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

Poster: Phobia of outdoors during coronavirus
Coronavirus can make life more challenging for those who are afraid to go outdoors.   Agoraphobia is usually related to a fear of being in public or a fear of large crowds. So it seems logical that enforced self-quarantine amid a viral pandemic is welcomed for those suffering from the condition. Unfortunately, the opposite is true.

From avoiding crowds to fearing them

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?

 Jaws & Community Safety in the Era of Coronavirus 

We’ve reimagined the movie poster for Jaws as a PSA urging people to stay home during the coronavirus pandemic. The virus is passed via tiny droplets expelled when one coughs or sneezes. It is classified by experts as extremely contagious, with the ability to live on surfaces for hours.  

Around the world, governments are encouraging the practice of “social distancing,” or maintaining a distance of at least 6 feet from other people, in hopes of slowing down infection rates. Governments now uniformly encourage hypervigilance when out in public, with some even encouraging citizens to report individuals ignoring social distancing guidelines.  

How the Coronavirus Pandemic Triggered Fears of Large Crowds and Being Out in Public 

By the middle of March, Coronavirus cases in the US numbered in the hundreds, and was mostly concentrated in parts of California and New York. Images of empty shelves, fights over toilet paper and overcrowded Costcos began spreading on social media, raising public concern across the countryGovernment officials like Bill DeBlasio made efforts to stymie the growing fear of large crowds and going outside by encouraging people to continue riding public transportation. Others have even suggested eating out and attending community events.  

Americans are likely to see more of this level of enforcement sweep across the country as lawmakers struggle to flatten the Coronavirus curve. This rapid change in rhetoric has sent many Americans already struggling with anxiety into panic. Social media has seen a significant rise in individuals’ self-supplementing (for example, with CBD) and searching wide and far for ways to keep calm in this period of uncertainty. 

Fear of the outdoors in Jaws 

Under normal circumstances, agoraphobic people are wary of crowds because the situation is out of their control. This crippling unease is well illustrated in the 4th of July beach scene in the 1975 movie Jaws 

By this point in the movie, Sheriff Brody already confirmed a shark attack was the cause of the dismembered remains of victim, but the mayor refused to concede Amity’s potential summer tourism incomegoing on to continue keeping beaches open.

As the 4th of July scene progresses, tourists race to the water and director Steven Spielberg follows Sheriff Brody patrolling the beach with his walkie-talkie. The director conveys a ramping sense of tension with Brody’s growing awareness of the potential for disasterculminating in him watching helplessly as the shark attack ensued. 

The situations in the fictional movie Jaws were isolatedbut the effects of Covid-19 are felt globally, with painstaking coverage by all major news outletsThe resulting extremity in community awareness has caused widespread fear of going outside – especially fear of crowds and enclosed spaces  even among those typically unaffected by agoraphobia. 

Stay Calm, Stay Home 

Due to the high infection rate, the expert consensus is that a period of mass quarantines is the best option for flattening the curve. Unfortunately, stress from the constant coverage of growing death tolls paired with natural feelings of isolation during quarantine is especially harmful for people already struggling with phobias and other forms of anxiety disorder 

Agoraphobia is characterized by panic in reaction to the mere idea of an uncontrollable situation involving large groups or outdoor spaces. The phobia is linked to anxiety disorders and affects nearly 3% of the population.

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.

CBD oil could be another viable solution. Studies conducted by the National Institute on Drug Abuse (NIDA) suggested that CBD can lower behavioral symptoms of anxiety in animals.

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.