We've all found excuses to wriggle out of situations we assume will be stressful, tedious or boring, but with people who have agoraphobia (with or without panic), avoidance moves to a whole new level.
A central characteristic of agoraphobia is the sense of not wanting to be stuck in a situation viewed as difficult to get out of. The number of situations are actually quite extensive and even include being caught up in a conversation that feels difficult to get away from. Some situations however are much more common than others and very typically these include:
- Crossing bridges.
- Standing or being on a bridge.
- Standing in line.
- Being in a shop or shopping mall.
- Sitting in a line of traffic.
- Sitting on an aircraft or in public transport.
- Sitting in a public waiting area or public complex (e.g. dentist, cinema)
- Driving on a busy highway with no obvious exit points.
As so many of these situations relate to everyday activities it's easy to see how pervasive a problem avoidance can become. At its most extreme avoidance is achieved by never leaving home, but some people use strategies and devices to help reassure themselves. Some people always take their car with them, I knew one person who used a walking stick purely for something to grab hold of and steady herself, yet others never go out without a trusted friend or relative with them.
I knew one lady who took her bicycle with her wherever she went. Over time she had become comfortable with the route to work (a small catering outlet) and one or two other places. This is very common and many people manage reasonably well so long as their routine, often centered close to home, remains in place. The bicycle was used both as a security prop and as a possible means of escaping difficult situations. This lady felt relatively secure so long as there was something to lean against or hold on to. If caught in the open, her anxiety symptoms became very pronounced and uncomfortable as she became light-headed, weak legged and felt sick.
People with a social phobia also experience situational avoidance because they fear traveling on their own or being in public. They avoid situations where the chances of social evaluation, judgment and possible criticism are highest. Interestingly, anxiety symptoms tend to differ from someone with agoraphobia. With agoraphobics, weakness in the limbs, breathing difficulties and dizziness are common, whereas in social phobia flushing, sweating and trembling are more common.
Although situational avoidance is one of the central features of agoraphobia and panic, it is also a common feature of depression. In this context however the motives may relate more to lack of interest and initiative. Having said that, anxiety and depression do have a habit of co-existing and this fear and avoidance can sometimes be mistaken for agoraphobia.