Are you anxious about crowds or fearful of public places? Learn about anxiety, agoraphobia

For this month’s Healthy Actions column, we are going to talk about agoraphobia.

The Healthy Actions column is a monthly look at a different medical topic of interest with a local medical expert. To read previous columns, go to www.tinyurl.com/BettyHealthyActions

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Agoraphobia is an anxiety disorder that stems from feeling overwhelmed in large crowds or being fearful of public spaces.

While some people have lived with this anxiety for some time, there are many who started experiencing symptoms due to prolonged isolation during the COVID-19 pandemic, said Dr. Gary Grosel, medical director for UnitedHealthcare.

Many people are struggling with the immense emotional and societal changes that the pandemic brought and are finding it hard to adapt to a “new normal,” said Grosel.

The following is an edited question-and-answer session from an interview with Grosel.

Can you explain more about agoraphobia?

It's an anxiety disorder kind of in the spectrum of the anxiety disorders. It can occur when someone has an excessive fear of a certain situation that normally wouldn't produce that kind of fear. It leaves someone just overwhelmed. They start having physical, social and psychological symptoms.

What are some potential symptoms of agoraphobia?

The anxiety may trigger a panic attack, rapid heartbeats, lightheadedness, blurred vision or elevated blood pressure, or upset stomach.

The person may really start to feel like they can't seek help. They feel like they're in an area where they cannot escape. Sometimes this is open places, sometimes it's very crowded places. It's long lines, places, just even outside you're home or on public transportation.

Can this be a fear of leaving your house or can an attack come on when you are in a crowd or situation that makes you anxious?

Yes, it’s almost like a panic attack or you might get the physical signs of chest pain, rapid heartbeat or feeling shaky. You start hyperventilating, getting lightheaded, flush, excessive sweating, and even you can have GI (gastro-intestinal) symptoms. You just are not feeling well.

What is the difference between a panic attack and agoraphobia?

Panic attacks are more a shortened time frame where it will happen and someone can get through it. Agoraphobia is a subset on the anxiety spectrum with the fear of something or some place. People who have panic disorders or anxiety or other phobias are more likely to become agoraphobic.

Agoraphobia may start to affect your daily activity, so everything you’re doing is “How can I stay home and not have to go out?”

Many times it's someone who experienced something in childhood or as a teenager, that was a death, a physical or sexual abuse or some kind of attack. Then they relate something with that situation that causes them to become extremely anxious or get to the point where it's affecting their daily lives.

It is also unknown whether agoraphobia is genetic, but it does seem like if there are other agoraphobics in the family that you are more likely to have that.

It is unknown if it is environmental or more genetic, but we do know it’s more common in women and women younger than 35. Unfortunately, I would say younger people seem to be more vulnerable as they're struggling with a lot of mental health, health issues, especially with the pandemic.

As a society, we all experienced the shutdown and for some people, it has been hard to get used to re-engaging. What’s the difference between someone being anxious in a crowd after the pandemic and someone who is agoraphobic?

For the most part, the pandemic has really increased agoraphobia. And you know, in some ways, agoraphobics felt more comfortable because, “Hey, I'm now allowed to stay home and it's actually a good thing.”

But as we’ve come to find out, it's really the avoiding situations is the wrong thing to do for agoraphobics. You actually have to get out into situations to not let it keep increasing.

The pandemic allowed this to proliferate. There are things with technology that increased this, like food delivery services or grocery pickup where before they had to go to into the grocery store, but now a person can just drop it off on your front step and I won’t even see you.

Even a great thing like telehealth, which we are encouraging, can be a negative. For agoraphobics, you want to start with telehealth and then gradually bring someone into the office and be face to face. But it's a tough go sometimes and even convincing someone to go to the office or make an appointment, you might have to start with telehealth. If all you're doing is telehealth, then that's an issue.

Has there been almost a double whammy for people who may be anxious about seeing someone or being in a crowd and adding the anxiety from COVID?

Exactly. One of the main reasons that we're getting new agoraphobics is because that uncertainty and that fear of getting the coronavirus and the calling “coronaphobia.” It’s a true thing. People are dying from COVID and we’re kind of coming out of all of that, but the fears are still there.

The earlier an agoraphobic can seek treatment, the better. You have a better chance of getting through it and almost becoming desensitized to it in a way. That's one of the treatment options that are used.

What are some tips for anxiety?

A: People are nervous about things like going back to work or going out again. Moderation is always the right thing. Eating healthy, eating in moderation, exercising, but in moderation. You don’t have go to a gym or be running a marathon, but getting outside for 30 minutes and walking in the fresh air can be helpful.

Practice breathing exercises, getting into yoga, meditation, things that just calm you in situations that you might have become very anxious about. Alcohol and caffeine can also be sources that increase anxiety levels.

Another tip is potentially avoiding social media and news that is constantly giving you bad news, or consuming it in moderation.

You mentioned going for a walk. Would it be helpful to suggest a walk with a friend who may not want to leave the house or a lunch on a patio instead of a concert with 300 people?

Yes, starting slow is the good. You don’t want to throw someone into a situation that might increase the anxiety even more.

Can agoraphobia be tied to depression? If I’m trying to gently encourage a friend to leave the house for a walk, what is too much or could I be adding to the anxiety?

This ties to the question of why is it wrong for someone to just want to stay inside all the time it leads to loneliness, which can lead to depression and other issues like alcoholism.

Maybe you can say: “Let's just meet and walk around the neighborhood for a little bit and just talk. I've missed you.” Or even talking to them on the phone at first or FaceTime or something just to help start a conversation.

Who should you see if you think you might have anxiety or agoraphobia?

Start with your family doctor and start to give them some of those symptoms to see if this is a diagnosis of agoraphobia. Your doctor may send the patient to a psychologist or psychiatrist.

What are some treatments available?

Not everyone needs medication, but for those who may, they are often prescribed selective serotonin reuptake inhibitors (SSRIs) or a type of antidepressant.

Cognitive behavioral therapy, which can include relaxing relaxation techniques or desensitizations, can also help manage the emotions in these “scary situations” that you've been in and over time you can train your brain to start to tell it “OK, this isn’t so bad” before you get anxious. This type of therapy, if you’re not on medication, can take about 12 months. And when you’re on medication, if could be half that. You could be on medication, therapy and you can get through.

The most important thing is going early. When talking about agoraphobics, who seek treatment and those who don’t, about one-third of the people will be completely fine afterward, a third will be getting through but will still have times where they have issues and a third will not improve that much at all.

What should you do if you have agoraphobic tendencies and you find yourself in a situation where you are beginning to panic?

I would go back to some of those deep-breathing techniques. If you’re walking into an area where there's a large crowd, maybe kind of focus your way to try to move to, you know, an area that's not quite as many people. Don’t completely avoid situations, but kind of slowly, but buy gradually incorporating into them and trying to use those techniques, maybe that can help you just feel more comfortable during them.

To read previous topics in the Healthy Actions series, go to www.tinyurl.com/BettyHealthyActions Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ To see her most recent stories and columns, go to www.tinyurl.com/bettylinfisher

This article originally appeared on Akron Beacon Journal: Healthy Actions: What's the difference between anxiety, agoraphobia?