Panic Attacks, Agoraphobia, and Spatial Orientation: Perception is Everything

Raise your hand if you’ve ever been plagued by agoraphobia. Well, my arm’s fully extended upward. I can recall being all but housebound because of it in the early 1980’s. And if I did venture out it was with a few drinks under my belt, a few beers in the car, and about ten cigarettes in my mouth. I can’t tell you how thankful I am those years are gone. But, one of the huge upsides is my ability to offer very meaningful and efficacious assistance to those suffering from the same misery. Well, then. I’d like to share some interesting information regarding the relationship between agoraphobia and something known as spatial orientation.

First, let’s make sure we have a solid foundation. “Agoraphobia” is a compound word. “Agora” comes from the Greek for “place of assembly;” and, of course, “phobia” comes from the Greek, “phobos,” meaning fear. So, literally we have “fear of the place of assembly.” Now, as you may know, agoraphobia and panic attacks are attached at the hip. In fact, a formal diagnosis of panic disorder is made “with or without agoraphobia.” Simply put, agoraphobia is, well, anxiety about being in places or situations where a quick exit may be tough to pull off. And why don’t we throw into the mix feeling uneasy about who will come to the rescue should panic-like symptoms, or an attack, occur. Ultimately, things escalate to the point where places and situations of perceived threat are most often avoided; and if not, they’re endured with tons of angst. Again, been there and done that way too many times.

Okay, so just what is spatial orientation? It’s pretty cool, actually. How ‘bout we say it’s our ability to maintain a sense of body orientation and/or posture within the context of our surrounding environment in the immediate. And this applies to when we’re moving and static. Though it’s so wonderfully natural it seems as though it “just happens,” such is definitely not the case. No, to maintain sufficient spatial orientation our brains blend proprioceptive (from the skin, muscles, tendons, and joints - tactile) and vestibular (from the inner ear) cues with visual messages. And, of course, adjustments are made as changes in environment and/or positioning occur.

Well, research has discovered a relationship between agoraphobia and problems with spatial orientation that makes a whole lot of sense, and explains much. It seems as though many agoraphobics have weak vestibular functioning. As a result their brains are forced to rely solely upon visual and tactile cues for spatial orientation. Well, this becomes a major problem if visual cues are tough to come by; say, if one is standing in the middle of a desert. And problems also occur if the visual input is overwhelming, like what may be experienced if one is on the dance floor of a popular night club. Finally, those with spatial orientation challenges have difficulty with irregular surfaces or landscapes; say, one of those goofy rooms in an amusement park funhouse where the floor is severely tilted.

Hmmm. Standing in the middle of a desert, being on the dance floor of a popular night club, a severely tilted floor in a funhouse. Aren’t these places and situations that are generally very disturbing to agoraphobics and panic sufferers? You bet. And it’s all about having difficulty with processing atypical audiovisual input.

I really enjoy uncovering and sharing tidbits like this. And the cool thing is, once we make our “scientific” discovery we always end up saying, “Well, hey, that makes sense. It happens to me all the time.” So, how ‘bout we chalk-up another manifestation of anxiety to biology. And the next time we become distressed over an issue of spatial orientation, let’s first consider the facts as to what’s really going on and learn to leave panic and avoidance behind.