Agoraphobia: Has COVID fueled this anxiety disorder? – Harvard Health Blog

The past year has been difficult for most of us. Who hasn’t felt anxious? Who has not sometimes wanted to withdraw from the world? Staying home when possible as COVID-19 rates soared felt safer – and in many places lockdown rules demanded it. Yet, could getting used to feeling less safe in public spaces sow or nurture the anxiety disorder known as agoraphobia? If you are wondering if the discomfort you are feeling is normal or if it has crossed a line, read on.

What is agoraphobia?

People with agoraphobia become anxious where they feel helpless, out of control, blocked or judged. A person with agoraphobia may avoid places where they might be trapped (such as an office meeting) or put on the spot and judged – perhaps in a conversation at a party. They can also avoid situations or places that seem out of control, such as traveling with other people where they do not control the time and schedule, or an open public space like a park. As a result, people with agoraphobia are often afraid to leave their homes.

In the United States, about 2% of adults and adolescents suffer from agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. About a third to half of people with agoraphobia have had panic attacks before diagnosis.

What are the symptoms of agoraphobia?

A dreaded situation – or even the thought of such a situation – triggers panic or panic attacks, often when a person is outside their home. A panic attack is an intense episode of anxiety that manifests itself physically as a pounding heart, shortness of breath, chest pain, sweating, and dizziness. Worrying about having another panic attack, especially in front of other people, makes agoraphobia even worse.

So where did the pandemic come from?

Agoraphobia is an anxiety disorder that causes people to be afraid and avoid situations where they feel embarrassed, helpless, or threatened. Their fear of a situation is out of proportion to its actual level of risk. Yet fearing public spaces as COVID-19 continues to spread is a normal response to such a threatening event.

According to a report by the American Psychological Association (APA), Americans are experiencing a nationwide mental health crisis that could have repercussions for years to come. Their investigation shows an increase in mental health issues like stress and anxiety since the start of the pandemic. However, it is not known how this relates to agoraphobia. Because crowded spaces are potentially dangerous right now, avoiding them is a natural response, rather than a sign of disorder. It is normal to have some fear of public spaces now, as the threat of danger is real.

When Are Anxiety Feelings Above Normal?

If you are worried about having agoraphobia or another anxiety disorder, ask yourself the following questions:

  • Is my response consistent with the potential threat of danger?
  • Are my loved ones concerned about my level of worry and avoidance?
  • Am I following the CDC’s guidelines for avoiding contracting or spreading COVID, such as practicing social distancing with people outside my home, wearing a mask, and washing my hands? Or am I avoiding more people and situations than necessary?

If you’re concerned about your anxiety, see a mental health professional. You can schedule a telemedicine visit to get help assessing whether your fear and avoidance is healthy or problematic. Contact your health plan and request a list of behavioral health clinicians.

How is agoraphobia typically treated?

Agoraphobia is often treated with cognitive behavioral therapy (CBT), which helps people understand the connections between thoughts, feelings, and actions. Usually, a mental health or behavioral health specialist will help you

  • understand the triggers of anxiety and agoraphobia
  • understand your internal thoughts about the situation that creates the fear
  • develop skills to better tolerate anxiety
  • start to cope slowly and safely with the situation that creates the anxiety and the avoidance that follows. This is usually done by practicing facing the dreaded situation in a controlled environment.

Medications, such as antidepressants and anti-anxiety medications, are sometimes used with CBT.

How to get help

It is difficult to overcome agoraphobia without treatment (only 10% of people are successful).

The SAMHSA National Helpline (800-662-4357) or the website may be able to direct you to mental health clinicians in your condition who are treating anxiety. Some may accept Medicare or Medicaid, or charge lower fees based on your income. The National Alliance on Mental Illness also has helpful resources on its website and through its volunteer HelpLine (800-950-NAMI (6264) or info@nami.org).

Agoraphobia is an anxiety disorder that can seriously limit quality of life, as those who struggle with it avoid many social events and situations. While it doesn’t usually go away on its own, the right therapy and medication can help people deal with anxiety and live life to the fullest.

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Jothi Venkat

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