Joel Ibrahim Kreps

The details of the case histories in this article have been altered to protect the identities of the persons involved. Any resemblance to persons alive or deceased is only very partial and neither their identities nor the characteristics of their lives should be inferred.

Anxiety

His eyes were bulging out, hyperthyroid-like, and his brow and temples were dripping sweat. The look on his face was as if he had seen the hell fires surrounding him and had just managed to escape.

His voice somewhat shaky, he slumped into the chair and, exhausted by his recent efforts, he offered up his summary statement, “That was tough!” It was clearly an understatement.
José was the son of Portuguese immigrants and he had just bicycled across the city to come to his third appointment. A female friend had driven him to the first two sessions out of compassion for his state. This time she was unable to do so, as she had to work. But it was not the strain of cycling that had generated his sweaty, short-of-breath appearance — it was his agoraphobia. This ailment had prevented him from using any public transportation for the last several years; thus, the bicycle was the only option left.
Agoraphobia is often associated with panic disorder and represents one of six major anxiety disorders described in DSM-IV (the Diagnostic and Statistical Manual of the American Psychiatric Association — arguably the most commonly used classification system in contemporary psychiatry). The other major anxiety disorders include Generalized Anxiety Disorder, Obsessive- Compulsive Disorder (described in the Winter 2003 Islamica edition), Social Phobia, Specific Phobias, and Post-Traumatic Stress Disorder.

DSM-IV defines Agoraphobia as: “Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having a panic attack or panic-like symptoms. Agoraphobic fears typically involve situations that include being outside the home alone (as in José’s case), being in a crowd, standing in a line, being on a bridge, or traveling in a bus, train or automobile.” Crowded shopping centers, sports stadiums and underground subway cars are particularly difficult for people with agoraphobia.

When found in one of these situations, the agoraphobic fears that he may develop a panic attack. A panic attack is “a discreet period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes.”

1. Palpitations or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Shortness of breath
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, lightheaded or faint
9. Derealization (feelings of unreality) or Depersonalization (being detached from oneself)
10. Fear of losing control or going crazy
11. Fear of dying
12. Paresthesias (numbness and tingling)
13. Chills or hot flashes