We all have stress. We all have sadness. We all have fears. These are all feelings within the wide spectrum of healthy human emotion. But with that said, not everyone struggles with an anxiety disorder, a depressive disorder, or a phobia. These diagnoses mean that specific symptomatic criteria have been met, mimicking physiological problems were ruled out (i.e. a brain tumor is not present to cause personality changes), and timeline requirements (i.e. experienced for over one month) have been met.
To be professionally diagnosed with a specific phobia, you need to fit the following criteria:
- Unreasonable, excessive fear triggered by a specific object or situation
- Immediate anxiety response that is out of proportion to the perceived or actual danger at hand; appears almost instantly when presented with the feared object or situation
- A significant negative impact on functioning in school, work, or your personal life
- Symptoms lasting at least six consecutive months
- Not caused by another disorder
Every individual has encountered their own unique experiences, both positive and negative. Even siblings who grow up in the same household endure their own set of obstacles and joys because of their unique external lives (i.e. what they are exposed to in school, who they hang out with) as well as their unique internal lives (i.e. the way they perceive the world, where they are in birth order, their natural sensitivities). You might develop a phobia after surviving a car accident, but you can also develop it after a shared experience you had with your sibling, such as being physically abused by your parent. That does not mean that your sibling will necessarily develop a phobia too, though, because trauma manifests differently in each individual.
One of the most common and well-known phobias is agoraphobia. The National Institute of Mental Health defines agoraphobia as, “an anxiety disorder that involves intense fear and anxiety of any place or situation where escape might be difficult. Agoraphobia involves avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.” An estimated 1.3% of U.S. adults experience some level of diagnosable agoraphobia at some point in their lives, and this number is projected to exponentially increase because of the current Covid-19 pandemic.
People who have agoraphobia fear and avoid situations where they could possibly feel threatened, judged, helpless, embarrassed, trapped, or out of control. This description makes sense in the context of avoiding a concert because of its overcrowding potential or avoiding a shopping mall because its large emptiness makes them feel out of control in their environment if something goes wrong. The problem with the onset of Covid-19 is that society not only normalized but encouraged individuals to stay inside of their homes and away from public spaces in order to remain safe and uninfected. This reality has exacerbated the symptoms of agoraphobia that many individuals already had, and has also pushed a lot of newfound people into being within the criteria to be diagnosed with agoraphobia.
Whether you have an official diagnosis of agoraphobia or not, your struggles with these feelings are valid. Feeling considerable anxiety about every element of Covid-19 is natural, and means that you are paying attention to what has been going on in the world. This anxiety can push you to be vigilant about wearing your N95 mask, washing your hands when you touch door handles, only hanging out with individuals whom you know are careful, and eating healthy to support your immune system functioning. But this level of anxiety can very quickly and easily increase to a point where it is no longer serving you. Pandemic anxiety can turn into pandemic agoraphobia if you are starting to completely avoid public places due to its germs, going beyond what the Centers for Disease Control (CDC) recommends for staying safe, and/or feeling very high levels of anxiety when you drive further than a few miles from your home.
Many times, individuals who struggle with panic disorder develop agoraphobia because the very thought of having a panic attack in a public space makes them avoid leaving the house. Other individuals who are at risk of developing agoraphobia are those with substance use disorder, childhood trauma, a family history of agoraphobia or other mental health disorders, unhappy relationships, and most coinciding with the pandemic, obsessive-compulsive disorder (OCD). If you think you have or are developing agoraphobia, it might be helpful to get bloodwork done to make sure that your symptoms are not being caused by a medical health condition, such as hyperthyroidism (which tends to mimic panic attack symptoms).
It may also be helpful to you to consider following these tips to alleviate your symptoms of agoraphobia:
- Identify your triggers. If you start to question your moments of high anxiety and think about what you saw or did before the start of this anxiety, then you can start to slowly figure out what areas of your life you want to spend more time and effort nourishing. This knowledge is exponentially helpful in breaking the relationship between the anxiety source and the actual anxiety because you can cut off its power source. Once you have a better idea of what your triggers are, you can start to slowly face them by slowly exposing yourself to them, working with a therapist, doing your own research to prove to yourself that your trigger is statistically not as dangerous as you are making it out to be, etc.
- Avoid alcohol. Being under the influence of alcohol can drastically increase your levels of anxiety. Alcohol changes the amount of serotonin and other neurotransmitters in your brain, which can worsen anxiety. Alcohol-induced anxiety can last for several hours, or even for a whole day after drinking. This extra anxiety that is exacerbating any agoraphobia symptoms you might be experiencing can be avoided.
- Build up your coping skills. It is really important that you have a toolbox of healthy coping skills to lean on when you are feeling anxious. If you become well-practiced in these coping skills and find which ones work well for you and which ones you could do without, then you can start to integrate the ones you like into your daily routine. When you are ready to face a triggering place or situation, you can walk into it with the support of these coping skills.
- Address potential underlying issues. There is a significant connection between panic disorder and agoraphobia, for example, so seeking medication, mental health treatment, and/or self-help for the panic disorder can help the agoraphobia to subside. Other examples of underlying issues contributing to agoraphobia may be carrying trauma from a violent crime or other life-threatening experience, genetic predispositions, or having another phobia.
- Seek professional help. You deserve to live a life that is not weighed down by agoraphobia. If you feel comfortable opening up about these feelings, you can be helped. There are so many psychotherapy options that you can try in order to feel better. Cognitive-behavioral therapy and exposure therapy are the two most popular treatment modalities for treating agoraphobia, although every individual is different and requires different care. Seeking support under the care of a mental health professional can enable that you are not pushing yourself to step into your triggers too quickly, making sure that you never feel alone, and helping you to be evaluated for possible anxiety medication (if that is something you are interested in trying).
- Consider going to a feared space with someone you love and trust. It is okay to want to tackle your most feared places and situations with someone you love. Having a ‘safe’ person to hold your hand or talk you into pushing past your discomfort as you step into a triggering scenario still very much means that you are pushing past your discomfort. Your safe person can be there to validate your feelings, remind you of some of the coping skills you may like, and show you that the situation you are in is completely safe.
- Acknowledge when your fear of something is in the realm of ‘normal’. Fears are not only normal but needed. Fears, when rational, keep us safe. Being afraid of driving 100 mph or riding a bike without a helmet, for example, could make the difference between life and death. But when a fear turns into something that is inhibiting your daily functioning and level of contentment, you may want to assess whether your fear has crossed over into becoming unhealthy. This may look like your loved ones being worried about you, your anxiety levels being noticeably higher, or realizing that your fears are blown out of proportion. You were once able to keep your fears at bay, and you can get back to that sustainable way of living!
- Stick to realistic goals. Beating yourself up for not being able to go on a plane because of your agoraphobia, for example, is only making yourself more disheartened. Instead of getting emotional that you cannot seem to hop on a plane, you can start very small by participating in activities like looking at photos of planes on the internet, watching a movie with a plane scene in it, or going on a more minor and controlled means of transportation like the bus. Once your mind realizes that you can tackle these small steps, the big goals you have to beat agoraphobia won’t seem as unattainable anymore.
- Do not follow media sources that increase feelings of anxiety. You already have enough on your plate. You don’t need to be constantly retriggering yourself and making yourself more afraid. Media sources should be looked at for news or entertainment and that is it. Constantly feeding your mind images and stories of how many people are dying from Covid-19 every day, for example, is something you do not need to know.
- Use logic. Humans are generally skilled at justifying even the most senseless decisions. The more an individual wants to do something (no matter how illogical), the more they can find convoluted but nevertheless supportive reasons for doing it. But logic can be a good friend. When you are feeling the wave of anxiety about doing something that is triggering your agoraphobia, you can talk to yourself logically about the actual (and not perceived) risks involved in doing the thing you’re scared of. Usually, it can be concluded that your anxiety is exacerbating an objectively safe situation.
Remember, developing agoraphobia is not your fault. Stress manifests in all different ways, and you don’t get to hand-select which parts of your body and mind are affected. With the onset of Covid-19, everyone has been carrying way more stress and anxiety than usual. The reality of living through a pandemic (which may turn into an endemic) has most individuals more concerned with germs, illness, and unsafe situations. With that said, agoraphobia is becoming more prevalent. The one silver lining of this increasing prevalence is that, hopefully, agoraphobia will be more researched, more understood, and less of a stigma. If you feel like you have agoraphobia (diagnosed or not), find solace in knowing that it is considered to be very treatable. You can feel better.
For Further Reading:
Mathew, H. (2014). Un-agoraphobic: Overcome anxiety, panic attacks, and agoraphobia for good. Conari Press.
Pollard, C. A., & Zuercher-White, E. (2003). The Agoraphobia Workbook: A comprehensive program to end your fear of symptom attacks. New Harbinger.
For Further Information:
Bartley, L. (2020, March 25). I conquered my fear of leaving the house – lockdown will hinder my recovery. Metro. Retrieved February 8, 2022, from https://metro.co.uk/2020/03/25/agoraphobia-coronavirus-12442331/
Bobbi Wegner, P. D. (2021, May 25). Agoraphobia: Has Covid fueled this anxiety disorder? Harvard Health. Retrieved February 8, 2022, from https://www.health.harvard.edu/blog/agoraphobia-has-covid-fueled-this-anxiety-disorder-202103152409
Iles, A. (2020, April 22). Managing agoraphobia during the COVID-19 pandemic. Priory. Retrieved February 8, 2022, from https://www.priorygroup.com/blog/managing-agoraphobia-during-the-covid-19-pandemic