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Fear of Open Places or Closed Places - Agoraphobia, Claustrophobia

Written by: Martin Winkler

First version: 22 Jul 2008. Latest revision: 25 Jul 2008.

Question:

 Explain fear of open places or closed places (Agoraphobia, claustrophobia)?

Answer:

Many people get anxious or indisposed in certain places or in certain situations. This occurs for example in new situations, with special attention or excitement or when in close areas or in vehicles. This is usually experienced as unpleasant, one sweats or the heart races.

For some people such situations are connected with strong anxiety and/or pronounced physical symptoms of fear, causing them to avoid certain places or situations.

Typically you fear that you could develop a panic attack or pronounced physical symptoms and/or lose control of yourself. This can especially occur for places you cannot easily leave, such as an airplane, elevator, or course, or where you cannot easily get help from a physician. Disaster thoughts can occur, such as:

  • I could get a stroke
  • I could die of heart failure/high blood pressure/heartbeat disturbances
  • I could act in a disturbed manner or lose control of myself
  • I could act irresponsible or like a drunkard.
  • I could suffocate
  • I could vomit and could suffocate from the vomit it

Characteristically of fear of place and/or Agoraphobia it that you do not go to certain situations (and/or places), you do not even try to go there to check if the anxiety really will occur.

Often you start to avoid only certain places or situations, because you sometime got a fear attack in this place or circumstance, so that you judge them as dangerous. You will often then generalizen this, so that even more places and situations are included in the avoidance behavior. Thus you start to avoid for example crowds, journeys, bridges or public places. You will not be able to do your work, or to get exercise, and your freedom to act is substantially limited. Unfortunately this can go so far that the patients do not dare leave their home except going by taxi, or you only meet friends if they visit your home. Even the journey to a physician or a Psychotherapist is avoided because of fear.

An example from clinical practice:

The 28 year old Julia K. comes to the emergency admission at a hospital. She has attempted suicide with tranquilizers. She tells the on-duty emergency lady doctor, that she is afraid of moving or that she has a brain tumor. She feels as if she is not herself, and that everything around her is unreal. For many years, she has not visited her friends any more. She cannot leave her home without fear. When going to the supermarket, she feels dizzy and are afraid of fainting. The physician finds nothing physically wrong with her. Her mother says that tranquilizers (Benzodiazepines) help her very well.

When asked, she descripbes strong fear and/or indisposition in certain situations, for example when:

  • In crowds in department stores or underground
  • When restriced in movement (such as an elevator)
  • On bridges or high stairs, or high floors in buildings
  • Fear increases with distance from her home
  • When alone.
She however also noticed that she in certain situations she feels somewhat better, for example when:
  • In the company of a friend
  • Close to a door or when able to see the exit
  • When her attention is grabbed by other things
  • When going to a physician
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