Agoraphobia and Avoidance
About one-third of people who have panic disorder will develop a condition called agoraphobia. The main symptom of agoraphobia is intense fear (panic response) of being in certain situations in which escape is difficult or potentially embarrassing, or where help is not readily available. More specifically, the focus is on the fear of having a panic attack in such situations.
The fear associated with agoraphobia is so intense that the person will usually go to great lengths to avoid the feared situations. Common situations that bring about a panic response due to agoraphobia include leaving home alone, staying home alone, traveling by car, train, plane or bus, being in an elevator, being in a crowd, being in a large store or mall, being in a confined area, being on a bridge or standing in a line. Can you imagine how difficult life would be if you are focused on avoiding all of these potential panic triggers?
The Safe Zone
Once the symptoms of panic disorder begin, agoraphobia can take a little time to develop, or it can come on rather quickly. Some sufferers believe their agoraphobic symptoms began after their first panic attack. Once agoraphobia takes root, avoidance behaviors often multiply quickly, and daily life becomes defined by a “safe zone.” The safe zone includes the places, situations or events that bring about the least amount of anxiety. Going outside of the safe zone is extremely difficult and distressing.
An Example of How Agoraphobia Takes Hold
Imagine you’re driving up to the top of a bridge and without warning you experience a dreaded sense of doom. Your heart begins to race wildly; your hands are shaking as you try to grip the steering wheel. It seems difficult to get air into your lungs, and you feel dizzy. There is no place to pull over, and you are completely at the mercy of this horrific thing that is happening. You wonder if you might be having a heart attack or dying from some strange, unknown illness. As you descend the bridge you begin to calm down. You are still quite visibly shaken, but you are regaining some composure.
You frantically try to find a logical explanation for the symptoms you’ve experienced. You may go to the emergency room or to your doctor for answers, only to find that you are physically fine. That’s good to know, but you wonder if they may have missed something.
Your thoughts become focused on what could have happened if you had lost consciousness or were unable to maintain control of your car when you were driving over that bridge. You think, “What if I drove off the bridge? What if I got into a car accident? What if I had to stop my car abruptly in traffic and people started blowing their horns and yelling at me?” The logical answer to maintain your safety and escape potential embarassment seems to be to avoid that bridge -- or maybe, all bridges.
But, then it happens again -- this time while you’re standing in line at a grocery store. You’ve just emptied your cart onto the conveyor belt and the panic hits you. Your heart is racing, you’re sweating, and you can’t seem to get enough air. You imagine that you may collapse right there, or you think about the embarrassment of losing control, and visualize yourself screaming and running out of the store. But, somehow you manage to stand there while the clerk completes ringing up your purchase. When you exit the store, your legs are weak and your hands are shaking, but you feel a sense of relief. You now start to avoid long grocery store lines -- or maybe, waiting in any lines.
Your safe zone continues to be defined by these experiences. You may begin to drive only on roads with an emergency pull-off shoulder. Maybe you just shop at small convenience stores with less people and an exit that’s always nearby. Or, perhaps you only venture out when you are with someone who will be able to help you in case you start to panic again. In a worst case scenario, you don’t leave your home at all.
The Importance of Getting Help Early
The symptoms of agoraphobia can be frightening and potentially disabling. But, the majority of sufferers find significant relief with treatment. The sooner treatment begins after the onset of agoraphobia, the more quickly symptom reduction or elimination will be realized. However, even those with long-term symptoms will generally experience improvement with treatment, and most will regain the freedom to resume many of the activities they once enjoyed.
Source:
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.
