Agoraphobia - Not Really a Fear of Open Spaces or of the Marketplace
Put simply, people who suffer from Agoraphobia are afraid to go out, or to go out alone, because they know they will, or fear they might, have a panic attack.
What is it about panic attacks that the person fears?
The precise circumstances which prompt a panic attack vary from person to person. This all depends on their own personal journey to get to where they are. It depends under what circumstances they have experienced panic attacks previously. It also varies with the degree to which they are able to allow panics to rule their life.
There are two basic groups of agoraphobics
Those who are afraid of the discomfort and symptoms of the actual panic attack.
These sufferers often experience chest pain as a symptom and believe they may be having a heart attack. Usually they have had numerous medical investigations which have shown no evidence of this. Yet they remain unconvinced.
If this type of panic has happened in a public place, whenever they go to that place or a similar one, their survival instinct recalls the panic and gives them a warning. This warning gets interpreted as the start of an attack… and so it spirals from there.
Those who fall into this category are often quite glad when an ambulance is called so their symptoms get checked out yet again.
This group fears going out because they believe that going out can bring on a heart attack.
This second group are those who are afraid that if they panic in public they will lose control and make a spectacle of themselves.
Unlike group 1, for these one of their worst fears is that some well-meaning bystander will call an ambulance and they will be carted off to hospital.
A common panic symptom for this group is the feeling they are going to faint. If they faint they lose control of what others are doing.
The scariest situation for them is to be alone amongst lots of people. They have usually had past experiences of feeling faint in crowded places, on buses, etc. so the moment they put themselves in such a position, the survival instinct gives the startle warning. This is then interpreted as the start of an attack, negative arousal increases and the attack gets worse...
Those in this group are often able to go out if someone they trust is with them because they know this person will not allow an ambulance to be called and will keep others from interfering of they do panic.
In a sense, agoraphobia today does indeed often relate to a fear of the marketplace. Because sufferers generally feel more vulnerable in crowds they develop fears of going to places like supermarkets. Some sufferers become so afraid of their symptoms that they refuse to leave the house at all.
For those who are perfectly happy to go out provided a friend or relative is with them it is because they are reassured that, if the worst should come to the worst and they have an attack, this companion will be able to look after them. It is because they believe that everything will be ok should they have an attack whilst out with this person that they stop fearing the attack and therefore it doesn't happen.
So even though agoraphobia may seem illogical and inconsistent to non-sufferers, there is always a logic behind it somewhere.
Each sufferer has their own personal view of what is or isn't a problem situation. This must be taken into account when overcoming this fear.
I recall back in the early 1970's when behaviour therapy was flavour of the moment, there was little real understanding of what agoraphobia was.
As a panic attack sufferer myself it was incredible to me that those diagnosed with this would frequently be taken out on buses etc by a nurse-therapist in the belief that this would enable them to overcome their fear.
Naturally, when accompanied by a therapist, most patients were unafraid because they knew there was someone to look after them should they panic. However, this did nothing whatsoever to enable them to go out normally on their own.
The general principles for overcoming agoraphobia are the same as for all the anxiety disorders but exactly which techniques are applied to what must be tailored to the very individual beliefs of each sufferer.