Would agoraphobia by any other name be as ghastly? The word for avoidant behavior brought on by repeated panic attacks borrows a Greek phrase for “fear of place of assembly/ market place.” There are only two things wrong with this word: it’s long and it’s wrong. The condition that causes such profound fear is created by fear of having a panic attack. A crowded place is only one of many circumstances that can produce a panic attack in one whose alarm system is haywire. A long bridge, long blocks of street lamps, a flickering light, a sudden noise, a harsh word, a memory, a sudden loss or tragedy are among things that can trigger a panic attack.
Of course, if we added all those other possible triggers, the word would circle the block a couple of times. What I – who has probably spoken, written and typed the word agoraphobia more than nearly everyone else – would like is a shorter word that captures the drama a little more accurately. Perhaps I’ll organize a contest on the blog at some point. In the meantime, what we’re really concerned with here is the effect that panic disorder has on a human and what steps said human can take to overcome the fear of panic attacks.
The level of fear is tremendously high that can cause a human to go to great lengths, almost any lengths, to avoid a repetition of the fearful event. We agoraphobes like to be close to home in stressful times just because it’s the place we’re least likely to feel fearful. Folks with other fear conditions have their own avoidance issues, but some of them keep close to home for safety and use the word “agoraphobic.”
I’ll describe a few other anxiety disorders that can cause the sufferer to avoid certain circumstances and places and when severe can force one into being homebound. During my 17 years as a mental health social worker I worked with hundreds of people whose lives are disrupted if not controlled by fear. Much of my knowledge about mental illness came from my work, but I’ve learned also from personal experience, from reading and from YouTube testimonials. The other disorders that can cause “agoraphobia:”
1. Post traumatic stress disorder. This anxiety disorder is caused by severe trauma that causes ongoing feelings of extreme fearfulness. Whether it’s a single event like a catastrophe, horrific accident, assault, or ongoing such as abuse, the tremendous blow to one’s ability to maintain is overwhelming. People with panic disorder are very familiar with an amygdala on overload – constantly sending alert signals throughout the nervous system. Someone with PTSD can have “revved up” feelings ranging from mild agitation to terror so extreme it can’t be described, only experienced. I hope a lot of research money is going into help for PTSD victims. For reasons beyond belief we can’t seem to stop sending soldiers off to kill people in other countries, causing huge traumas in the lives of young people on both sides of the battle lines. Some PTSD victims are so fearful they become homebound.
2. Obsessive compulsive disorder. By Wikipedia’s definition, this anxiety disorder is characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry. Most engage in defensive behaviors of some sort, from repetitive checking to excessive washing to extreme hoarding. The preoccupations can range from fairly benign to violent, sexual or religious thoughts. OCD, as with most mental illnesses, varies in degree. I had several OCD clients at the Mental Health Center and became accustomed to assisting someone with avoidance when I could. As a former sufferer of excess anxiety I was always attentive to need for safety. The cause is at least half genetic, according to Wikipedia, and the rest of what causes a person to begin extreme defensive behaviors is under study, as they say. OCD can be so severe it can limit mobility.
3. Social anxiety disorder. This anxiety disorder is the most common of such disorders according to Wikipedia, and apparently develops fairly early in life. It also comes with its own perfect acronym. I’ve known a few people with this SAD condition but can’t say that I’ve come to understand it. It’s described as “intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some of life’s general activities. These fears can be triggered by perceived or actual scrutiny from others.” Panic attacks and fear of intimacy can confine one with what is also called “social phobia” to staying very close to home if not homebound.
4. Emetophobia This disorder is one the Greeks hit the mark with: “vomit – fear of.” According, again, to what I read in Wikipedia, this disorder is characterized by excessive fear of vomiting or seeing vomit or seeing others vomiting. The number of obsessions that arise in a person with severe emetophobia can cause the sufferer to avoid so many things that they can become homebound.
5. Labyrinthitis. A search of Harvard Medical School’s website for psychiatric studies reveals that researchers discovered a link between this inner ear disturbance and panic attacks. I suffered from labyrinthitis in my youth, about the same time I started having panic attacks, so I speak as an expert witness. In brief, the researchers discovered the neural signal that triggers sudden imbalance in the inner ear is so similar to the neural signal that triggers a sudden adrenaline flood that the amygdala as guard at the “incoming” gate could be misreading the signal and mistakenly causing a panic attack. The problem is so severe for people afflicted with labyrinthis that there are at least 3 online forums dealing with the effects of sudden vertigo. I read several entries by people who suffer regular panic attacks and have even become agoraphobic because of the threat of panic attacks. A similar condition, “vestibular neuritis” can be difficult to shake. I haven’t had vertigo since age 19 and long ago stopped having symptoms of slight loss of balance due to inner ear infections. The condition is complex and extremely troubling. I’m going to discuss labyrinthitis and VN at greater length in the next blog. It would be a relief to these folks if they could find a way here to overcome the panic attack problem and then only (??!!) have to deal with the extreme dizziness, nausea, and blinding headaches. One entry I read was from a woman who said her labyrinthitis symptoms improved greatly once she was able to overcome the panic attacks.
Hope marches on.