“With no warning, I feel as though the world is crashing down around me, and I am about to die. My heart starts pounding, feels like it’s beating really fast and I can hardly breath. I start to feel really hot. I feel dizzy like I am about to pass out, and sometimes my vision starts to get blurry and turn to black. I just have to escape wherever I am at. It usually passes pretty quickly, but I am left feeling sweaty, disoriented, and embarrassed. I just need to get home.” Anonymous
Imagine for a moment one of your worst fears. If you can’t think of something terrifying, try one of these examples: your driving on a busy highway and hit a patch of ice, your in an airplane and it’s about to crash, you wake up from sleep and hear a stranger trying to come through your front door. Scary thoughts? Now think about how you would feel. Your body would begin to release large amounts of chemicals that trigger the fight or flight response. Your heart begins to race, your body starts trembling, you may start to sweat, become dizzy, and unable to breath….you feel like your about to die.
If you have ever been in a life threatening situation, you can probably easily recall those feelings and relate. Now try to imagine, if you can, how you would feel if this intense feeling of panic happened to you, for no reason and without warning, while you were riding a bus, and you felt trapped, terrified, and afraid of humiliation. Would you want to get on that bus again? Or might you avoid public transportation in the future? Some people are able to chalk it up to an unusual occurrence, and give the bus another try, but to some people the fear was so intense, they just can’t bring themselves to get on the bus again. This feeling of sudden panic happens to some people in all kinds of places or situations, not just my example of a bus. Sometimes simply driving a car, shopping at a store, or just being somewhere in which there are a lot of people, can trigger these episodes of panic.
When this happens to someone, it can lead to a disorder called panic disorder with agoraphobia. The root fear is believed to be a fear of being unable to escape, or seek help, if these feelings of panic happen again. The quote at the beginning of this article was given by someone who is living with this condition.
Agoraphobia is a type of phobia that often prevents a person from being able to leave their home. The home literally can become like a self imposed prison, because the person has a very real fear of feeling intense anxiety, that may progress to severe panic, if they leave their home (place where they feel safe). So we can see how this fear of something scary and embarrassing happening to an individual, in public places for example, could result in dysfunction that ranges on a continuum of severity, from just avoiding certain types of places, all the way to being completely confined to the home. In some cases, the person can travel, but will only do so if a trusted person accompanies them, so they will have someone to help them if they need it. Others are able to leave the home, but often confine their excursions to places within a set radius of their home, or to places where they feel safe visiting. The main component is that the feared places are avoided to attempt to control anxiety.
Agoraphobia most commonly develops, in some people, after a person experiences one or more of these severe episodes of panic (also known as a panic attack) in public. It can also occur in someone without panic attacks, but is not as common (APA, 2000). The word agoraphobia actually is taken from the Greek language which translates the word as “fear of the marketplace”. When used in mental health, agoraphobia is most simply defined as “a fear of anyplace where escape may be difficult” (Psychology Today, 2017).
A panic attack is defined as: the sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom (APA, 2000). The person may feel as if they are losing their mind, or about to die. For example, the person may think they are having a heart attack, or other catastrophic health condition. The physical symptoms that the person feels can include any, or all, of the following: chest pain, heart racing/increased heart rate, shortness of breath, hyperventilation, upset stomach, sweating, chills, dizziness, vision problems, or choking feeling. A panic attack is usually short in duration, lasting an average of 10 to 15 minutes. However, despite the quick resolution of the acute symptoms the person is left feeling exhausted, anxious, and embarrassed.
Panic disorder is actually a separate disorder, and is one of the anxiety disorders, that can occur alone, or in combination with agoraphobia. Panic disorder is one that perpetuates itself. In panic disorder the person usually has an initial panic attack. After the first panic attack, the person obviously does not want to feel that way again, so they develop an intense and persistent fear of having ANOTHER panic attack. This is called anticipatory anxiety. These constant feelings of fear, about having another episode of panic, can actually be the cause of another panic attack, and so the cycle continues. This is panic disorder. Panic disorder may precede agoraphobia, or vice versa. But in the majority of cases, panic disorder often progresses to include agoraphobia, after one or more of these attacks occur in some public place (APA,2000).
Panic attacks are hard for some to understand if one has never experienced the condition. We all have mild anxiety at times, but this is not the same as a panic attack, even severe anxiety is not the same. During a panic attack a person may become completely out of touch with reality, with a real and immobilizing feeling of imminent danger. It’s a very severe state of panic, in which the fight or flight response is fully activated. It’s not surprising that it’s so difficult for other people to understand. They can’t see, or feel, the imagined impending doom that the other person is feeling, and to the onlooker the person seems to be completely irrational. The fear the person is feeling truly is irrational, but to the sufferer it feels completely real.
When the environment outside the home feels unsafe it can be debilitating, and causes significant problems for the person, such as not being able to work, attend school, shop, ride a bus or airplane, travel, and/or visit public places. Complications can include financial difficulty, substance abuse, social isolation, and depression. Psychology Today (2017) estimates that approximately 1/3 of people who have this condition can’t leave their house and are unemployed.
There is not one specific cause of the anxiety disorders. Anxiety disorders may develop after a significantly stressful life event. Some people are able to get through stressful events better than others. Strong support systems and coping skills, can help a person navigate through a highly stressful event, or trauma, without developing an anxiety disorder. What predisposes some individuals to develop an anxiety disorder is not clearly defined, but it is believed to include a combination of genetics, environment, coping skills, and previous life experiences.
The good news is that if a person is able to receive effective treatment, approximately 75% of these people do recover. Exposure therapy is a common and productive treatment for phobias. Exposure therapy involves gradually exposing the person to the source of their fear, in baby steps and with the help of a trained therapist, until the anxiety gradually begins to lessen to a manageable level. Other treatments often used, usually in combination, include cognitive behavioral therapy, talk therapy, therapies aimed at learning relaxation techniques and coping skills, and medications. Medications commonly prescribed to help treat the symptoms of anxiety include: antidepressants, anti-anxiety drugs, and beta-blockers (NIH, 2016). It’s worthy to note that medications alone generally will not cure anxiety disorders. Effective treatment generally will use medications to help minimize the symptoms of anxiety, while at the same time the person participates in therapy designed to help a person learn to cope with anxiety, and/or work through issues that can be contributing to anxiety.
As I mentioned above, anxiety disorders can often be prevented, and people can recover. Having a strong support system is a very important part of both prevention and/or recovery. If you know someone who has an anxiety disorder, try to offer the person empathy and support. Maybe discuss with them what you have learned about their condition. They will most likely be surprised, and grateful, to have someone to talk to who believes them. Many people with anxiety suffer alone, because it’s hard for those around them to understand what they are going through.
If you suffer from anxiety, and don’t have anyone to talk to, try joining a support group for people with anxiety and/or depression, if one is available in your area. Having the support of people who understand, and won’t judge, is very beneficial. I have posted some links below that may be able to help you find a support group, and mental health proffessional in your area. I browsed through the lists in the links that I posted and found that physically located support groups, specific to anxiety, were not listed for some U.S. locations. If you have trouble finding a physical support group to attend in your area, there are now many online options for support groups as well. The online support groups can be just as beneficial, the benefit comes from being able to connect with others who can relate to what your going through, and to offer each other support.
Another important part of a path to recovery is finding a quality mental health care professional, that can help you set up therapy, and assist with medications. Just don’t give up, sometimes finding the right mental health care provider that works for you, and the right treatment options for you, can be a process that takes a little time. But it can be accomplished and will only improve your quality of life in the long run.
I would love to hear your thoughts, comments, and suggestions if you would like to share in the comment box below. If you have something personal to share you are welcome to contact me directly using the Contact Form
Possible Resources for Support
- Anxiety and Depression Association of America
- Anxiety & Depression Online Support Groups
- Help for Social Anxiety and Phobias
- Panic Disorder Helpline 1 (800) 64 PANIC
- There are also many resources available if you visit the page I have posted with phone numbers for national crisis hotlines and helplines: Helplines and Hotlines
American Psychiatric Association [APA]. (2000) Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington D.C.
National Institute of Health [NIH]. (2016) Anxiety Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
Psychology Today. (2017) Agoraphobia. Retrieved from https://www.psychologytoday.com/conditions/agoraphobia