Some of us leave the house regularly without thinking about it. Others feel some anxiety when going out, especially if we haven’t done so in a while. But at what point does this anxiety tip into agoraphobia? And if we do live with agoraphobia, what could help us to manage it?
What Is Agoraphobia?
Those of us who have heard of agoraphobia may know of it as a fear of going outside. This isn’t wrong – people with agoraphobia are often anxious about leaving their home. But we can break it down further than that.
The NHS defines agoraphobia as ‘a fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong’. This isn’t limited to being outdoors, it can include some enclosed spaces such as shopping centres or public transport.
Physical Symptoms Of Agoraphobia
The symptoms of agoraphobia can be split into physical, behavioural, and cognitive symptoms. To be diagnosed, we usually have to have the phobia for a minimum of six months.
Physical symptoms tend to be similar to those of a panic attack and usually appear when we’re in an anxiety-provoking situation or environment. Symptoms can include feeling hot, dizzy, faint, disorientated, sweaty, shaky and sick. We might have a super-quick heartrate, our ears might ring, and we might struggle to swallow. Our breathing can quicken to the point where we’re hyperventilating. And our bowels can also kick-off, making us need the toilet over and over again.
Many of us who live with agoraphobia rarely feel these physical symptoms, at least not to the point where they’re totally disabling, because we avoid situations that trigger them.
Cognitive Symptoms Of Agoraphobia
Cognitive symptoms are those linked to our thoughts and feelings.
We might worry that if we go out then we’ll have a panic attack or meltdown. This worry can spiral as we start feeling anxious about looking stupid in front of others, not being able to communicate our needs and all sorts of other things. If we’re someone who can recognise when our anxiety is about to tip into panic, then we’ll often worry that we won’t be able to escape from where we are in time to stop a full-blown panic attack.
We might also worry about losing control in public, strangers talking to us, people looking at us, not being able to function without help, and so much more. It’s easy to fall into a spiral of worry-based thoughts that can escalate into a panic attack before we’ve made it as far as our front door.
Behavioural Symptoms Of Agoraphobia
Behavioural symptoms describe the things that we do.
We might avoid situations or places that we know cause us anxiety or are likely to lead to a panic attack. Some of us become trapped in our home, especially if we live alone and feel unable to go out without the company of someone we trust. If we do leave our house, we might not go very far because we need to know that we can get back quickly at any point, should we need to.
Sometimes we’re aware of the behaviours we use to try and avoid the crushing anxiety we so often feel. But there might be some behaviours that we’re not aware of doing. Sometimes it takes a loved one pointing out our behaviours for us to notice them.
What Can Cause Agoraphobia?
The majority of people with agoraphobia notice it develop from an existing panic disorder.
Around 2% of the population live with panic disorder, and of this 2%, around a third will be diagnosed with agoraphobia. It’s twice as common in women as it is in men, and is most prevalent in those aged 18-35.
Agoraphobia isn’t usually caused by one single thing, but can be triggered by a single event. For example, if we have a panic attack in a particularly difficult, scary, or embarrassing situation then we might start to worry that it will happen again. This can mean that we avoid that situation altogether.
As time goes by, our worry might escalate as we start to fear a similarly scary panic attack happening in other embarrassing places. We might begin to avoid these places or situations, too, and our agoraphobia gets worse.
For some of us, anxiety and panic run in our family. Our genes might predispose us to anxiety disorders.
We’re all born with a ‘fight or flight’ reflex. We’d be a bit stuck without it. It’s a vital part of our make-up, playing an important part in keeping us safe by priming us to function at peak capacity when fighting or running away from a threat. Unfortunately, with anxiety and panic disorder, it’s often triggered at the ‘wrong’ time, resulting in panic attacks.
We all have neurotransmitters in our brain. They help with regulating our mood. When we live with anxiety, depression, or another mood disorder, our neurotransmitter levels become unbalanced. This can lead to us feeling extra-stressed and panicked.
The ‘fear-emotion-generating’ part of our brain triggers the physical effects we feel when we’re scared. In panic disorder, our ‘fear’ generator can go a bit over the top. This often leads to panic attacks.
Spatial awareness can be tricky when we have panic disorder. It makes it hard for us to judge where we are in relation to the world around us. This is overwhelming and disorientating, especially when in crowded or unfamiliar places.
Some things increase our risk of developing a panic disorder which, in turn, increases our likelihood of developing agoraphobia.
A history of mental illness, alcohol abuse or drug abuse can all increase our likelihood of developing agoraphobia.
Trauma could contribute to a panic disorder. It can come in different forms. Something that causes a trauma response in one person might not do so in another. Examples of things that could elicit a trauma response include bereavement, abuse, a life-threatening experience, or serious illness in the family.
High-stress periods can increase our risk of developing agoraphobia. Stress peaks can be caused by lots of things including moving house, losing our job, changing schools, going through a divorce, our parents/carers going through a divorce, or someone close to us dying.
For those who don’t have a history of panic disorder, being a victim of a violent crime or attack, concerns about being infected with a serious illness, or fear of embarrassment can all raise our risk of developing agoraphobia.
How Does Agoraphobia Feel?
Living with agoraphobia can be a frustrating, isolating and lonely. We often feel trapped. It can be strange at times, listening to the world carrying on around, feeling totally disconnected from it all. We might feel hopeless and helpless. The lonelier and more isolated we become, the further our mood drops. We might feel useless and totally dependent on others, as we need help to do ‘basic’ things like posting a letter or nipping to the local shop. The anger and frustration we feel towards ourselves can make us want to scream.
It can affect our job prospects and studying opportunities. Though some jobs and study spaces will be remote, they can be hard to find. This can lead to significant money problems, exacerbating our ‘I’m useless’ thoughts and feelings.
The constant battle in the background of our mind sometimes intensifies and becomes all-consuming. We live life split in two; half of our brain tells us that we’ll be okay, the other half grips us so tightly with anxiety that we’re chained to the spot, our body tense, our mind exhausted.
There are lots of treatment options for agoraphobia. Things that help with anxiety and panic attacks can also help with agoraphobia. Grounding, deep breathing, and self-soothing can be particularly helpful because they’re things we can use when out and about as well as inside.
Working on self-kindness and self-care isn’t always easy, especially of feelings of anger and frustration are overwhelming us. But it can make a huge difference in how we feel and give us a solid foundation to build on. Starting small and building things bit by bit can help us to introduce self-care in a measured way.
Support From Others
We don’t have to cope with agoraphobia alone. Our loved ones often want to help us. But they might not always know what to do. We might now know how they can help either, and that’s okay! We’re all learning as we go.
Patience is so important. We’ve learned that patience is usually more constructive than getting annoyed with ourselves. Others need to be patient with us, too. It can be frustrating supporting someone with a mental illness. We know that – we get frustrated trying to support ourselves! Being open, honest, and sharing our frustrations with one another can help our loved ones to better support us, and us to better understand them.
Sometimes it can be tempting for others to ‘take over’, but this can lead to a case of ‘killing with kindness’. If people always do things for us, then there’s no reason for us to try and do those things ourselves. So we don’t, and as a result, we don’t move forwards.
Ideally, our loved ones will take our lead and ask us what’s helpful and what isn’t. We might not be able to answer the ‘what is and isn’t helpful’ question, but we could explore it together. Often we’ll only know how helpful or unhelpful we find things by trying them out.
For some of us, asking our loved ones to help us find some professional support, can be a big help. Looking for professional support is a big step and can be totally overwhelming. Having someone by our side can make the world of difference.
Accessing Support From Our GP
Sometimes it’s hard to access a diagnosis or any support. Our GP is usually one of the first places we visit. The problem is, if we’re agoraphobic, then leaving the house to attend a busy GP surgery isn’t always a possibility.
Some GPs might be happy to do a phone or online appointment if that’s something we’re comfortable with. If we struggle with phones, we might be able to ask for a home visit, especially if we need a physical exam to rule out any physical causes for our anxiety symptoms.
If we’re able to attend a GP surgery, there are some things we can do to make it more accessible. We could ask for the first or last appointment of the day – the surgery and waiting room are often quieter at these times. Our GP might be able to offer us an appointment just before the surgery opens which would ensure an almost empty waiting room. Some surgeries might have a quiet room that we can wait in, away from any other people. If waiting rooms are too difficult, then we might be able to wait in the car and ask reception to give us a ring when our GP is ready to see us.
Other things that can help include wearing comfy clothes, taking things to fiddle with, using headphones or dark glasses, having a book to look at, or focusing on an app that we know helps us feel calm.
Beyond Our GP
If we need more support, our GP might refer us to the local mental health team. Sometimes, we can access our local mental health team without going through our GP. If we’re struggling to visit the mental health team in person then we might be able to use phone calls, an app, email or ask for a home visit.
Some treatments used for agoraphobia include Cognitive Behavioural Therapy (CBT), Exposure Therapy and medication. If we want to try a therapy that’s not offered through our local NHS, and we can afford it, then we could choose to access private support.
With support, we can often reach a place where our symptoms are more manageable with around a third of us reaching a place where we’re totally symptom-free.
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