What is agoraphobia? As portrayed by Marin Ireland, who plays the role of an actress in Sparrows Dance, suffers from stage-fright, which ultimately turns into agoraphobia, as she becomes determined to not leave her apartment or be in public places, as she is worried about the anxiety and panic attack.. She continues to spend her days exercising and ordering food, avoiding public places and any physical contact with people. This changes when a plumber begins to visit her to fix her overflowing toilet, and attraction blooms between them. Her regular interactions with the chatty, saxophone-playing plumber lead her to finally changing her house-bound life.
The media’s portrayal of agoraphobia in a rather superficial manner, such as in Sparrows Dance, further fuels the stigmatization of a severely misunderstood condition in an attempt to raise awareness about said condition. Agoraphobia is an anxiety disorder where one avoids places and situations that make them feel trapped or helpless in fear of illness (such as a physical one), harm, or public embarrassment (such as falling down) [2][3]. As Emmie E, a patient dealing with agoraphobia, describes; “It’s not about being scared to leave the house; it’s about avoiding triggers of panic, of being ‘stuck’ and unable to ‘escape.’ It's anxiety of anxiety.”[1] People isolate themselves at home, which they consider to be their ‘safe’ place, to avoid the humiliation of having to deal with a panic attack in public, that they ultimately have no control over.
Similar to other anxiety disorders, Agoraphobia is usually accompanied by other psychological illnesses, such as panic disorder and personality disorders, which can trigger panic and anxiety attacks. Hara et al. (2012) conducted a study that suggested that symptoms of panic disorder patients vary according to where one’s first panic attack or, “FPA” took place. [4] Eight hundred and thirty participants were classified into five groups based on the place of their first panic attack “(home, school/office, while driving, public transportation vehicle, or any public setting)”. The researchers also compared the analytic features of panic disorder in participants who faced their FPA at home compared to elsewhere. The study showed that there was a significant difference in the drinking status, smoking status, sex ratio, depression score, severity of the panic attack, level of agoraphobia (as per the Diagnostic and Statistical Manual of Mental Disorders DSM-III-R-defined agoraphobia: none, mild, moderate, or severe) and degree of avoidance behaviour. It was also observed that the group of patients at home experienced the fear of dying recurrently and were more severely distressed throughout their FPA as compared to the participants in other groups. On the other hand, participants who faced their first panic disorder in public transit vehicles or driving groups had a higher tendency to exhibit comorbid agoraphobia. Hence, the study emphasized that the patients who suffered from their FPA at home should be treated with a focus on the fear and pain that was provoked by the attack in order to understand its nature and learn how to overcome the fear. Overall, researchers concluded that each patient suffering from agoraphobia is a unique case and requires individual examination and specific form of intervention.
The symptoms of agoraphobia are treatable in most cases. However, there are limited forms of therapy to completely eliminate it from one’s daily life. Instead of focusing on complete alleviation, the main focus of most treatments is working on the different types of anxiety that accompany the disorder. One such way of identification is “imaginative desensitization”—a coping technique where an individual uses his/her imagination to help overcome the triggers associated with panic attacks and feelings of anxiety. For instance, they can picture themselves in places or situations that typically trigger panic attacks, and use a relaxation technique to work through these fears and anxieties. In essence, desensitization works by helping someone gradually unlearn their fears.
Exposure therapy is another technique used to treat agoraphobia. It is a method used to encourage one to be exposed to their fears without any intention of causing harm. The techniques in this form of therapy are used in different intensities to help the person manage their anxieties in a public space, usually starting with places that cause the least discomfort and gradually moving to settings that make them more anxious. Hence, patients are given the opportunity to face their fears and anxieties and ultimately find ways to beat them.[6] Systematic desensitisation is a behavioural technique where one is exposed to an anxiety-producing situation, public places like a supermarket or a school, along with a relaxation technique. In this process, one first identifies the hierarchy of objects that causes anxiety. Next, they learn a relaxation technique, such as control over breathing, as an attempt to not tense up. Lastly, the patient is presented with the lowest fear on the hierarchy and once the patient is calm following the exposure to the first stimuli, the second one is presented. The exercise is repeated until all of the stimuli is presented. If during this exercise, the relaxation exercises do not work efficiently, the exercise is completely stopped and started over with a different relaxation technique. Ultimately, this leads to one being exposed to their fear and finding a way to cope up with it at the same time as it eventually breaks down the conditioned response of fear.[7] There are also medications like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) that are recommended to lessen the intensity of the symptoms of anxiety caused in public places.
These details of agoraphobia depict how the media's portrayal is not flawed, but simply incomplete. Not every case of agoraphobia is as exaggerated as Marin Ireland in Sparrows Dance. Not everyone is able to overcome their fear of public panic attacks the same way Marin Ireland did. And lastly, agoraphobia is not synonymous with introversion, or being anti-social; it is an anxiety disorder that needs much importance, discussion and treatment. With an estimated 0.8% of U.S adults [3] experiencing agoraphobia at some point in their lives, the most common stereotype surrounding them is that people who suffer agoraphobia are introverts, which is certainly not always the case. Although people with agoraphobia dread public places, most prepare themselves with a ‘safety kit’ which can help them calm down during a panic attack; the kits usually include essential items like water and money, which helps them believe that they can get out of a situation in which they may feel trapped. This helps them cope with the anxiety caused by the phobia and minimize the impact on their daily life. If someone is experiencing symptoms of agoraphobia, it is advised to consult an expert as soon as possible, as early recognition and treatment can prevent more fear, anxiety and panic.
[1] 15. Postpartum Disorders“Postpartum depression/anxiety/PTSD. Everyone is quick to assume it’s just the baby blues or that, & Disorders, 1. (2018, June 1). 15 Types of Mental Illnesses We Don't Talk About. Retrieved from https://themighty.com/2018/06/uncommon-unknown-mental-illnesses/
[2] What is Agoraphobia? Signs, Symptoms, Diagnosis & Treatment. (2019, September 12). Psycom.Net - Mental Health Treatment Resource Since 1986. https://www.psycom.net/agoraphobia/
[3]Agoraphobia Symptoms, Signs, Statistics, & Side Effects. (2014, February 20). Addiction Hope. https://www.addictionhope.com/mood-disorder/agoraphobia/
[4] The development of agoraphobia is associated with the symptoms and location of a patient’s first panic attack. (2020, August 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349583/
[5] Florida Behavioral Health. (2019, October 7). Misconceptions About Agoraphobia. Behavioral Health Florida. https://www.behavioralhealthflorida.com/blog/misconceptions-about-agoraphobia/
[6] Carbonell, D. (2020, July 14). Agoraphobia Treatment: Beat the Fear Habit. Retrieved August 15, 2020, from https://www.anxietycoach.com/agoraphobiatreatment.html
[7] Mcleod, S. (1970, January 01). Systematic Desensitization. Retrieved August 24, 2020, from https://www.simplypsychology.org/Systematic-Desensitisation.html
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