Phobias

Have you developed agoraphobia?

By M. Johnson

Published on 25th November, 2021

For many people these days, lockdown has meant staying indoors and self-isolating. Agoraphobia is a type of anxiety disorder that can leave people feeling housebound for years. For some people it comes on suddenly. If you have been dealing with agoraphobia for a long time, since the COVID-19 pandemic, you might have experienced the condition getting worse over the last year because lockdown conditions restricted you from leaving the house.

If you are naturally an introvert, lockdown may provide a legitimate excuse or the perfect alibi to stay at home. You might be affected more than others if you have been struggling with pre-existing anxiety disorders such as social anxiety, OCD, or a panic disorder that stems from severe anxiety. At times it might feel like a really hard condition to manage. In certain situations, you might develop a mindset that prevents you from stepping outside. The uncertainty of ‘small talk’ with neighbours fills you with dread. Working through the anxiety can positively help to stop the problem from growing into full blown agoraphobia.

We all have personal ‘lockdown’ days when even answering the phone feels too much. If it normally takes an enormous effort to answer the phone, you might prefer to live with your phone set on ‘do not disturb’. Alternatively, you may prefer to communicate via text messaging and email instead. For some, the ringing phone is like a force-field that can trigger a freeze response. This feels more intense especially if it’s from an unidentified caller. In extreme cases of anxiety, initiating important phone calls such as phoning the doctor or other official calls can be a struggle.

I can breathe again when the phone stops ringing!

Agoraphobia, a similar mental health condition to social anxiety, is more an extreme discomfort of being around people. Some people cannot stand being noticed, or simply the attention of being looked at can trigger anxiety. They are much more aware of hyper-vigilance, and so agoraphobia feels much worse in crowds.

Causes of agoraphobia

Childhood trauma and the resulting PTSD

These can exacerbate feelings of general anxiety. If you’ve experienced long-term trauma in childhood, adverse events in the present can feel more intense. Some people feel like these are ‘last straw’ traumatic events. The emotional calluses that were formed through all the years in survival mode can feel picked at, stripped off and the world can feel a confusing, unsafe and overwhelming place.

If, for example, you are someone who has been repeatedly attacked in the school playground or experienced physical or sexual abuse at a very young age, you may be predisposed to struggle with your anxious feelings. This can take almost everything out of you so that even leaving the house for work, or visiting the doctors can seem daunting. Some of my clients have reported feeling faint if they’re out alone. Some people experience extreme anxiety as panic attacks.

Sexual abuse

Any attack on a person’s vulnerability, especially in the form of adverse sexual experiences, threatening and violent sexual behaviour (sexual assault, molestation, rape, threats involving weapons, sexual abuse, following or stalking behaviour, attempts to lure someone into a vehicle, cat calling, sexual harassment in the workplace etc.) can be a cause for agoraphobia.

Some people can develop sudden and severe agoraphobia after a traumatic event in adulthood. A female client recently described severe agoraphobia after abuse from a stalker incident.

Domestic violence

Violence at the hands of an abusive partner can cause symptoms of agoraphobia that is rooted in a fear of men. There can be many reasons for this, such as: helplessness over legal outcomes, fear that perpetrators of sexual violence are ‘getting away with it’, that not enough is being done to protect victims, the perception that people who commit heinous crimes are not being held legally accountable, insecurity over feeling victimised and defenceless, fear of injustice and reverse assault charges.

For victims of sexual abuse, you may find it difficult to ‘rationalise’ your feelings because it may not seem logical to you or others. You may have other underlying mental health conditions, so it might feel very real and plausible that a man will hurt you again. For you it may feel much harder because unlike some other anxiety disorders, your experience is founded in the abject truth of lived experience.

Complex mental health problems

Problems such as persistent and prolonged depression, if left ignored for a long time can lead to agoraphobia. Some people who have been diagnosed with bipolar disorder are known to experience agoraphobia in between cycles of mania and depression.

If your anxiety is related to complex-PTSD, you may want to keep it hidden from your family, especially if your trauma is related to abuse within the family. You may be concealing shame, hidden embarrassment or harbouring a pre-existing fear about going anywhere in case of a flashback ‘episode’ occurring in front of other people. Denial of your deeper rooted toxic shame, ‘fibbing’ or making light about it being ‘simply a depression thing’ might feel more acceptable to you while giving you a safe, temporary way to cover it up.

Serious illness

Sometimes agoraphobia can be triggered if you have suffered with any anxiety disorder or complex PTSD throughout your life, the agoraphobia can be debilitating and mentally exhausting. The COVID situation hasn’t helped because your immune system may be further compromised after invasive treatments like chemotherapy and your anxiety might feel worse. With more severe illnesses like epilepsy, the escalation of anxiety can trigger a full-blown seizure.

Disabilities

“I developed it very quickly after becoming disabled and had to leave my job years ago. I went from being extremely active and social to rarely leaving my house. I was devastated. I was so embarrassed. I went from a good job to living on welfare. My family turned against me, accusing me of being lazy. I had been diagnosed with fibromyalgia and chronic fatigue syndrome and I was so sick. Turns out it was severe complex-PTSD. I couldn’t go grocery shopping if my life depended on it. Luckily I had a friend who would do it for me. It’s come back again full swing since COVID”.

The pandemic has caused a lot of stress to most people. It doesn’t help your condition to be around people in stores because of the widespread panic, violence and growing desperation.

Outside influences

Influences such as listening to the news and hearing traumatic news stories about shootings, acts of terrorism and violence can exacerbate anxiety and symptoms of agoraphobia. Such events remain largely out of your control and can trigger past memories which serve as reminders of past trauma.

When it’s normal for it to be an ‘event’ to go outside, lockdown makes it even more of a difficult event for you because the fear of getting infected has made many people nervous about going out. The overhead of hyper-vigilance, the extra precautions of wearing a mask, keeping socially distanced, strategising which areas to avoid makes it even more uncomfortable for people to leave the house.

I’ve dealt with this for sure when things get rough. I know how tough it is, but you’ve got to keep going out before it gets to the point of no return.

Social isolation

For some people, the lockdown has caused a return of agoraphobic symptoms, reversing any progress of getting themselves outdoors before the pandemic. Normally, people get their socialising in the workplace, but working from home has taken this opportunity away from a lot of people.

All those things that were once considered normal, are now being done online, like doctor’s appointments and food shopping has created a sense of adversity about old ways of doing things and familiarity with a ‘new normal’ about connecting with the outside world via the internet.

Symptoms and struggles with agoraphobia

For some, all sense of safety is lost because of altercations with angry others, anti-maskers, fear of infection makes people paranoid about social distancing measures, conscientious about being two metres apart, while dealing with others making angry 'reminding' gestures about other people’s distance.

If you are afraid of going out and the idea of meeting people again is a scary prospect, you might find yourself hoping that lockdown will be extended. Remaining connected with the outside world is necessary for your mental health and wellbeing in general. Subsequently, if you previously got your connection needs met through regular or occasional meetings with friends and family, and this option is not available in the usual way these days, then you need to be mindful about this and try to find a healthier way to deal with the underlying anxiety.

Similar to social anxiety, for some people agoraphobia means fearing anything that has to do with people. Symptoms come and go, ranging from manageable to severe. Sometimes it is hard to distinguish overlapping symptoms of depression, especially on days when you are barely able to drag yourself out of the bedroom to eat and get to the bathroom.

Normally, on sad, empty days, I can go to bed and reset for the most part, but the uncertainty of not knowing when the anxiety of having to face others will lift is painful. I know how irrational it is, but just being aware of it doesn't help.

If you feel you’re suffering all alone with this condition, please know that you’re not the only one.

Some people feel ashamed about their feelings, because they don’t feel safe or in control and find it hard to function outside the house. This gets worse the longer they stay in. Some of this anxiety can be related to past trauma and can easily be addressed through therapy.

Agoraphobia is a painfully bewildering condition that can affect your interpersonal relationships.

You may be familiar with the feeling of ‘going backwards’, when you just want to hide and it feels more comfortable to stay at home rather than going anywhere, even after being invited by friends. Your relationships and friendships bring you a mixed sense, a push-and-pull-feeling. You might feel bad about your feelings, that people are not approachable.

If you are not good at making friends, you might even make false self-judgements, thinking that you’re freaking other people out, or that you are being deceptive, bad or just different. You might withdraw from people, sheltering yourself, or staying at home way more often than normal.

“There's the rebound effect where I crave human connection, but it's pretty hard for everyone one else when I've been so diligent in avoiding everyone during those ‘storms’. It's rough because no one understands, but how can I expect them to when I myself realise how crazy it is!”

Going out can feel completely draining, like the life has been sucked out of you. Being in traffic, in front of crowds and in small enclosures is deeply distressing. Waiting in store checkouts can cause reactions of nausea and sweating, ranging from minor anxiety to a full-blown cold sweat panic attack. Sometimes, when anxiety is so badly triggered by certain noises and lights, you might find yourself restricting going out for things unless they are absolutely essential.

Fear grips people to an extent that the only way they can go places is with a partner, or to travel in a state of trance using sedative medication. A food shopping trip or a visit to the doctors can be extremely daunting, sometimes only made possible to cope by calling a taxi on needing to go out. Staying ‘inside’ protects from feeling ‘fully outside’ because asking for a ride to the shops or waiting in the car is the preferred option, while someone else, usually a partner or spouse goes into the shop. It is not uncommon for agoraphobia sufferers to wait until it is dark before putting the rubbish out or leaving it until you’ve nearly run out of food before going shopping.

I can’t even be around my caregiver.

What to do about agoraphobia

The best treatment for agoraphobia is psychotherapy because working through the underlying anxiety helps to alleviate symptoms. Here is a list of alternative coping strategies which could provide a temporary fix for your condition.

Psychotherapy for agoraphobia

Psychotherapy can help you by enabling a safe and confidential space with a psychotherapist for dealing with any persistent anxiety or underlying PTSD that is causing your agoraphobia. Some people have experienced relief from agoraphobia with CBT (Cognitive Behavioural Therapy). Although CBT can help someone to examine thoughts in relation to resulting feelings and behaviour, many also experience relapse and find themselves back in therapy with returning symptoms. At times it might feel a really hard condition to manage, it isn’t a fun disorder but working through the anxiety in therapy can help to make enjoying going outside possible.

Medication

Calming high arousal levels with medication can be viewed as a temporary fix and it works by bringing everything down to a manageable level, to reduce anxiety, calming the system just enough to give you the necessary lift to help you to start getting yourself out gradually. The unfortunate downside of medication is the side effects that can leave you feeling very spaced-out and lethargic.

Mindfulness

This is an east-meets-west approach for emotional regulation that can help you connect in a deeper way with your mind and identify parts of your body where you might be holding on to repressed negative energy.