Couple should discuss fears with their physician

Q. My mother has not left home without my father, me, my husband, or her sister in almost 10 years. When I talk to my father about it, he says she seems happy, so leave her alone and don’t mention it again. Why is he ignoring a serious problem?

A. Your mother has agoraphobia, defined literally as fear of the “marketplace.” When she attempts to leave home without one of you, she becomes fearful and begins to catastrophize that horrible events will occur. Since this feeling seems unbearable, she has ceased to leave home alone.

Because your mother does not seem unhappy, she is likely receiving both primary and secondary gains for her condition. Primary gains are a defense mechanism that allows people to avoid emotional conflict or tension. If she does not visit friends, attend events, or even shop alone, there is probably little conflict in her life. She is also receiving secondary gains which can include the opportunity to rest, get attention from her family, and be released from responsibilities.

Your father may not be upset about your mother’s agoraphobia because he is also receiving primary and secondary gains. If she does not leave home, he does not have to worry about her spending money, seeing someone else, not having dinner prepared, or wanting to work outside the home. He likely has her total attention.

As an adult child, you cannot solve the family problems. However, you can suggest to both parents that they should discuss agoraphobia with their physician. He or she can prescribe a medication that will lessen your mother’s fears, and make it easier for her to leave home. Additionally, urge them to see a cognitive-behavior therapist together. If your father has become too comfortable with his stay-at-home wife, he may unconsciously or consciously sabotage her efforts at recovery.

A. I’ve had panic attacks for years. What brings them on and what can I do to get rid of them?

Q. Panic attacks are caused when the nervous system activates the “fight or flight” response without a reason. Although this system served people well in our evolutionary past, we no longer have to worry about the tiger outside the cave. In some people, because of heredity or life experience, this system becomes overly activated and panic occurs.

While panic attacks can be frightening, they are not dangerous under most conditions. They last from a few second to a few minutes. After that, another part of the nervous system regulates the distress level and the panic begins to subside.

There are several techniques you can use to make these episodes less frightening. When panic begins, most people notice a rapid heartbeat, feeling warm, difficulty breathing, or a slight dizziness. Try to accept these feelings without catastrophizing. When you do begin to be fearful, the panic escalates.

Most panic attacks occur in public places such as a store or mall. When you feel the beginning of an episode, drink something cold or even touch something that is below room temperature. If you are in the grocery store, head for the frozen food aisle. Additionally, slow down your breathing; put your finger on your wrist pulse point until you have slowed your heart rate. That should alleviate some of the symptoms.

Since there is also a significant gut and brain connection, some people experience panic when they have indigestion or stomach problems. Sometimes popping an antacid can take away both the indigestion and the panic.

If you continue to be disturbed by these episodes, discuss the possibility of medication and psychotherapy with your doctor. There are also numerous self-help books on dealing with panic disorder that you may find helpful. Check your local bookstore or on-line to find one that is best for you.

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Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She currently teaches psychology at Southeast Arkansas College. If you have questions, e-mail them to They will not be answered personally, but could appear in a future column. There will be no identifying information and all e-mails remain confidential.