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Hi – I am a psychiatrist with over 30 years’ experience of working with agoraphobia and have written “Freedom From Agoraphobia.” This is a program for overcoming agoraphobia both for people who have the condition and for therapists. In order to make its contents available to more people, I shall be sending in the educational portions of this book as articles free to subscribers to Phobics-Awareness.org. I am not including most of the assignments because I want it to be absolutely clear that I am not attempting to provide treatment over the Internet. Indeed, since I am an M.D., I cannot express my point of view without being concerned about liability (as we are hearing about so much in the news lately). So please note the following disclaimer before reading further:
Any medical information in these articles is not intended as a substitute for informed medical advice and you should not take any action before consulting with a qualified health care professional.
Through these articles, I hope to share my particular take on agoraphobia and the means of overcoming it. Thus, I make no claim to represent or even agree with the mainstream of medical thinking about the condition. (I’ll let you know when I depart from this as far as I know it.) I only claim to have a lot of experience and some good success with agoraphobia. Hopefully, sharing with you what I have learned over the years will be both educational and encouraging – which was my purpose in sitting down to write in the first place.
Mark Eisenstadt, M.D.
Article One
Agoraphobia and Panic Disorder are closely related conditions involving panic attacks and behaviors designed to avoid them. Panic Disorder is simply the condition of having panic attacks. You probably do not need a description of these, but for anyone who does, here goes: panic attacks are episodes of feeling extremely frightened together with having a number of physical symptoms related to fear - such as shortness of breath, rapid heart rate, feeling your heart pounding, butterflies in the stomach, sweating, feeling weak-kneed, tingling in hands and feet, dizziness, feeling that you are likely to faint, go crazy or die and feeling that you or your surroundings are not quite real. Happily, few people experience all of these each time they have a panic attack. (If just reading that list of symptoms caused you to feel some of them, take heart – you’re reading in the right place.)
Panic attacks generally last from 20 minutes to one hour. You often feel drained or empty after they are over. Some people even feel a sense of relief or that the pressure has been released.
Often, it seems that the panic attack came on for no reason. Such panic attacks are called “Spontaneous Panic Attacks”. However, as you come to know more about your panic attacks, you will find that they usually are not spontaneous. Instead, many people have learned how they "work themselves into a panic attack". For example, a common way of bringing on a panic attack is to fear that you are going to have one and then becoming more and more anxious at the thought. This kind of anxiety is called "Anticipatory Anxiety" because it is anxiety created by the anticipation of something awful happening (the panic attack).
If you have panic attacks at least once a week or have feared having another one for at least four weeks, you meet the diagnostic criteria in Psychiatry for Panic Disorder. (See DSM IV in the reading list at the end if you want the full, official definition of the condition.)
I do not need to tell you that panic attacks feel terrible. In fact, it may be that people try to avoid this experience more than any other physical and emotional state. So people are very motivated to find ways to not have them. For many, it seems that panic attacks are brought on by particular places. A person trying to avoid panic attacks will, of course, avoid those places. As more and more places are identified as causing panic attacks, the individual's world becomes more and more restricted. Thus, in some few, very severe cases, people will not leave their homes or even their beds.
Having a group of places that one avoids is called "Agoraphobia". The “agora” was the marketplace in old Greece. Hence, the word literally means: "fear of the marketplace". Since so many agoraphobics have trouble at the supermarket, perhaps this is not such an outdated idea after all.
The agoraphobic often develops an area close to home in which she feels safe. Usually, she has also identified other “safe places”. The home of her parents may be one even if it is farther from her own home than she normally feels comfortable in going. A therapist’s office may become a safe place. Also, there are usually “safe people”. These are people (frequently close friends and relatives) with whom the agoraphobic feels safe. Thus, with a safe person, she is able to go outside her usual radius from home or to other places she avoids when by herself. The agoraphobic often says that she feels safer when she is with the “safe person” because “there is someone there to help if I have a panic attack”. On the other hand, she is usually aware, if asked, that the safe person really does not have any special way of helping in the event of a panic attack. Also, young children and even infants can be “safe people” because the agoraphobic feels that with them she can go places she would avoid if she were alone.
In this way, most people who have panic attacks also develop an avoidance pattern. So most people who have Panic Disorder also have Agoraphobia. Because of this, the two terms are often used interchangeably in these articles. However, to be precise about it, there are some individuals who have an avoidance pattern but no panic attacks and there are others who have panic attacks but no avoidance pattern. (This begins to sound like Lewis Carroll’s Cheshire cat.) As a result, there is officially a diagnostic distinction between Panic Disorder With Agoraphobia, Panic Disorder Without Agoraphobia and Agoraphobia Without A History Of Panic Disorder. In my experience, they usually go together, so I will assume that this is the case for you. From here on, therefore, I will speak as if you have both panic attacks and an avoidance pattern.
Agoraphobia (really "Panic Disorder With Agoraphobia") usually crops up in the '20s. For reasons we will examine later, it fluctuates between better and worse over the years. This means that most people experience periods of having many panic attacks alternating with periods of having very few. Until you solve it by a program such as this one, effective therapy or working out your own solution, it always seems to come back.
Many more women develop Agoraphobia than do men. This does not mean that women are worse off, however. It seems that men often solve the same problems that result in Agoraphobia by turning to alcohol. Clearly, this is not better. Since you are reading this article, you are more likely to be a woman. So I will usually refer to agoraphobics as "she" rather than using the clumsy "she or he", "she/he" or "s/he". If you are a man, don’t worry. These articles apply to you just as much in every way. And reading something that speaks of agoraphobics as “she” may even help you overcome any lingering “macho” tendencies, if you have any.
Agoraphobics tend to be masters (mistresses?) at concealing the fact of their condition. The list of excuses they invent for not going somewhere can be truly impressive. I have had patients who had Agoraphobia for many years but whose families where completely unaware of it.
Different studies have found the prevalence of Panic Disorder and Agoraphobia to be 1.6% to 2.2%. This means that about one out of every 50 people will have it sometime in her life. Some estimates have gone as high as one out of every 20!
The prevalence of depression in persons with Agoraphobia or Panic Disorder is over 50%. This makes good sense for reasons that will be explained later. Also, some people give themselves a double whammy by having Agoraphobia and drinking alcohol as well.
Some words about growth and change
Reading a book is never going to cure your Agoraphobia. Change is. Change comes about by making what you have read into something that is your own. You have to put it into practice and test it out. You must make discoveries about yourself and the world. You need to treat yourself and others differently and have new experiences. In a word: you have to grow.
One of the nicer facts about life is that growing offers a way out of every psychological problem. This means that every such problem has a solution that results from our becoming more whole, more complete people. So, we must open our eyes and hearts and minds to more of what is true and really happening, both in us and outside us. This sometimes makes us more loving or more forgiving. We may need to become more accepting of our own and others’ frailties. We often discover more of who we are. Sometimes we find beauty where we only saw ugliness. Sometimes we learn to laugh at ourselves. And sometimes we learn to cry.
There are many ways for dealing with problems that do not involve growing. One can use a medication or other chemicals to try to get rid of the feelings. One can change one’s environment rather than oneself. One can try to compensate with food or relationships or excitement. You know the alternatives. We’ve all tried lots of them.
For those who seek it, however, there is a treasure to be found in the wilderness of each problem. And the seeker finally emerges as a more complete person.
But to grow takes doing. There are many excellent programs out there. They have many different approaches and many of them are quite effective. Different ones fit different people. That’s fine. My suggestion would be for you to find a program that not only enables you to overcome Agoraphobia, but which also leaves you better equipped to go through the rest of your life experiences.
Assignments for Chapter 1
Now that I have said that I will not be including most of the assignments, I am going to include the first one because it is such a vital part of educating yourself about your Agoraphobia.
1. See your doctor. There are two vital pieces of information you need from your family doctor or Primary Care Physician before you go on.
First, you need to know that you do not have one of the numerous physical conditions that can have the same symptoms as Agoraphobia. It could be quite disastrous if you assumed you had Agoraphobia when you really had a medical condition needing treatment that you never got. These conditions include thyroid disorders, certain heart problems, hypoglycemia, adrenal disorders and a number of others. See your Family Practitioner and tell her all of your symptoms. Ask to be checked out for the possible presence of a physical cause of those symptoms. Tell her that you are going on the assumption that you have Agoraphobia and need to know that you are not working on the wrong problem.
Second, ask whether it is harmful for you to have panic attacks. Although panic attacks are scary and uncomfortable, for most people, the physical stress of panic attacks is well within the range of what our bodies can tolerate safely. This is not surprising. If our built-in reaction to the threat of danger was itself harmful to us, our species would not have lasted very long. (Who would be around today if early man had keeled over with a heart attack at the roar of a sabre-toothed tiger?) So for your general peace of mind as well as for reasons that will appear later, it is most important that you learn whether there is truly any cause for you to fear panic attacks.
Final words
This concludes the first article for Phobics-Awareness.org. Future articles will cover the biology, physiology and psychology of Agoraphobia, three of the most established forms of treatment, the facts and myths regarding medications, family issues and more. Although I am sure you already knew much of the material in this first article, I hope you found some information of interest. I look forward to joining you next month – with an article that I believe has more information that will be new to you. Until then,
Peace,
Mark Eisenstadt, M.D You can now find the second article Here
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