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AGORAPHOBIA - my understanding

By Katee Crowther

Every time my psychiatrist commented on my agoraphobia, I'd think to myself: I'm not agoraphobic - I don't mind open spaces. A little bit of research finally convinced me that I am agoraphobic. It's not about open spaces!

Agoraphobia: described back in 1871 as 'the impossibility of walking through certain streets or squares, or possibility of so doing, with resultant dread of anxiety' (Westphal)

Agoraphobia causes a wide range of inexplicable problems. For example, I want so much to go and see my sister who is due to have a baby in 7 weeks. I can't go in the car - what if it breaks down, what if we get stuck in a traffic jam, what if I get that trapped feeling and can't get out of the car, what if, what if...? The train seems a better option - I can walk around, there is a toilet... but what if...? How to explain the terror that I face when doing 'new' journeys? I break down in tears but I can't explain why. I can do certain journeys on the bus but only if I adhere to a strict routine and don't sit down at the bus stop for more than 5 minutes before the bus is due. If I'm being given a lift, I start pacing half an hour before they're due. This ritualistic behaviour is my 'magic thinking'- if I do this or that, it'll be OK.

Agoraphobia: a pathological fear of being in public spaces.

Consider 'public spaces'- the public spaces that haunt me are shops, hairdressers, the dentist, days out, meeting friends, going on holiday, hopping on a bus, the cinema...

It seems really daft to get so anxious about having your hair cut but I couldn't do so for years. My mum would periodically chop off an inch or two - even that was stressful because I was 'stuck' until she'd finished.

This need for an escape route can, in some ways, fuel the phobia. If you escape you'll find it even worse next time. I went to the opticians recently and had to escape twice - first of all, I said I'd left my mobile phone at a café and that I'd better go and get it, and after the eye test - after being trapped in that chair looking at letters and coloured blobs - I said I had to rush for my bus rather than choose new frames that day. Next time I go, however, I will know roughly how long I will be there and can practise sitting on a chair for half an hour. Really, though, I should have stuck with it as, (I'm told), the anxiety cannot keep getting worse and worse. Sometimes I even challenge myself to be the first person to drop dead from fear whilst standing in a queue at the supermarket. Imagine the absolute worst case scenarios and work through them. Go as far as you can in your mind and deal with each problem as it comes. Persevere.

When having an 'attack', the symptoms of agoraphobia include dizziness, shortness of breath, anxiety, shaking, nausea, wobbly legs and, in my case, a desperate need to get out of the situation. (when really I should be facing the fear and letting it pass)

As an agoraphobic, I suffer from an obsessive need for familiarity. Anything out of the ordinary completely throws me. I cannot be spontaneous; I cannot handle changes to plans. Big events like weddings and Christmas are chewed over in my head. I go over all the 'what-ifs' weeks in advance and dope myself up on the day. I think I have slept through a couple of big family affairs.

It is really difficult to explain agoraphobia and how/why I am so afraid of public things. Phobias are fears, which are irrational and exaggerated, which you feel you cannot control and which cannot be reasoned with.

I have always had to be the one setting the challenges in overcoming my fears. I can do a 20 minute bus journey, by myself, with low anxiety. If there was someone with me, I feel that my thinking that I would make a fool of myself in front of them would only compound the anxiety.

Preparing for my sister's wedding, I visited the church daily. At first I could only bear 5 minutes, but, come the big day, I was able to enjoy the service.

Distraction helps when out and about, 'staying with it' should help too, but this is quite a challenge. Breathing exercises, relaxation and patience with yourself play a part in recovery. I carry a small card with reassuring comments on it like, 'It will be OK, this feeling will pass'. Some people carry special objects with them - I have a squishy ball that I take around with me. Goal setting can be quite rewarding - the pleasure in having been able to go out for a coffee with a friend sets you up for the next goal - perhaps going for a snack next time.

If you are a friend or relative of someone suffering from agoraphobia, you probably cannot begin to understand the fear we experience. How can it make sense? Arm yourself with information - for you and the sufferer. Help them help themselves. Be patient, be reassuring, be encouraging.