Avoidance Behaviors and Agoraphobia

Understanding Agoraphobia and Avoidance

Woman sitting near window
Agoraphobia-related avoidance behaviors can leave you feeling isolated. undefined

Panic disorder is an anxiety disorder that is characterized by recurring and unanticipated panic attacks. These attacks involve many physical symptoms, including shaking, sweating, shortness of breath, chest pain, and nausea. Panic attacks may also occur with cognitive symptoms, such as derealization and depersonalization, in which the sufferer feels disconnected from themselves and their surroundings.

Panic attack symptoms can be difficult to manage. While having a panic attack, it is not unusual for a person to perceive his experience as frightening. The person may fear that he is going to lose control of himself or his mind. Some panic sufferers develop avoidance behaviors as a way to deal with their fears about panic attacks.

What is Agoraphobia?

About one-third of those with panic disorder will develop this separate anxiety disorder. Agoraphobia involves a severe fear of being in certain situations and having panic attacks or other similar panic-like symptoms, such as fainting, feeling dizzy or lightheaded, vomiting, or experiencing a migraine headache.

In particular, people with agoraphobia are afraid of having a panic attack in circumstances from which it would be extremely difficult and/or humiliating to escape. A person with agoraphobia may also be fearful of having a panic attack in a place where he feels no one would be able to help him.

Fears associated with agoraphobia often lead to persistent avoidance behaviors.

What are Avoidance Behaviors?

Common feared and avoided situations for people with agoraphobia include crowds, large open spaces, elevators, bridges, and traveling. Avoidance behaviors often occur in groups of related fears.

For example, an agoraphobic who fears having a panic attack while driving may also begin avoiding other means of transportation, such as being a passenger on a bus, train, or plane.

Avoidance behaviors tend to grow over time and can impair the agoraphobic’s quality of life. The person’s work, home, and other responsibilities may suffer. For example, an agoraphobic may not be able to travel to important appointments, attend special occasions, or perform common day-to-day activities. Avoidance behaviors can intensify to the point that the person becomes homebound with agoraphobia.

It may be difficult to comprehend how a person can develop avoidance behaviors. To get a better understanding of avoidance behaviors, imagine that you have panic disorder: you are in a crowded movie theater when you experience an unexpected panic attack. You begin to tremble, your chest hurts, your heart races, and you feel as though you are choking. You don’t want to make a scene, but you start fearing for your life.

You wonder if you are having a medical emergency. You begin to feel as though you are watching yourself from a distance. You feel trapped in the movie theater, and despite your embarrassment, you run out of the theater.

After you left and your symptoms have subsided, you feel ashamed about how you reacted. The next time a friend invites you to go see a movie, you decline, finding it too difficult to go again. You begin fearing having a panic attack in other similar situations, and start avoiding other crowded areas, such as shopping malls or concerts. Your avoidance behaviors begin to put restrictions on your life.

Overcoming Avoidance Behaviors

Once a person develops avoidance behaviors, it can become extremely challenging to face feared situations. Avoidance behaviors may feel comforting, giving the person temporary relief from anxiety. But these behaviors only reinforce their fear and anxiety in the long run.

Agoraphobia and avoidance behaviors can worsen if left untreated. Fortunately, there are treatment options that can help in managing agoraphobia and overcoming avoidance behaviors. Typical treatment will involve a combination of medication and therapy.

A treatment process, known as systematic desensitization, is often utilized to help the person gradually face his avoided and feared situations. A person with agoraphobia often finds it comforting to confront his fears when accompanied by a trusted friend or family member.

Through treatment and the support of loved ones, a person with agoraphobia can expect to manage his fears, experience fewer panic attacks and avoidance behaviors, and resume a more independent life.

Source:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision. Washington, DC: Author.

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