.

Treating Agoraphobia: Cognitive and Behavioral Therapies

A viable first step in the case of agoraphobia is consultation with a doctor, especially if there are panic attacks. This is because some pathologies can cause the same symptoms or promote the appearance of agoraphobia, such as disorders of the inner ear or hyperthyroidism. If agoraphobia is confirmed, it’s time to pass the baton to a psychiatrist or psychologist.

Doctors frequently recommend cognitive-behavioral therapies (CBT). The goal is to work on the behaviors themselves: both the false beliefs and what we say to ourselves. More traditional therapies can help, but with uncertain results.

Some agoraphobes try to build their own CBT program through books and websites. In practice it is necessary to identify dreaded situations, to classify them from simplest to most difficult, and to find the means to confront them progressively.

Other Possible Treatments for Agoraphobia?

Anxiolytics, mainly represented by benzodiazepines (e.g. Lexomil, Lysanxia, Temesta or Xanax) may be useful for relieving seizures. However this isn’t a viable strategy for the long term, because of the risk of dependence and side effects. Medication with drugs shouldn’t become a reflexive response, because they’re only likely to prevent any meaningful progress.

Antidepressants that reduce the intensity of emotions (e.g. Seroplex or Deroxat) are sometimes prescribed. However, they only work if there is underlying depression and/or panic attacks.

Hospitalization isn’t helpful unless there is real depression or a risk of addiction, as in situations where alcohol or other drugs have been used to deal with fears. Some institutions, however, offer follow-ups in day hospitals as part of an intensive CBT. Some specialists agree to travel to a patient’s home when agoraphobia prevents them from attending consultations.