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GUEST BLOG: Agoraphobia and Gender Post Covid-19

Women’s social, economic, cultural and political inequality with men undermines good mental health and wellbeing in a wide range of ways, including the impacts of gender stereotyping, medical misogyny and racism, and of course the disproportionate impact that austerity, Covid-19 and the cost of living crises have on women's mental health.

In this long read, guest author Muna Saeed explores the impact of gender on agoraphobia, and how this affects women in the aftermath of the Covid-19 pandemic.

Imagine a world where the thought of leaving your home fills you with dread and anxiety.

As the world outside continues to spin, you're trapped inside, desperately seeking comfort from the chaos that lies beyond your front door. This is the reality for those diagnosed with agoraphobia, a condition that goes beyond a simple fear of public spaces. It's a suffocating fear of being in situations where escape is difficult, and the fear of panic attacks threatens to consume your every waking moment. But what happens when we introduce gender into this equation? As a mental health worker who works closely with individuals grappling with mental health challenges, including agoraphobia, my aim is to shed light on the intricate and gendered complexities of this condition in a post-Covid-19 world.

Agoraphobia

Agoraphobia, as defined by the NHS, is characterised by an intense fear of situations where escape may be difficult or where assistance might not be readily accessible in case of an emergency. People with agoraphobia may feel anxious or fearful when they are in situations like using public transportation or feeling restrained, leading them to avoid going to places where they perceive they may be unable to escape or feel trapped. Consequently, this avoidance behaviour often leads to a fear of leaving their own homes.

In the UK, approximately 2 out of every 100 individuals are estimated to have a panic disorder, with the belief that about one-third of these individuals will subsequently develop agoraphobia.

Agoraphobia and Covid-19

As a mental health support worker, I have had the opportunity to work with many individuals who struggle with agoraphobia. The fear of being in crowded or enclosed spaces, coupled with the uncertainty and stress caused by the pandemic, has made it increasingly difficult for people with agoraphobia to manage their symptoms and participate in activities that were previously manageable.

Since the Covid-19 pandemic forced many of us to isolate at home and avoid others, many health professionals believe it may make it harder to treat those who are already suffering from agoraphobia. I personally went through a difficult journey trying to regain my comfort with being outside after spending several years feeling stuck, isolated, and trapped. I'm sure many of you can relate to this as well. During this time, staying at home felt like the safest option, shielding me from any surprises or risks of contracting a new and unfamiliar disease like Covid-19. The pandemic has undoubtedly presented unique hurdles in treating those who are already coping with agoraphobia.

According to the Anxiety and Depression Association of America, individuals with agoraphobia may have experienced heightened worries during Covid-19 lockdowns, influenced by several factors. Firstly, the limited availability of support services created additional challenges in seeking assistance. Moreover, the similarity between certain Covid-19 symptoms, such as shortness of breath, and those associated with a panic attack exacerbated their concerns. The mere mention of terms like "quarantine" and "physical distancing" could have triggered fears of isolation and a sense of being cut off from necessary help. Additionally, the prevailing anxiety and uncertainty within the general public regarding the future contributed to their overall distress. The increased risk of social isolation and the potential development of depression further intensified their anxiety levels. Lastly, individuals with agoraphobia might have experienced even greater anxiety when venturing out in public than they had previously encountered.

It's important to note that while Covid-19 may have exacerbated agoraphobia symptoms for those already diagnosed with the condition, it did not spontaneously create agoraphobia out of thin air. According to Sandy Capaldi, associate director for the University of Pennsylvania's Center for the Treatment and Study of Anxiety, if there was a pre-existing inclination towards agoraphobic tendencies, the past two years may have intensified them, but they did not solely give rise to the condition.

Agoraphobia and Gender

Numerous studies have consistently shown that women are more likely to be diagnosed with agoraphobia than men, with prevalence rates ranging from 67% (Weissman et al., 1985) to 95% (Marks and Herst, 1970). This gender disparity in agoraphobia is often attributed to cultural factors, including societal expectations that prioritise traditional gender roles, such as caregiving responsibilities and household management. These factors can contribute to feelings of dependence and insecurity, increasing the vulnerability to developing agoraphobia (Bekker, 1996).

Moreover, the higher prevalence of agoraphobia in women has societal implications, as it is more socially acceptable for women to confine themselves to their homes due to these gender norms (Chambless and Mason, 1986; Bekker, 1996). On the other hand, agoraphobia in men may be underdiagnosed in Western societies, as societal norms dictate that men are not expected to avoid public situations. As a result, men may be more likely to cope with their phobic tendencies through strategies such as alcohol use and attempting to confront phobic situations as if they do not have agoraphobia.

Based on my experience working with female patients diagnosed with anxiety and agoraphobia, I have observed that these women tend to respond positively to support inside their homes more so than outside. They would also be receptive to support when they have a trusted companion such as a husband, son, daughter, friend, or mental health professional by their side. However, it is worth noting that certain societal expectations, such as the pressure to fulfil caregiving roles and the fear of burdening their loved ones, may lead some women to prefer relying solely on professional support.

This aligns with the findings of Joyce Davidson's study, which involved interviews with agoraphobic women from Scotland. The research highlights the close association between the perception of safety and security and the concept of home. The interviews revealed that women viewed the boundaries of their homes as both reinforcing and extending a protective environment. This stark contrast in the meaning ascribed to home spaces compared to the outside world holds significant importance.

Feminist scholars have extensively explored this disparity, particularly in relation to the division between "private" and "public" spaces. They argue that this division is not only a reflection of gender-based dichotomies but also a socially constructed concept influenced by them. The work of Bondi and Domosh (1998), Dowling (1998), and Duncan (1996), cited in Davidson's study, sheds light on these ideas. Despite the progress made by feminism in expanding women's opportunities, women's gender identities continue to be more intertwined with the domestic sphere than those of men.

However, the experience of home for individuals with agoraphobia can be complex and ambiguous. Some perceive their homes as excessively secure, to the point of preventing them from venturing outside. Consequently, they may experience their homes as both a prison and a sanctuary, evoking simultaneous feelings of being trapped and protected.

Supporting Women with Agoraphobia Post-Covid-19

One of the main difficulties of working with patients with agoraphobia is helping them to gradually face and overcome their fears. This can be a slow and incremental process that requires a lot of patience and understanding.

It is important to remember that every person's journey with agoraphobia is unique, and what works for one person may not work for another. For example, working with a patient with agoraphobia who has a strong spiritual connection can present unique challenges. This patient may seek signs and symbols, or people in specific places at specific times, to assure them that their loved ones are still with them and providing support. This kind of reassurance can create a positive experience for the patient and provide the necessary encouragement for them to continue making progress with support. Thus, it is crucial to approach each patient with empathy and to tailor treatment to their individual needs, beliefs and goals.

Another challenge of working with patients with agoraphobia is dealing with the stigma and misunderstandings that still surround mental health issues. Many people with agoraphobia may feel ashamed or embarrassed about their condition and may not want to talk about it or seek help. It's worth noting that gender can play a role in the experiences and challenges faced by individuals with agoraphobia. It is important for us as mental health support workers to create a safe and non-judgmental space where patients feel comfortable sharing their thoughts and feelings.

The Process of Desensitisation and Graded Exposure

In my work, I have found the process of desensitisation to be a critical aspect of working with people with agoraphobia. This technique involves gradually exposing patients to the situations and environments that trigger their anxieties in a controlled and safe manner. It's essential to ensure that the patients themselves are in control of the process and have a say in what outcomes they wish to achieve as part of their support plan.

It is crucial to tailor the exposure to each patient's unique needs and pace. The ultimate outcome of this process is to help patients regain a sense of control and independence, enabling them to lead a more fulfilling life.

What can we do?

The rise of agoraphobia in the UK related to Covid-19 highlights the importance of addressing this serious condition. The pandemic has caused widespread anxiety and stress, leading many people to feel unsafe in crowded places or around large groups of people. Working with people diagnosed with agoraphobia can be challenging, as it requires a great deal of understanding and patience. It is important to recognise that agoraphobia is a serious condition that can have a significant impact on an individual's quality of life.

It is crucial to enhance our comprehension of agoraphobia, especially its impact on women, and provide the necessary assistance to help them navigate the hurdles they encounter in a world recovering from the Covid-19 pandemic. This entails gaining a deeper understanding of women who display agoraphobic tendencies or fear of going outside.

We should also aim to create safe spaces where women with agoraphobia can openly share their experiences and seek assistance without the fear of being judged. Promoting dialogue and peer support will help alleviate their sense of isolation and facilitate the healing process.

Guest posts do not necessarily reflect the views of Engender, and all language used is the author's own. Bloggers have received some editorial support from Engender, and may have received a fee from our commissioning pot. We aim for our blog to reflect a range of feminist viewpoints, and offer a commissioning pot to ensure that women do not have to offer their time or words for free.