It’s a well-known fact that adults with Asperger’s (AS) and High-Functioning Autism (HFA) tend to have more than their fair share of anxiety. And sometimes the anxiety is so severe that these individuals receive a diagnosis of anxiety disorder. Agoraphobia is a type of anxiety disorder in which people avoid situations that they are afraid might cause them to panic. They might avoid being alone, leaving their home or any situation where they could feel trapped, embarrassed or helpless if they do panic. Individuals with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. The fears can be so overwhelming that they may be essentially trapped in your own home.
Agoraphobia treatment can be tough because it usually means confronting one’s fears. But with medications and psychotherapy, adults on the autism spectrum can escape the trap of agoraphobia and live a more enjoyable life.
Agoraphobia is a type of phobia. A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place. Commonly feared places and situations are airplanes, bridges, crowds, elevators, lines of people, public transportation, shopping malls, and sporting events.
Typical agoraphobia symptoms include:
- A sense that one’s body is unreal
- Fear of being alone in any situation
- Fear of being in crowded places
- Fear of being in places where it may be hard to leave (e.g., elevator, train)
- Fear of losing control in a public place
- Inability to leave the house for long periods (i.e., being housebound)
- Over-dependence on others
- Sense of helplessness
In addition, one may also have signs and symptoms similar to a panic attack, including:
- Chest pain
- Excessive sweating
- Feeling a loss of control
- Feeling light-headed
- Rapid heart rate
- Trouble breathing
- Trouble swallowing
- Upset stomach or diarrhea
Possible agoraphobia risk factors include:
- Being female
- Experiencing stressful life events (e.g., sexual abuse or physical abuse during childhood)
- Having a tendency to be nervous or anxious
- Having an alcohol or substance abuse disorder
- Having panic disorder
Agoraphobia greatly limits a person’s daily activities. In severe cases, one may not even be able to leave the house. Without treatment, some individuals become housebound for years. They may not be able to visit with family and friends, go to school or work, walk their dog, run errands, or take part in other normal daily activities. They may become dependent on others for help (e.g., grocery shopping). Agoraphobia can also lead to depression and anxiety. And individuals with agoraphobia may turn to alcohol or substance abuse to help cope with the fear, guilt, hopelessness, isolation and loneliness.
Antidepressant and anti-anxiety medications are often used to treat agoraphobia and panic symptoms. Adults on the spectrum may have to try several different medications before they find one that works best for them. A doctor is likely to prescribe one of the following:
- Anti-anxiety medication. Also called benzodiazepines, these drugs can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. The doctor will weigh this risk against the potential benefit of this class of drugs. Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include alprazolam (Xanax) and clonazepam (Klonopin).
- Selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac, Prozac Weekly, Sarafem).
- Other types of antidepressants, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.
Several types of psychotherapy or counseling can help agoraphobia. One common therapy that's used is cognitive behavioral therapy. Cognitive behavioral therapy has two parts:
- The cognitive part involves learning more about agoraphobia and panic attacks and how to control them. Individuals learn what factors may trigger a panic attack or panic-like symptoms and what makes them worse. They also learn how to cope with these symptoms (e.g., breathing exercises, relaxation techniques).
- The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization (sometimes called exposure therapy). This technique helps one safely face the places and situations that cause fear and anxiety. A therapist may join the client on outings to help her stay safe and comfortable (e.g., trips to the mall, driving a car). The more the person goes to feared places and realizes she is okay, the more her anxiety will lessen.
If one has trouble leaving the home, how can she possibly go to a therapist's office? Therapists who treat agoraphobia will be well aware of this problem. They may offer to see clients first in their home, or they may meet clients in one of their “safe zones.” They may also offer some sessions over the phone or through email. Asperger’s adults with agoraphobia should look for a therapist who can help them find alternatives to in-office appointments, at least in the early part of treatment.
Certain dietary and herbal supplements have calming and anti-anxiety benefits. Before one takes any of these for agoraphobia, she should talk with her health care professional. Although these supplements are available over-the-counter, they still pose possible health risks in some individuals (e.g., the herbal treatment called kava is marketed as a treatment for anxiety, but the supplement has been linked to multiple cases of severe liver damage).
Living with fear of panic attacks can make life difficult for anyone with agoraphobia, no matter how severe it is. Professional treatment of agoraphobia can help people overcome this disorder or manage it effectively so that they don't become a prisoner to their fears. Individuals can also take some steps on their own to cope and care for themselves when they have agoraphobia:
- Alcohol and illegal drugs can worsen panic or anxiety symptoms. Avoid these substances!
- If one takes medication or is already in therapy or counseling for panic disorder, she should continue to follow her treatment plan. If she develops any symptoms of agoraphobia, she should get treatment as soon as possible, which will help prevent symptoms from getting worse over time.
- If one has experienced panic attacks or has panic disorder, she should get treatment as soon as possible. Because panic disorder and agoraphobia are closely related, getting treatment for panic disorder may prevent the development of agoraphobia.
- Individuals with agoraphobia are overwhelmed with worry about losing control or having a panic attack. Working with a health care professional, people can learn how to calm and soothe themselves. They can practice these skills on their own, especially at the first hint of anxiety.
- Meditation, yoga and imagery are among the simple relaxation techniques that may help — and the person can do them in the comfort of her own home. It’s a good idea to practice these techniques when you aren't anxious or worried, and then put them into action during stressful situations.
- Consider joining a self-help or support group, where you can connect with others who understand what you're going through.
- Get enough rest, eat a balanced diet, and try to exercise every day.
- It may take a couple of weeks to start seeing benefits when you first start a medication, but stick it out. Also, don't stop a medication without first consulting your doctor, because some medications can cause withdrawal-like symptoms.
- It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more places does make them less frightening and anxiety-provoking. Family, friends and your therapist can help you work on this. Anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you.
Living With Aspergers: Help for Couples
• Anonymous said… I rarely leave the house... I get angry when my husband points out that I never go out.. I go on defense, though I know he's right... I guess because I know it's an issue and I don't know how to battle it. I've been this way as long as I can remember and no matter how hard I try, I can't seem to beat it.. There are a lot of times I think I should probably seek professional help, but that, in itself, is terrifying for me.
• Anonymous said… I know it feels hard. Think if your husband didn't love you, he wouldn't push so hard. That being said, you have to feel ready to do it for yourself. What is the worst that could happen seeking professional help...maybe getting unstuck, and better? You may not know how to handle it, and that is where the pro's come in. If you call around a lot of places you can have a therapist visit your home.
• Anonymous said… I just have a lot of trust issues.. I find it really really hard to open up.. especially verbally. I am not good at talking. My husband made a comment last night about how getting me to open up is like having to get through a difficult maze. He's not wrong. I've been to a therapist before.. and I've had a psychiatrist.. for a long time.. But years ago. I keep thinking I need to start going again.. But somehow, the longer I go, the harder it is to go get help.
• Anonymous said… You are correct in this diagnosis of Aspies not wanting to leave the house when we don't want to but what is your point? Do you have a solution or formula that makes me want to go out somewhere and socialize? I go out when one of my kids wants to go shopping. I am not going out to hang at a bar or anything like that. I like being home alone. No, I don't have a husband and nor do I want one.
• Anonymous said… My daughter and I have an understanding that we will go to the BJ's next weekend. Her husband comes over occasionally to get a plate of food when I cook and he's driving for Uber at night.
• Anonymous said… I don't want to be among people when I don't have to be...oh, wait, maybe it's because I have Aspergers! lol
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