My partner has developed agoraphobia, what do I do?
November 20, 2010 4:07 PM   Subscribe

My SO is housebound by agoraphobia. What should I expect of his recovery? How can I help and how can I avoid hindering his recovery? And how can I best reduce any detrimental impact on my life and our relationship? Nice big snowflake enclosed.

First off, I don’t know if it’s Social Phobia or Agoraphobia that he’s suffering (or even if there’s a difference between them). He’s been diagnosed with social phobia by his GP, but he’s as good with people now as he’s ever been – just as long as they’re on the phone or come to our home – and he’s certainly more socially adept than me. His problem is roughly that he feels like he’s going to have a panic attack whenever he goes to leave the house. Since I’m not seeking a diagnosis here, I will for the sake of convenience call it agoraphobia. But please do correct me if I’m way off here.

It’s over 10 weeks since my SO meaningfully left our house. (He made it 400 yards to the post box in his car a few weeks ago, but no progress since then.) In three days time he’s having his first appointment with a mental health professional who will (I assume) begin treatment. FYI: He’s been taking an anti-depressant for approximately the last 6 weeks.

My approach so far has been to let him get on and manage it by himself. I’ve never suffered a panic attack so I have no clue what they feel like. Even so, in the beginning I encouraged him to leave the house every couple of days to practise at being outside because I believed the only way he’d get over this would be through exposure to what he perceived to be the trigger. However, he soon became ratty over being pressured into going out when he didn’t want to. Neither of us likes being ordered around, so to avoid arguments I agreed with him that I would help when asked and not otherwise push my help onto him. Our relationship is good at the moment and I don’t want this to destabilize it.

To me it seems he is to trying to think his way out of the problem. He’s read books about panic and he’s become very knowledgeable about panic attacks. However since I stopped asking, in the past 4 or 5 weeks he’s only mentioned a few times about going out and only once has he actually made it out. I understand that it’s his condition and I can’t solve it for him and so I’m quite prepared for him to take as long as he needs to recover, but I can’t deny that it does affect me and that it’s inevitable that if he doesn’t recover it will affect our relationship.

He’s also chosen to keep his houseboundedness secret. He’s not told any of his friends or relatives. I assume it’s because he’s embarrassed. I don’t mind making excuses for him when people ask where he is and I don’t mind running his errands, but I feel like keeping this a secret is going to make recovery more difficult, am I right? I personally believe pretending there’s not a problem is not a good way of dealing with one, but because I’m worried about undermining his recovery I don’t dare say anything negative about the way he’s choosing to tackle it.

But, would it really be damaging to his recovery for me to question his choices? I’d love to talk openly and frankly with him about it without having to censor my biggest doubts and having to be so careful about how I word any negativity. Additionally, because it’s a secret and because I don’t want to undermine him I have no-one I can talk to about this in an honest way. I feel isolated and it’s starting to cause me stress when I’m sure it shouldn’t. Does anyone know of any online communities where I can chat with people in my situation? I think this could be helpful even if it were OK to talk honestly with him.

Although he’s been on meds for a short while now, next week he starts treatment proper. What can I expect from this? How long does it/could it take for him to get over this? Google’s turned up no answer to this one and I assume it’s because there is no answer -- everyone recovers at different rates, right? But what’s a best-case scenario? Do people snap out of it? Can one or two panic-attack-free exposures be enough to banish the fear?

I want to know because in two weeks he’s due to appear in court. (The court is an hour drive away.) Since It’s a just a small-claims case between him and another man, a no-show shouldn’t be a huge deal because of his doctor’s note and good medical reason, but it would surely be a setback for him, especially given he’s been preparing for and looking forward to this court date for months. I want him to set realistic recovery goals but I’m not sure this is one. But again this isn’t something I’m comfortable challenging him about for fear of showing a lack of faith. Are realistic goals something he’ll talk about to the mental health person next week?

However what’s actually stressing me out now is that in a little over 4 weeks we, us and his father, are booked to fly 4 hours from the UK to Cyprus for 3 weeks Christmas vacation. The trip was booked before he became housebound and what I’d like to know is whether this in any way a realistic goal given his current condition? Also is it selfish of me to want him to cancel this trip and not re-book until he’s recovered? The thought of abandoning the trip at the last minute, having to make alternative plans for Christmas and having to pick him up from an inevitable slump is making me a little stressed.

You see, we’ve been here before. Prior to him becoming housebound he has been for the past few years (18 months of that with me) been too scared to fly. With me at his side he’s bailed-out of flying at the airport 4 times (one time he did actually made it on the plane) and several other times he’s cancelled the flight before even leaving home. This time last year we were booked to go away for the same 3 weeks but it didn’t happen because he wasn’t up for flying. I don’t want it to happen again; it wouldn’t be good for either of us. And as it stands, having a vacation planned for the both of us that he currently wouldn’t go on makes his agoraphobia my problem. I don’t like this but that’s how it feels.

I really really want to believe him that we’re going away this Christmas and I’m justifying this by telling myself that his fear of flying, which is really a fear of having-a-panic-attack-at-30000-feet will be cured when he cures his fear of having-a-panic-attack-when-he-leaves-the-house. Is this crazy? My gut’s telling me that it is and that we’re not going. The tension between what we both want to believe and what my gut’s telling me is stressing me out, and because I can’t talk openly with him about this I can’t resolve it.

So my gut is saying that this is too much too soon, that he needs to open up to this friends and family about what he’s going through so he doesn’t try and recover in secret, and that he needs to properly accept how serious his problem is. It is serious, right? People with mild problems that can be worked around don’t stay inside for 10 weeks, surely.

TL;DR: For the last 10 weeks my SO hasn’t left the house for fear of having a panic attack. Is it feasible to go from housebound to travelling hours away from home for a period of weeks within the space of a month? Am I being selfish for not trusting his outward belief that he’s going to overcome his fear of leaving the house AND his fear of flying within the space of a month? Should I disclose my doubts about him to him? or if not, to whom? (I need to tell someone).

Throwaway email:

Additional note: My SO and I are both male and we live alone together in the UK. Neither of us has family nearby.
posted by anonymous to Health & Fitness (13 answers total) 2 users marked this as a favorite
Cognitive behavioral therapy is really helpful for coping with specific phobias and for changing behaviors. I have no idea how available it is in the UK, but if it's possible it's something he might want to look into in addition to the meds & talk therapy.

The Christmas trip seems completely undoable to me, though. Can you cancel it for re-booking later?
posted by Sidhedevil at 4:36 PM on November 20, 2010

It seems unlikely your partner can make that trip. It's something he may want to address in his first sessions the mental health pro. Here's why - it's going to be a stressful situation coming into his immediate environment. It could undermine the support network he has with both his partner and his father. It's worth putting that issue to the top of the pile.

Considering the history, your partner may have some unrealistically hopeful ideas about who quickly he can recover. His therapist can help him set realistic expectations.

You're not being selfish to want to have some control of your situation.
posted by 26.2 at 5:04 PM on November 20, 2010

I think saying

"SO, this is making me miserable, what you're doing doesn't seem to be working. Please get help instead of trying to solve this yourself, because, again, this is making me miserable."

is reasonable here. Beyond that, it's difficult to impossible to help the person who isn't ready for it, especially without harming your relationship and driving yourself crazy in the process.
posted by zippy at 5:06 PM on November 20, 2010 [5 favorites]

You are both putting his needs always before your own. It is completely fine to let him know he is ignoring your needs, especially with the secrecy. I had a partner pull that on me once and in retrospect, it made the situation much worse for me and has had life-long negative repercussions.

Please share your pain with others, whether friends or a therapist since your partner is not being supportive in the way you need. This is your own experience and I do not think you need his "permission" to describe how your life has been impacted the past three months. It also "confirms" to him that this is something to be ashamed of because you obviously agree.

I agree the vacation with him is probably not going to happen. It would probably be very good for you though to get away from being his caretaker and continue on the trip without him. You are not responsible for "picking him up from his slump" if he does not go on the trip - he is. He needs to take more responsibility for himself and his health and you need to feel your needs are just as important as his.

You should be discussing this with him. You are spending all you energy tip-toeing around him and trying to manage him and that imbalance destroys the relationship from both ends.

It would probably help both of you to talk to a therapist together. Good luck.
posted by saucysault at 5:21 PM on November 20, 2010 [5 favorites]

I would be shocked if he could fly in 4 weeks. As for the rest, it sounds like you would benefit from talking to a therapist yourself. You're in a really stressful caretaker role and your partner isn't willing or able to support you right now.

You also might want to see if your SO and his therapist will let you talk to his therapist, both to express your concerns and answer your questions about how his treatment might progress.
posted by Mavri at 5:38 PM on November 20, 2010

Therapies for phobias generally tend to be exposure based. A typical course of treatment would involve him learning learning some form of relaxation skills, and then being exposed to some small version of the feared thing while trying to hold onto, or recover, his relaxed state. CBT, Behavior therapies, biofeedback, hypnosis, etc. are typical modalities. They are often supplemented by anti-anxiety medications. The success of these therapies will depend A LOT on your SO's motivation, as practice is required.

It's frustrating for family members because people can be really suffering, can be debilitated by anxiety, and yet also be motivated to avoid changing.

One thing that is very challenging is for family members to find a way to avoid "enabling" the disease. Like, if you make all kinds of allowances for him, and make it so he can avoid his responsibilities, it can support the phobia, not the person. It's a tricky balance to find, and it's especially difficult to advise you not knowing the particulars of your SO's experience. You might find some interesting reading matter pertaining to this area in books about codependency - not to say that you are codependent, but that this is an area the codependency issues crop up in a lot.

The general rule is that, without needing to "fix" him, that you should be able to, with love, say the things that you need to say. This is sometimes helped by "I" statements - e.g., rather than saying "You should get out of the house today" you would say "I feel scared that you can't go out of the house, and yet we're booked for this big vacation coming up"
posted by jasper411 at 5:41 PM on November 20, 2010

Re the vacation, I think this would be a fair thing to ask the therapist about. I have an older friend whose panic attacks have been helped by medication, so you need to see if that is a possibility.

Barring that, I think I would tell him that you are not going to go this year and then make alternate plans. He already has a set pattern of backing out at the last minute and afaik dealing with these things takes time.

My grandmother was fairly agoraphobic -and occasionally I have struggled with it a bit-so please don't be angry with him, it's not a fun thing to have and he's not doing this on purpose. He is taking the right steps by getting treatment, so he needs to not view cancelling the trip as a punishment but as wisdom regarding his situation.
posted by St. Alia of the Bunnies at 6:05 PM on November 20, 2010

It's possible to fly somewhere, and be away from home, as an agoraphobe. Which doesn't make any sense, especially if flying seems terrifying...but it is possible. I've done it, and what amazed me about it was how not-scary it is. There's something so anonymous and artificial about airports, that it is almost comforting, and flight itself is so different from what the fear tells you it will be's like, hey look, the power of science is keeping us aloft! I had a little Xanax in my system for my first flight, which may have contributed to the utter euphoria of watching the world sink away beneath me, but there was also a lot of internal monologue: "What's that sound? Oh, that's the wheels being put away. What's that? Oh, that's the flap on the wing moving so we can turn or slow down or whatever is those flaps do. What's the guy next to me thinking about me? Oh, he's busy with his papers."

Court is similarly possible--and almost for the same reasons. There are all these set rules, there are these security guards to make sure everything is safe, the whole thing is so processed and artificial that the terrifying randomness of Outside doesn't seem to penetrate. ("He's going to yell at me. Oh, no, he just wants me to say what I already said on the papers. That guard is going to think I look suspicious and shoot me. Oh, no, he just wants me to walk through the metal detector.")

Here's the thing about agoraphobia: It's an internal monologue that is hard as hell to interrupt--hard to do it if you're the agoraphobe, and I imagine even harder if you're the person on the outside. You are living, at all times, with a sort of script running in your head, the script being written by every frightening or embarrassing experience you have ever had, ever heard of, or ever imagined. What if I get in the car but it breaks down, or someone hits me? What if I'm at the store looking for canned peaches but I accidentally throw up all over the place? What would people say? And those cans...what if they're tainted? How much of a botulism-infested peach would I have to eat before it killed me? Would I know if the can was infected? They do taste a little funny, I better throw them away. Except now there's this thing in the trash can and if I take the trash outside, my neighbors might see me. What might they say?

And it never stops.

When you're talking to an agoraphobe, you're talking to a terrified dog that growls and snaps and can't tell friend from foe. Someone who will fight every attempt at assistance, not because he hates you, not because he doesn't understand something is wrong, but because you don't understand how dangerous the world out there is, how full of peril even that short walk to the mailbox is.

Agoraphobia makes you think you know certain facts about the world, even while clouding that world and making it hard to ask the basic questions that, if asked, would make the fear seem ridiculous. Like: You know if your neighbor saw you walking outside to mail a letter, something horrible would happen. That's fact. There is no denying that something horrible would happen. But what is that horrible thing? Laughter? Ridicule? Murder? One of the frustrations of the fear is that you play out these terrifying scenarios in your head, but when you try to pin down that fear, when you try to ask what, exactly, it is you're afraid of, the fear gets evasive. Because you know, some part of you knows, that your neighbor isn't going to kill you, laugh at you, yell at you, get you into unspecified trouble. ("But he might!" "In the ten years you have lived here, has he done anything more socially involved than saying hello and talking about the weather?" "No, but he might!" "So he points at you and laughs, so what?")

So look. There's this world of voices in his head. Probably he is terrified that he is going crazy, if he isn't killed outright, or laughed at, or criticized. And what he wants to do, more than anything, is hide from that horror. If he's anything like me, there's this belief that if you could just keep it all at bay for a while, if you could just close the curtains and turn the ringer off the phone, if you could just breathe for a minute, you'd feel better. Unfortunately, agoraphobia doesn't particularly want you to feel better, and the fear very easily creeps into other areas of your life (see the canned peaches, above...great method for weight loss, by the way, if you assume every morsel of food is either infected or poisoned).

There's probably nothing you can really do to undermine his recovery, short of pretending there is no problem. If you accept this as normal, if you accept that this is the way he is always going to be, then yes, it's doomed. You'll become the focus point of safety because you offer him nothing to fear, no exposure to the outside world. What you want to be is a tricky balance--you want to be the support and the danger. It sounds like you are pretty engaged with the solution--you want him to see the doctor, you want him to see the world.

As for seeing the world...I think it would probably be easier now, after only 10 weeks of being housebound, than it would be after 10 months or god forbid 10 years. Maybe that's overly optimistic, since he has bailed on flights before, so yeah, prep yourself for staying home...but talk to his therapist, if that's okay, about this trip, about what it means to you, about whether it's just impossible. No way to know that, I guess, until he either goes or freaks out.

Gah, I'm not being much help here. What I really want to say is that agoraphobia is treatable, and you're not necessarily in for a life sentence of taking care of a panic-stricken love. You need support. You need someone to talk to, because the treatment can take a lot of time--especially the time it will take for him to drop the secrecy, and time to learn how not to offer him pretend safety that only ends up hurting--it can take time, but there are established methods for treatment, there are medications, there are therapies, there are books (yeah, I know he has read them, but most of them involve actually doing something other than reading, because reading isn't enough to stop those scripts from playing in your head). Being housebound isn't the inevitable outcome here. A full cure, I don't know about...I still wince when I'm taking out the trash and someone drives by, but at least I'm taking out the trash, going to the store, getting on the plane, doing half the things that normal people do. They just don't realize how terrifying it is.
posted by mittens at 6:49 PM on November 20, 2010 [9 favorites]

A lot of antidepressants take more than 3 months to really start working. Wait. Be patient ( oh, i know, that's harder than it sounds). See what happens after 3 or 4 months.
posted by honeydew at 8:30 PM on November 20, 2010

Has he tried Xanax? It's great for dealing with short-term, immediate anxiety attacks. But you build up a tolerance over time so he'll need something else for the long-term.

I've had some mild anxiety-related agoraphobia. I've found that I can deal with familiar places (like going to my office) but leaving the house to go somewhere new is very intimidating and stressful. So perhaps help him start out by going to the same place over and over until that place feels "safe." Then add additional places as he is able to cope with them. Just realize that it may take him a while to wind himself up to do it, and then a few days to recuperate afterward.
posted by Jacqueline at 3:46 AM on November 21, 2010

Agoraphobia is definitely treatable. I had problems with it when I was in college and for a few years after; I was able to graduate and hold down a job but getting out the door each day was a monumental struggle. If I didn't absolutely have to leave the house, I wouldn't. But panic is a weird thing - I visited Paris three times (I'm in the US) during this period. However, I don't have a fear of flying, and that's a separate issue from his agoraphobia. Probably lots more people are afraid of flying but are not agoraphobic.

Years later, I am still not where I'd like to be with the agoraphobia, but it's much better. Medication is the #1 thing that has helped me, along with the patience of my spouse. He encourages me to go out, but he's still supportive when I don't. Early on in our relationship, he had a tendency to want to "break" me of my anxiety, which backfired in a big way. I urge you not to do this. Don't give or withhold affection based on whether or not he accomplishes progress in treatment. Also, telling me to "calm down" in the throes of a panic attack is like telling water not to be wet. If I could calm myself down, I would have.

Ask him what you can do to help him calm down when he has a panic attack, and certainly don't try to provoke one, but don't try to prevent them either. If you want to go out to dinner, find a friend and go out to dinner if your SO won't go with you. Like other commenters have said, it is a delicate balance, and frankly, you may find that you do not have the patience to wait for your needs to be met. You're not a terrible person if you decide that this is an untenable situation. Six weeks on anti-depressants is not enough time to gauge how this will go, though. This particular medication may not even work, and he'd have to find another.

I think it may be unrealistic for you to think that everything will be fine after a few treatments, and he'll be a "normal" person. He's probably really afraid of disappointing you if he doesn't go on this trip. If he has an appointment with a therapist, I'd have him ask him or her whether he should go, and have the therapist coach him on how to tell you if the answer is "no." I am sure you will feel disappointed, and there's nothing wrong with that, but try to see it as if he had come down with a horrible virus. He's not doing this on purpose.

I wish you luck and I hope this disjointed comment has made some sense.
posted by desjardins at 8:18 AM on November 21, 2010

I've had a serious series of panic attacks several years ago and am still "getting over it" - it truly is a life-changing, crippling event. For a long while I was afraid to drive because I thought gravity might reverse itself and fling me out into space. Weird huh? But I very much thought of the possibility - I couldn't even look at the moon for a year.

He probably is trying to think himself through it as you mentioned - it really does feel like reality is slipping away. Losing control.

I think you are right in thinking that exposure can help, but it has to - has to - be exposure on his terms. Inquire as to what "sets him off" or what "feels wrong". I couldn't ride in cars of friends because I wasn't in control of the situation. I had to build up exposure by riding with my wife - I knew she understood my new eccentricities and would stop if I needed to stop.

I would seriously consider excusing him from the upcoming trip. You do not want him to feel trapped in an airplane. I had to fly from NY to Hawaii and did not care for it one bit. The idea of flying seems abhorrent to me now but in high school I flew from NY to London with no remote problem.
posted by carlh at 8:35 AM on November 21, 2010

I think the 3-week vacation is off for now and for maybe a long time. (At least, with taking him along. Would he be utterly devastated if you went alone?) That's a huge amount of pressure on him to go and a lot of money to waste if/when he freaks and doesn't go and a huge amount of resentment on your part if/when he freaks and doesn't go. (I'm guessing at that last part. If I were you I'd probably be really pissed, anyway.) He has a long history of last-minute bailing out on flights and I wouldn't try it again soon soon. If and when he's recovering enough to want to give flying a shot, don't do a long trip- try some "practice flights" and pick the shortest/nearest/cheapest locations to go to so that if he freaks, you're not out too much money. He may need to work his way up to Cyprus, you know? Maybe wait until he's done five flights in a row without freaking out before you book a long trip?

I think it's kind of unfair of him to insist that you keep his secret. After awhile, people are going to notice that he hasn't shown up to any gatherings in a long time, and it's not fair to you to have to always make up lies for him. That might be something to talk to him about.
posted by jenfullmoon at 8:05 PM on November 21, 2010 [1 favorite]

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