Anxiety disorder becomes a fear of fear

Mary’s problems began when she was a teen-ager.

Her first recollection of her terrible discomfort came when she was walking in a crowded shopping mall surrounded by strangers.

Suddenly, she felt faint; her heart pounded wildly. As she began to tremble all over, she thought she would lose consciousness and there would be no one to help her.

She managed to return to the car, where she cried until her mother returned.


A month later, she was in the family car again, this time crossing a bridge near her home, when she felt the same overwhelming and incapacitating fear overcome her. She gripped the armrest and closed her eyes.

After these two situations “attacks,” Mary started staying at home in familiar surroundings.

Gradually, her whole world began to shrink. She soon began refusing to leave the house unless it was absolutely necessary. Then she would only go if she were accompanied by one or both of her parents.

As she grew older, Mary found that having a couple of beers “calmed her nerves” enough to get through a necessary trip into town or for a visit with relatives. Her use of alcohol increased to the point of dependency.

Mary suffers from an anxiety disorder known as agoraphobia.

According to the word’s Greek origins “Agoraphobia” literally means a fear of the market place.

Agoraphobics have a marked fear of being alone or being in public places where escape is difficult, or where finding help should impairment or incapacitation occur, would draw attention to them.

Sitting in a line of cars at a signal light makes them feel threatened, especially if cars are in front, back and on both sides.

They fear getting in the midst of a large group in a public place and being unable to leave without being noticed.

Avoidance behavior develops. They tend to decrease their normal activities, often insisting that a family member or friend accompany them wherever they go.

In this disorder, the individuals generally begin to anticipate the problem even if they are not already feeling nervous, anxious, panicky or fearful. It then becomes a self-fulfilling prophecy and the fear of the fear becomes a chief component of the problem.

Eventually they are comfortable only in situations of extreme familiarity such as their home or office.

Many victims of agoraphobia suffer from feelings of guilt, blaming themselves for weakness in letting fear dominate their lives.

Most eventually feel a kind of hopelessness, and depression is almost inevitable.

The onset of agoraphobia often occurs after a period of intense stress.

Illness, financial loss, divorce or prolonged job-related stress may precede the first “attack.”

In an attempt to reduce the anxiety, individuals often resort to using alcohol or other drugs. This only further complicates the problem.

Next week I will complete this series of phobias with a discussion of treatment.

Copyright c 1994 Harold H. LeCrone, Jr., Ph.D.