Being behind bars: that’s what agoraphobia feels like. So many things you want to get out and do, but breaking from your prison cell seems impossible. You’re desperate and wonder if you’ll ever be free. Stop, just stop. Do yourself a favor – take a breath and calmly read on…
But from personal experience I can tell you that first and foremost is the will to keep moving forward – even an inch at a time – when false evidence tells you to freeze.
I remember those days of crippling agoraphobia all too well. So much time behind bars. I wanted to do so many things, but couldn’t get past fear and avoidance. Fact is, I ended-up all but housebound. Heck, going to the mailbox took guts.
Cutting straight to the hope I mentioned in the title, I haven’t lived like that for thirty years. Did it take hard work to get where I am? Yep. Do I still have flashes of agoraphobia? Yep. But lots of folks have lifelong, shall we say, inconveniences. Why should I be any different?
It isn’t a stretch to say I’m an agoraphobia expert. So I, with some help from a great source, want to lay it down for you.
What is agoraphobia?
Agoraphobia is characterized by an over-the-top fear of public places, as well as specific environments and situations. Often, the perception is such places are too open, crowded, or dangerous. Agoraphobia comes from the Greek agora: “place of assembly” or “market place” and phobia: “fear.” It’s categorized as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Here’s the flow: the individual with agoraphobia enters the frightening place or situation – or even anticipates the scenario – and on comes massive fear. That flips the switch on distress, which generates all sorts of unpleasant phenomena: panic attacks, rapid heart rate, breathing issues, excessive sweating, and more. And off one goes to the races.
Of course, each such episode reinforces the fear and reactions. And so the cycle of misery and avoidance continues.
Agoraphobia often coexists with panic disorder, major depressive disorder, persistent depressive disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. As if they weren’t a big enough pain.
Agoraphobia can commence at any age; however, most commonly in the 20s. It’s believed to impact 2% of the population and is statistically much more common in women – probably because men don’t own up to it and seek treatment.
Okay, let’s take a look at some of the most common lifestyle and physical symptoms of agoraphobia…
- Isolation, detachment
- Fear of being alone, overdependence on others
- Fear of losing control in public
- Avoiding fear-generating places and situations
- Refusing to leave one’s residence
- Substance abuse
- Rapid heartbeat/palpitations
- Excessive sweating
- Feeling generally ill
- Chest pain
- Gastrointestinal discomfort, diarrhea
- Choking feeling
What a load of fun, right? I can personally tell you all bets are off when it comes to any form of anxiety and the symptoms above. I’ve had the pleasure of experiencing them all. And those physical symptoms? I’ve never been diagnosed with a medical condition.
What causes agoraphobia?
Well, you know how it goes with emotional/mental disorders – no one seems to know for sure what causes them. So, as always, we’ll go with these agoraphobia triggers, contributors, and risk factors…
- Chemical and hormonal imbalances in the body or brain
- Specific personality types, such as people who crave control or approval
- Family history of agoraphobia, as well as other emotional/mental disorders
- Influence of overly controlling behaviors by family members
- Lack of spatial awareness
- Childhood trauma
- Impaired fight/flight response
- Previous history of emotional/mental disorders
- Traumatic events
- Vestibular disorders
How is agoraphobia treated?
As we begin our discussion of how agoraphobia is treated, it’s important to bring hope back into the picture. True: agoraphobia is incurable, so if you have it now, you likely always will. I can attest to that. However, I can also attest to the fact that there are numerous effective interventions. That means if you want to prevent agoraphobia from dominating your life, you most certainly can. I mean, here I am thirty years later.
Now, as with any disorder, the first order of business is learning all you can about agoraphobia, as well as its accompanying lifestyle and physical symptoms. Doing so removes all sorts of mystery, you won’t feel nearly as alone, and you’ll bump into a lot of coping strategies and techniques.
Next comes stress management, which you absolutely have to do. You name it: exercise, healthy diet, sleep quality, easing-up on caffeine and nicotine, mindfulness exercises, grounding techniques, meditation, yoga, progressive muscle relaxation, deep breathing exercises, visualization – take your pick.
Therapy, especially cognitive behavioral therapy (CBT), is a huge component of agoraphobia treatment. It’s especially helpful with breaking negative cycles of thinking – feeling and behavior. And then there’s exposure therapy, such as systematic desensitization, to help with overcoming fears – ultimately avoidance.
Finally, there’s medication. Typically, the first meds chosen are the selective serotonin reuptake inhibitors (SSRIs: Paxil, Celexa, etc.) and the serotonin norepinephrine reuptake inhibitors (SNRIs: Pristiq, Cymbalta, etc.). If they aren’t effective, other antidepressants (tricyclic, MAOI, etc.) may be prescribed. In some cases, a doc may turn to an atypical antipsychotic, such as quetiapine (Seroquel). Commonly prescribed is the beta blocker propranolol (Inderal), which aids in stabilizing heart rate. Last but not least are the benzodiazepines (Klonopin, Xanax, etc.). But you need to be very cautious regarding tolerance/dependence. In fact, a lot of docs don’t like prescribing them.
Hey, all of the above can be of great assistance in managing agoraphobia. But from personal experience I can tell you that first and foremost is the will to keep moving forward – even an inch at a time – when false evidence tells you to freeze. Don’t be fooled, okay? You have to stop the cycle, and you can do it. Have faith in your safety and your ability to guarantee it.
Even if it’s an inch at a time
If you’re wrestling with agoraphobia, I have no doubt you feel as though you’re behind bars. But rest assured, you can break free from your prison cell. It’s going to take hard work, but if I could do it, so can you.
Stop, just stop. Take a breath and gather yourself. Now get on about the business of living your life, even if it’s an inch at a time – for now.
Thanks to theravive and Dr. Kevin Fleming for the reference info.
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