Authism - Autism Burnout and Agoraphobia

Having suffered sometimes with agoraphobia since young adulthood it never occurred to me, until I learned about autism burnout, just how striking the similarities are.

Most people think of agoraphobics as being housebound because of the fear of panic attacks and a whole array of symptoms. But the fear of going out from the saety of home is usually the end result to avoid the unpleasant symptoms.

Agoraphobia comes from Greek and literally means fear of the assembly or market place. It was coined by Karl Friedrich Otto Westphal in 1871 when he observed three male patients 'displayed extreme anxiety and feelings of dread when they had to enter certain public areas of the city'. There are many other ‘fight or flight’ symptoms associated with agoraphobia such as dizziness, fear of collapse, not being to breathe, palpitations, jelly legs, sweating and overwhelming need to escape urgently to avert something terrible happening.

It’s not hard to see that crowded markets and market places are hotbeds of sensory overload The modern day equivalent of the outdoor market - the supermarket - is ramped up with bright articial lights, flurouescent signs with numbers and bargains assaulting our senses at every aisle and checkout. Is it any wonder supermarkets are an agoraphobic's nightmare? Same with busy roads and public transport - all that noise, all those people, all that movement. Is this why autistics often suffer with agoraphobia? The reactions to sensory overload are so similar. If you think about sensory overload and being unable to process it, your brain, nervous system and body are going to do strange things under such stress. You're possibly going to go into fight or flight mode. Not everyone responds to sensory overload like this. Neurotypicals have different or better filters and can more successfully screen out the flood of information. 

It also makes sense why familiar places and routes feel safer for agoraphobics because you learn to ignore a lot of the extra sensory information that is coming at you from all angles when you're in a new place. My sister and I have often arrived in a new place like a holiday destination that's supposed to be relaxing but after any journey and particularly a long one, we've found it hard to get our bearings. We've felt dizzy and light headed and needed to hold each other for support and it takes a day or two to recover.

In the nineties, there was a place in Chester doing research into something called Organic Brain Dysfunction which was said to be associated with, if not the cause of agoraphobia. My sister and I saw one of the practioners who was operating on the south coast. Many of the questions he asked were very similar to those also asked prior to an autism assessment. Questions related to clumsiness and bumping into things (dyspraxia) and balance, P.E. and riding bikes. Anyone who's ever suffered with agoraphobia will know that balance problems and fear of collapse are central to the condition. The researchers were working on the premise that it was a primitive reaction as seen in babies that had carried into adulthood. My sister and I have always maintained that it's a physical condition (which like any such condition can be worsened by stress) so it was good to see this research was focussing on physical causes and weakness in the body.

So it makes sense that under stress, trying to walk around a supermarket or by a busy bypass when there are other stresses like flashing lights and loud noises your body isn't going to respond well. You may feel dizzy and walk as if you've been drinking. 

I rarely frequent supermarkets now but whenever I had to negotiate them, I instinctively felt better wearing sunglasses (reduces stimulation) and pushing a trolley (something to hold onto and so less likely to fall). Busy carpets and wallpaper can have the same effect. Most agoraphobics say they feel better walking out at night than in the day, again because of the reduced stimulation. 

Queues have also been a trigger for my own symptoms of agoraphobia eg queues where there is no escape. In a queue, it is the standing still and having time to think about falling or collapsing and becoming aware of my unsteadiness, symptoms etc which is worse than if I keep moving. If calm, I am better able to cope with supermarkets, queueing etc (I do little queueing now because of other conditions).But it is often after prolonged periods of stress that agoraphobia kicks in. Then it is maintained by avoidance. Prolonged tightened muscles also give that feeling of dizziness and incorrect breathing.

Many people mistake agoraphobia for fear of open spaces and while people can feel both, there are differences. This is why being in the open countryside or on an empty beach may be calming to the same person who is fearful in the busy dizzy city. Having said that, my sister reminded me that you can feel this way even in the country if eg there's nothing to hold onto. I've also felt this on a beach if there's no shade. But often if you're on your own you can escape. It's a feeling  of being trapped with other people that can bring on panic attacks.

On the other hand being in a wide open art gallery with eg shiny white floors and walls may trigger the need to escape but this is more likely to be unnatural sensory stimulation with no natural landmarks, causing the brain to react. I found this interesting article on Kenophobia which you can read more about here:

Fear of Voids or Empty Spaces Phobia - Kenophobia | FEAROF

And more on sensory overload by following the link below:

https://www.bristolautismsupport.org/sensory-overload/

Bringing it back to writing I have mentioned agoraphobia in The Other Side Of Carrie Cornish who I think is autistic, as I wrote on a previous blog. She mentioned her agoraphobia several times in the book.

Well, I hope that has provided food for thought and if you're an autistic person who is suffering it has suffered with agoraphobia I'd love to hear from you.