The current global pandemic has not only manifested itself in terms of the physical symptoms but has also taken a toll on our mental health and how we function in everyday life. 

With home confinement and remote working conditions, people have developed this lingering fear of germs, social and public spaces and of coming in contact with other people. Although such feelings are normal given the current situation, if not addressed and dealt with can lead to major psychological disturbances like agoraphobia.

What is agoraphobia?

Agoraphobia is anxiety that occurs when people are in a public space or situations from where they believe escape is not possible.

It usually occurs when people find themselves in a crowd, or using public transport which makes them feel embarrassed, helpless and stressed out.  

People with this phobia may feel completely overwhelmed in any social place and might feel like always going along with a companion or just not leaving the house at all. Very often, people suffering from this phobia know that it is an irrational fear but find it difficult to control and deal with it. 

According to the Diagnostic Statistical Manual-5 (DSM-5) around 1.7% of the population have agoraphobia.  The National Institute of Mental Health estimates that the lifetime prevalence of agoraphobia is 1.3%, with an annual incidence rate of 0.9%. 

Also, agoraphobia is twice as common in women than in men. During their lifetimes, 87.3% of individuals with agoraphobia will also meet criteria for another psychiatric disorder, including panic disorder, social anxiety disorder, specific phobia, generalized anxiety disorder (GAD), and substance use disorder.  

Summary- Agoraphobia is an anxiety disorder that makes people avoid places or situations that makes them feel trapped, embarrassed or helpless. Around 1.7% of the population has it and it is more common in women than in men. 

How does it tie up with the current pandemic situation

With the pandemic completing a year, people have become more comfortable and “used to” their confinement spaces at home and may find it difficult to even go out for a small stroll because of the fear of contracting the virus. Also, with the lockdown restrictions changing every time, people are not able to establish consistency in their ways of functioning in their lives. 

Thus, those who used to go out to walk their pets, or for a small walk have now not been able to do so. Also with the news and social media constantly bombarding us with covid related information, it has negatively impacted our mental health and psychological well being. 

In fact research has shown that people of ages 18-35 face anxiety issues due to media coverage of the virus. Thus, with the fear of going outside and with anxiety levels on the rise, people may develop symptoms of agoraphobia.

People may develop a sort of ‘temporary agoraphobia’ due to the current citation and may be able to function normally after the pandemic ends. However, some people who are not able to cope, are facing extensive levels of anxiety and stress about being in situations may develop the phobia in response to the pandemic. 

Those already suffering from agoraphobia and other anxiety disorders who made some sort of progress through exposure therapy or any other treatment have not been able to keep engaging in those activities because of the current pandemic restrictions.

Kenn Goodman, an anxiety specialist, says that people who have been forced to stay at home due to the lockdown are now being able to get a glimpse into what agoraphobia actually is and what it feels like. It sort of gives them a reason to stay at home which otherwise would have been possible if the pandemic had not existed. 

Diagnosis of agoraphobia

when do these feelings of anxiousness move beyond normal and translate into agoraphobia? Diagnosis of agoraphobia is clinical based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

To meet the DSM-5 criteria for diagnosis, patients must have marked, persistent (≥ 6 months) fear of or anxiety about ≥ 2 of the following situations:

• Using public transportation
• Being in open spaces (eg, parking lot, marketplace)
• Being in an enclosed place (eg, shop, theater)
• Standing in line or being in a crowd
• Being alone outside the home

Fear must involve thoughts that escape from the situation might be difficult or that patients would receive no help if they became incapacitated by fear or a panic attack. In addition, all of the following should be present:

• The same situations nearly always trigger fear or anxiety.
• Patients actively avoid the situation and/or require the presence of a companion.
• The fear or anxiety is out of proportion to the actual threat (taking into account sociocultural norms).
• The fear, anxiety, and/or avoidance cause significant distress or significantly impair social or occupational functioning.

Summary- Anyone facing fear of public and enclosed spaces to the extent of experiencing panic attacks and impairment in social or occupational functioning for more than 2 months meet the DSM-5 criteria for agoraphobia.

Treatment for agoraphobia

• Therapy

• Medications

What can you do by yourself to manage the fear

• Make sure you are following the treatment plan

It is very important to follow instructions and suggestions given to you by your psychiatrist or therapist as regular practice can make a big difference. Also don’t forget to follow your prescription drugs if any. 

• Practice meditation whenever you can 

Having a calm and peaceful mind is often associated with reduced levels of anxiety. Research shows that mindfulness-based stress reduction (MBSR), which is based on mindfulness meditation, helps people with social anxiety disorder regulate their emotions better, for example. In one study, people who completed an MBSR program were less anxious and depressed and had higher self-esteem levels.

• Maintain a healthy lifestyle

Make sure to eat healthy and get enough sleep and these can also have an effect on the anxiety and panic levels to some extent. Also exercising and keeping yourself physically active will benefit you. 

• Avoid alcohol and drugs

Panic disorder with agoraphobia promotes excessive alcohol use as self-medication. On the flip side, chronic alcohol abuse and alcohol withdrawal induce neurochemical changes that promote panic. In alcohol abusers, they found that alcohol increases carbon dioxide sensitivity, thereby promoting panic. Thus it is important to stay away from these substances. 

• Find social support

As the pandemic has restricted face to face social interactions, having someone to share your feelings and experiences at home or through any online medium can really help you. Although there is evidence supporting the role that the spouse may play in the agoraphobia-marriage interaction, there is also a large and growing body of evidence indicating that genetic, family-environmental, and social interpersonal/relationship factors are involved in the etiology and maintenance of this disorder. You can also join support groups online with people facing similar problems.

How to help others facing agoraphobia during the pandemic

• Read more and understand about the disorder

The more one reads and understands about the disorder, the more aware one will be when the other person shows symptoms of it. One also understands what triggers the phobia and thus is better to make more informed decisions and choices.

• Dont critize them or be condescending 

It is very important to give people with agoraphobia or any anxiety disorder their space and time to wrap their heads around the problem. Thus, using words like ‘its just in your head’ or ‘get over it already’ may make them feel invalidated and they may bottle up their feelings and emotions which then increases the likelihood of the phobia showing up when triggered.

• Be patient and provide feedback

Being patient with people learning and trying to make a change in themselves and rewarding them with praise or appreciative feedback can really boost the confidence levels of the person.

• Check if they are following the treatment plan

Very often people with phobias and anxiety disorders forget to keep track of their treatment procedures as the mental illness itself takes a toll on their lives. Thus it is important to check if they are following instructions and prescriptions from time to time.

Get some personal opinions and suggestions from people already dealing with the disorder during the pandemic by clicking here