National Post (National Edition)
The struggle is real
Grappling with agoraphobia as pandemic wanes
As people start to venture out, Ashley Perkins might be struggling more than most. For years she had been living life relatively large despite her agoraphobia, until pandemic constraints shrank her world to the drive between work and home. “This is by far worse than even before I was diagnosed in 2008,” the 38-year-old pharmacist said.
The anxiety disorder, more common in women, is frequently associated with a fear of leaving the home. But the core issue often is an underlying panic disorder that can first flare in a place seemingly routine, such as the grocery store, said Sally Winston, a clinical psychologist and executive director of the Anxiety and Stress Disorders Institute of Maryland.
“Agoraphobia is the fear of having a panic attack in a place or situation in which you feel trapped or unable to get to safety,” Winston said. That first panic attack with its surge of adrenalin, rapid heartbeat and other symptoms can feel physically overwhelming, “like a traumatic catastrophe,” she said, and makes people retreat to a perceived safe space, often their home.
Agoraphobia can't be diagnosed until someone has experienced at least six months of symptoms, severe enough to affect daily life. Nine months into the pandemic, clinical psychologist Karen Cassiday started seeing patients who had been coping well with the disorder for a decade or longer. “They were saying, `I'm scared to drive. I'm scared to go into a big box store, or even go in a store where I can't get out quickly. I'm afraid to go to the dentist or get my hair done,'” said Cassiday.
Also, she said: “People who never had agoraphobia were coming in, and they've got it.”
But Winston, who hasn't noticed a similar uptick, is dubious. “Somebody who does not have that genetic predisposition, it would be highly unlikely,” she said. Agoraphobia runs in families. Also, someone can inherit a trait called anxiety sensitivity that can be part of agoraphobia.
That doesn't mean people might not have settled into new patterns and routines that might prove challenging to break, Winston said.
“To get out of them, yes, there's some discomfort, some distress and certainly anticipatory anxiety,” she said. “But that's within a normal realm — it's not the disorder agoraphobia.”
The risk of developing agoraphobia should in theory increase with any stressor, “particularly a stressor that threatens one's personal health and safety,” said Steven Taylor, a clinical psychologist and professor at the University of British Columbia who wrote The Psychology of Pandemics. But it will take years to know if rates have changed in the wake of the pandemic.
The pandemic has accelerated people's tendency to cocoon, complicating efforts to sort out the agoraphobics from the homebodies, Taylor said. “You're creating a pleasure palace,” he said. “You've got your Netflix, you've got everything delivered to you, the food is delivered. You don't need to go outside.”
While anxiety disorders tend to run in families, there's also an element of learned behaviours related to agoraphobia that can date back to childhood, Cassiday said. As part of developmental growth, one must learn to face one's fears and anxieties, whether that's battling nerves through a play audition or the discomfort of asking someone out, she said.
Cassiday said she has noticed a deep-rooted aversion among some patients to returning to in-person work.
“They are justifying it by saying, `Why should I waste that time commuting?'” she said. “But really, it's that, `I'm afraid to be away from home, to be on the expressway, to be where I feel trapped and can't get to my safe comfort zone.'”
Agoraphobia, which may include panic attacks, involves elevated and persistent fear about at least two of the following situations, according to the latest diagnostic criteria. They include public transportation; open spaces such as a marketplace; enclosed spaces such as a store; standing in line or being in a crowd; being alone outside the home.
Even those who have not been diagnosed with the anxiety disorder should start pushing against their personal comfort boundaries, says Cassiday. If driving on the highway provokes more anxiety than it used to, she suggested driving a few exits farther. “What you're trying to teach yourself is that my body doesn't have to be afraid, and my mind doesn't have to be afraid — it's just an unpleasant sensation,” Cassiday said.
Perkins, who had been able to board crowded planes and eat in restaurants before March 2020, found it frustrating to watch her hardfought gains slip. In late 2020, she became further isolated when she moved with her husband and young son from West Virginia to Florida.
When she decided to fly to Boston last fall, she struggled, successfully, to avert a full-blown panic attack as people piled up in the security line. “I had my arms wrapped around me. I'm literally just rocking.”
But this spring, Perkins resolved to expand her daily scope: “I want to go back out. I'm getting there.”
In March, she met a small group of women at a restaurant, and soon, Perkins has plans to board a plane again.