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Community Health Needs Assessment

Outside Calm May Mask Inner Fear for People with Agoraphobia

Agoraphobia, whose Greek translation means “fear of the marketplace,” is an anxiety disorder that involves intense fear in places or situations from which escape might be difficult.  People with agoraphobia often avoid going outside of their own home, fearing that they may have a panic attack if they suddenly begin to feel trapped or boxed in.  With onset most typically occurring in the late teens or early twenties, people with agoraphobia begin to believe that the only way they can cope with their extreme anxiety is to withdraw and avoid most social situations.

In understanding agoraphobia, it is helpful to realize that most of us have been around someone who was one step away from a panic attack.  When you go to a school concert, the mall, a ball game, or the grocery store, there is quite possibly someone a few feet away who is fighting the urge to walk, or run, away from that place as fast as they can possibly go.  However, unless we know that person well, we may have no idea.  When people with agoraphobia do go to feared situations they may appear relatively calm or even detached on the outside.  The first point of understanding agoraphobia is to realize that the person’s inner world may be very different than their surface appearance.

I met my wife when we were in college – graduate school to be more precise.  I had only known her a few weeks when she had to give a presentation in one of our classes.  I was impressed.  Her note cards were well organized, she looked very professional, and she had clearly practiced.  After class I commented on how well she did and how easy it all seemed.  “I was pretty scared,” she confessed.  “I’m sure everybody could tell how nervous I was.”  Her response baffled me.

While my wife does not have agoraphobia, I think back on that incident when I treat people with agoraphobia.  As I listen, I have to remind myself that I may have little immediate understanding of a person’s inner world.  In fact, I think that many people with agoraphobia develop an uncanny ability to turn their emotional volume to “very, very low” when they are around other people.  However, inside they may be about to jump out of their skin.

One of the tragedies of agoraphobia is that avoidance can become self-perpetuating.  In the short run, people with agoraphobia do get some immediate relief by staying home, choosing to miss events or people that they truly enjoy rather than deal with intense anxiety.  They may start to believe that the only way to deal with the anxiety is to avoid things.  The starting point of treatment is to challenge that belief.

The foundation of treatment for agoraphobia involves helping people learn to cope with their fears and anxieties in ways other than avoiding them.  Fortunately there are many different kinds of treatment available.  Psychotherapy is often quite effective for agoraphobia, as are medications.  Conquering overwhelming anxiety takes time, lots of support, and practice, but the benefits are well worth it.  If you know someone with agoraphobia you may be able to assist them with the first step.  Try not to downplay their anxiety, but also tell them that you will help them work through it.  People with agoraphobia can learn to conquer their fears, and the rewards of doing things they truly enjoy make it well worth the effort.