Exact causes of agoraphobia are not known. There are physical and/or psychological causes linked to this. It is usually said to be a complication of panic disorder characterized by regular episodes of panic attack which can be very frightening, the person may feel that he is dying. The University of British Columbia Psychology Clinic says “Panic disorder seems to be a risk factor for agoraphobia. The longer people live with panic disorder, the more likely they are to develop symptoms of agoraphobia." According to Anxiety and Depression Association of America, about one third of people with panic disorder develop agoraphobia as they are always in guard for their next panic attack which shrinks their world.
It has also been found that long term use of tranquilizers and sleeping pills like benzodiazepines has also resulted in agoraphobia.
A traumatic childhood experience and history of drug abuse can also be associated as the cause of agoraphobia.
A woman in her 20s was working in a high rise building; her office was on the 25th floor. Everything was going good until one day when the elevator went bizarre it suddenly dropped from 25th floor and dropped down to 17th floor with a thud. The woman felt that she was almost dead she was numb when she came out. After this she dreaded going to the elevator she tried lot of times to overcome this fear but it just got worse. Once she was traveling in a train and this panic attacked her again. The tunnel through which the train passed triggered the same memory. Now, she isn’t able to travel by train, go by elevator and doesn’t leave her home until she is accompanied with someone she trusts.
There are various physical, psychological and behavioral symptoms related to the agoraphobia. Accelerated heart beat, nausea, break out in sweat, trouble in breathing etc are few physical symptoms. Psychological symptoms like the sufferer feels that he is going crazy, he fears that during an attack his heart would stop beating and he may die. He is also fearful of getting embarrassed of the panic attack in front of people. All this can cause depression, lose of self control, dread of being left alone. The behavioral symptoms of agoraphobia are avoidance that is avoiding the places like elevator, theatre, shopping mall etc where chances of panic attack are more. At times the person may take help of alcoholic drink or tablets to overcome this which can be fatal for health.
This is a story of an excellent student, a very good musician and a sports person this is how he was in his childhood days. At the age of six, his father abandoned him and his mother. This triggered panic attacks he was scared of being alone. When he was in sixth grade he stopped going out with his friends, going to school, playing his favorite sports and caged himself in the boundary of his room. This went on for years.
His mother did all she could but nothing happened. One fine day, he came across a magazine article which reflected his own life and read how that person became a millionaire later. He was really inspired and then he realized that his negative feelings were controlling him. From that day on he learnt to stop thinking about the Ifs and Buts, started positive talking, changed his negative thoughts to positive thoughts, regular exercises and stopped having caffeine.
These are just simple ‘self do’ ways to overcome this phobia. But always this is not possible. In severe cases help of a psychologist is needed. There is psychotherapy which includes persuasion, reassurance, suggestions so that the person is motivated to overcome this. There are other psychotherapies like cognitive behavioral therapy (CBT) , interpersonal therapy, psychodynamic therapy, and family therapy.
Cognitive Behavioral Therapy or CBT, there are two parts cognitive part which focuses on learning about the causes of anxiety and panic and practicing deep breathing exercise. The second part is Behavioral therapy in which the person is made to confront the panicking situation in a safe set up with the therapist and slowly the patient realizes that what he thinks is not what happens.
Agoraphobia can tear family apart but can also bring the family close to help the person feel better and overcome this. Interpersonal therapy wherein a bond is created between the therapist and the subject, the therapist tries to understand the relationship style and other relation style that are contributing to the agoraphobia. This is one of the best methods to overcome this phobia.
Support groups are also very beneficial in this. When one finds others too facing the same problem they feel more comfortable and together they try to overcome this.
No magic will help you overcome your fears. Its your will and support from others that can help you scare your fear.
The article is jointly written by Mrs Anu Goel (Counselling Psychologist) and Diksha Kharbanda