In this chapter, Dr. Claire Weekes discusses the fear of leaving the safety of home. A common, and often confusing symptom of agoraphobia. She discusses accompanying her patient to an eye appointment and how she spoke to the doctor about this womens symptoms and how this may affect her vision during the appointment. (Let's remember how anxiety, fear and panic affect the human body with physical symptoms). The Opthamologist told her that he was skeptical of what she had told him as it was in the early years of before nervous illness (aka anxiety symptoms and disorders) were talked about and understood. We have so much to be thankful for with all that we know today about anxiety. In the early years there was so much unknown - misunderstandings and assumptions about those who were "housebound" and because so little was spoken about many felt alone in their sufferings.
People often suffer in secret.
All too often people suffer in secret. They often feel too ashamed, self-conscious, and embarrassed, to discuss what they are feeling or thinking with anyone else, even their own family doctors. They often withhold this information for fear of what others may think of them. It is not uncommon for those suffering from agoraphobia to avoid busy markets, crowds, or even being alone. Many are afraid to go to the supermarket alone and so they take a child or someone else with them, and they may even send someone else to go into the store for them. Supermarkets are just an example of a public place that brings on much anxiety and panic to a sufferer. Agoraphobia does not limit itself to grocery stores but it could be just about any public place. It is not uncommon for those suffering to pass up promotions at work simply because the promotion may include more responsbility such as traveling far from home or even flying on the plane to another state or country. This fear is difficult to explain to others because the sufferer often does not understand themselves why they are this way. At one time they know they were not like this and they often cannot make sense of why they are like this now. They often feel frustrated because what used to be easy has now become difficult for them. But as Claire Weekes points out, once people in this position understand there is a reason for this and that they are not alone (many suffer with the same experience) they are more open to talk about their experience and are eager to learn ways to overcome it. Dispair turns into hope!
So what are agoraphobics really afraid of?
You have heard it explained as "fear of the marketplace" and/or "fear of open spaces" but it is not this at all. Dr. Claire Weekes explains that it is not a place that is feared but instead the sufferers interpretation of their inner physical experience - they fear their own stress reaction to stress, anxiety, panic that involves dizziness, heart palpitations, sweating, racing thoughts, etc. and fearing that these sensations will happen in a place where they cannot easily escape or cope and they fear making a "fool of oneself". Fearing what others may think should they "lose control" only escalates the stress response they are already feeling in their bodies and minds. The sufferer mistakenly thinks that outsiders will see what they are feeling when most times noone on the outside can even tell. It is these things that causes people to stay close to their "safe" places, people and things. This is why they often sit in the back of meeting halls, closer to the door and may even look beforehand where the bathroom is, so they can easily step out without drawing attention to themselves should their discomfort become unbearable. Avoidance behaviors are most common and typically cause sufferers to avoid being in places where escape may be difficult. Some examples are standing in line, riding in an elevator, riding/flying on public transportation, even sitting in a car at the stop light or being stuck in traffic.
Symptoms often begin with palpitations, dizziness, weakness, feeling faint or that they may "pass out" or collapse. Agoraphobia often begins after a person experiences their first severe panic attack. The experience alone is so traumatic that it leaves a lasting impression, so much so that the sufferer will do whatever it takes to avoid feeling that way again. If the first major panic attack happens in the grocery store (for example) the sufferer may want to avoid grocery stores because the experience was so traumatic that they fear it might happen again if they go in there. Much of this is caused by the brains memory, reminding the sufferer of "Hey, remember what happened the last time you were in there? Maybe it will happen again. Maybe it will get worse." And it is the fear alone of that happening that promotes the likelihood that it will. So, sufferers have a tendency to stay closer to home, take short trips, and venture out when they feel less at risk of having an "attack". Their traumatic stress experience has sensitized the person to the point where they notice every little symptom in their body and are alerted to the point where they stay guarded wondering when it may happen again. Nothing is worse than feeling like "attacks" spring up without warning - so the sufferer gets very "in-tune" with how they are feeling at all times. The experience is so horrifying that over time through avoidance behaviors they are reluctant to step into situations where they can escape or that will open up the possibility of embarrassment.
Many have taken trips to the Emergency Room fearing a heart attack, stroke, brain tumor, feeling like they cannot breathe due to hyperventilation only to be told it is "just anxiety". It is often hard to accept that something more serious isn't going on. They feel the doctor must have missed something and still fear their body symptoms may become worse and they may be found helpless and hopeless - afraid that symptoms will come when help cannot be acquired (again, another reason to stay close to their safe place, person and/or thing). Agoraphobia can affect anyone, of any age, any sex, any culture, and anywhere in the world.
What is your most disruptive physical anxiety symptom?
With all the physical symptoms of anxiety there is, one of the most dreaded is the sensations of "dizziness" and "light-headed-floating-whirling". These sensations alone cause so much fear only adding to the already existing symptoms of anxiety. It is hard for people with anxiety to accept that this sensation is a common and normal physical symptom of their anxiety. Thoughts of "it must be a brain tumor" is often a worry or concern even after trips to the doctor have assured them this isn't the case. It is the most disturbing symptoms that keep people from wanting to venture out - whether to grocery shop, appointments, and sometimes even just leaving the house to get the mail in the mailbox. There is always an underlying fear that "what if something else is wrong and I will have no help." So it is common for those suffering with Agoraphobia to want to stay home unless they are accompanied by a "safe person" or even a "service animal". Many people nowadays bring pets with them so they do not have to go anywhere alone. As for anxiety sufferers, they are often used for distraction purposes to bring feelings of comfort, or perhaps feelings of safety. If the animal is genuinely trained as a Certified Service Animal they would know what to do should they fall or require medical help. But, unless a person has been diagnosed with an actual medical condition that would require this kind of help, it is mostly used for feelings of "emotional security". Even things like vision are often affected by anxiety - so eyesight may seems blury or hazy during episodes and it's common for anxiety sufferers to over-estimate the likelihood that something terrible might happen to them should they experience that in a public place or far from home alone.
Most times there is no hidden mystery to anxiety. Some will say there is something from their past that they haven't dealt with or some past trauma that keeps it going - and for some, this may be true. But what is more common is the memories of past traumas, the past experiences of panic attacks that keeps people on edge. They continue to think, "if it could happen then and it came "out of the blue" then how is one to know when it will happen again?".
Understanding is an important factor to recovery.
Claire Weekes says that "so much depends on the doctors ability to explain why". THIS RIGHT HERE is so very important! Alot of the time people will go to the Emergency Room with their very first panic and/or anxiety attack experience. They go there for help believing something SERIOUS is wrong with them. All too often the ER doctor - who lacks empathy or even understanding - and says to you, "it's just anxiety!". Not really ever having an experience of their own to identify with - then says, "just take one of these pills 3 times a day for 10 days" with NO real explanation of whats going on inside the body and mind. You end up leaving with a sense of confusion but also fear of "when will this happen again". The longer a person goes without real understanding while experiencing repeated panic attacks, the bigger that fear is allowed to grow into darkness, dispair and isolation. With this increased fear, the world of the agoraphic often becomes smaller and smaller and until they REALLY understand what is happening and are given tools to break out of it, they are confined to their safe space and safe people.
Fear is such a normal, human emotion especially when we don't understand what is happening to us physically or mentally. Once a clear understanding has been achieved you can then put this understanding into action by moving forward using skills that will help you rewire your brain the truth about anxiety and panic attacks.
What's Your Experience?
In Chapter 2, Claire Weekes help us to understand that the fear of leaving the safety of home isn't really a fear of a "place", but instead a genuine fear of your own anxious, panicky symptoms.
- Has your anxiety or panic ever brought to you a point where you found yourself avoiding doing certain things or going certain places due to the fear of your symptoms?
- Have you found yourself suffering in secret? Withholding information from your family, friends, or even your physician?
- What does your inner thought sound like when you have to venture out of your comfort zone?
- Do you implement any skills that you have found helpful when facing those things you typically avoid?
- What was your first panic experience like? Did you go the ER? Did you get a proper understanding of what was happening to you and why?
- What is your most distressing symptom of anxiety and/or panic?
Chapter 2 - Fear of Leaving the Safety of Home - Let's Talk!
Do you fear leaving home? What are your avoidance behaviors due to panic and anxiety? Tell us your experience.