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Agoraphobia and the Telecommuter

How working from home enabled one woman's mental illness to flourish.

Labor experts and industry analysts have written at length about the explosion of telecommuting in the last decade. Yahoo CEO Marissa Mayer’s decision to ban workers from telecommuting earlier this year attracted the ire of working moms and other critics who call the work-from-home trend the “inevitable wave of the future.” A growing body of evidence shows that full-time employees who work from home tend to be more productive than their cubicled counterparts, but some say telecommuting promotes disconnection among colleagues.

Just over 3 million Americans qualify as telecommuters, or those who work full-time at home for someone other than themselves. Coincidentally, the same number of Americans also suffer from agoraphobia, an anxiety disorder and the most common type of phobia. Not exactly the fear of open spaces, as the popular definition would have it, agoraphobia is, simply put, the fear of being trapped in a place or situation where you think you can’t escape or get help.

A term first used in 1871, agoraphobia has also been known as “locomotor anxiety” and “street fear.” These names make sense, considering thatmodern wide boulevards first emerged in Paris in the 1870s and, around the same time, technological breakthroughs such as extended railroad networks and long-distance commercial steamships had just begun to allow for the possibility of higher-speed, long-distance travel.

In Western cultures, agoraphobia can be particularly “debilitating because social and interpersonal skills are the primary traits that allow the acquisition of resources,” according to the first volume of Cultural Sociology of Mental Illness. In other words, making a living has historically been difficult for agoraphobes, although that could be changing.

To the severely agoraphobic, the housebound, telecommuting life may sound like a dream. While some sufferers unable to work outside the home may be eligible to receive disability benefits, full-time telecommuting remains an attractive option: It opens the door to something much more closely resembling a normal life.

But it’s less intuitive to think that someone might become a full-blown agoraphobe after he or she starts working from home.

After graduating from college two years ago, I landed a job as an editor for a mobile news startup, which meant I could work from anywhere with nothing but a laptop and Internet connection. “You’re so lucky,” everyone said when they learned I worked from home, and I agreed. I didn’t need to pack a lunch every day, or worry about commuting costs. Pajamas and no makeup made for an easy uniform in the mornings. My desk was often just a couch.

Just before getting hired, I suffered my first-ever panic attack while on a plane flying back home to Los Angeles from Boston. Twenty minutes after takeoff, I hovered outside the bathroom, weak and dizzy, having thrown up from sheer terror

Panic attacks are fairly common and do not necessarily lead to agoraphobia. With the release of the DSM-5, agoraphobia was unlinked from panic disorder, in which sufferers experience sudden and unexpected attacks. Anxiety researchers now view agoraphobia as a separate disorder.

Working from home was wonderful, convenient, and money-saving, but as time went on, my small anxieties devolved into something more destructive. I’d obsess over uncomfortable yet fleeting bodily sensations, growing convinced that every twinge of my gut or gnawing headache signaled something ominous. I later learned that this is what’s called “anxiety sensitivity,” and is experienced by those who are particularly attuned to the subtlest of changes in their body. Soon, my self-talk often went something like this: What if I go to the store and faint in front of everyone? What if I get food poisoning at the restaurant? What if I can’t escape? What if I go insane and die? In my purse, I always carried ibuprofen, Pepto Bismol chews, Xanax, acidophilus pills, and water, just in case.

The symptoms were always the same: guts churning, icicles for fingers, my skin at once numb and on fire, head disoriented. Once, while I was having a panic attack on a road trip, I begged my friend to let me roll down the window, even as we whipped down the freeway, our ears shuddering from the wind. Later that night I caught sight of my reflection in the bathroom mirror—the blood vessels in my eyes had burst from hyperventilation.

With time, things worsened. Soon, I couldn’t think about getting into a car or on a bus without panicking. I made excuses to avoid going to dinner or on trips to visit family. When I worked from home, I could easily ignore my growing impulse to withdraw, to stow myself away in my house where I was always within reach of a bottle of medication, a bathroom, a bed. These were talismans more than remedies, but life crept on, and every two weeks I received my paycheck direct-deposited into my bank account.

To be clear: Working from home didn’t cause my agoraphobia, it just enabled it. As someone who already had latent anxiety issues, I lacked incentive to prove myself wrong about all the imagined catastrophes that could occur if I were “trapped” somewhere. Telecommuting offered me the retreat I craved, but it helped to reinforce my avoidance patterns. And so the agoraphobia blossomed.

“Avoiding anxiety-provoking stimuli tends to both perpetuate our anxiety and erode our self-confidence, thereby worsening our anxiety—this is true for all anxiety, not just agoraphobia,” said Dr. Kilianne Kimball, the Sacramento clinical psychologist who eventually helped treat me.

It was true. My world grew smaller every week, but working from home meant my world didn’t need to be that big in the first place.

*  *  *

From 2005 to 2012, the number of people who worked from home multiple times a week grew by nearly 80 percent; not even the recession could interruptthe ascent of telecommuters. And its rise isn’t over yet—the number of professional workers in the U.S. who telecommute at least once a week has been forecasted by the Telework Research Network to rise 60 percent by the end of the decade.

Currently, the scientific literature has nothing to say, specifically, about the connection between agoraphobia and telecommuting, though there are several possible reasons for this, according to Dr. Anu Asnaani, a clinical psychologist at University of Pennsylvania’s Center for the Treatment and Study of Anxiety. Psychology researchers may be unaware of new employment trends such as telecommuting, meaning they won’t study potential mental health problems linked to them. And it takes time to conduct and publish a study, even if someone was interested in doing the research.  And without a body of research to build on, psychologists are less inclined to come up with options for intervention or outreach.

Plus, agencies that award funding for psychology research currently tend to support studies examining the neurobiology behind behavior and mental disorders, as opposed to the psychosocial factors of anxiety disorders, such as shifts in work environments, Asnaani says.

“I think the topic itself is very interesting to anxiety researchers as we continue to integrate technology and newer lifestyle information into making our treatments more widespread and better,” Asnaani told me in an email. When we spoke earlier, she said she believed the issue of mental health and telecommuting simply needs greater visibility in the scientific community in order to be studied rigorously.

“I could see where [agoraphobia] would really perpetuate if people developed the ability to ... make a career from home,” said Dr. Dennis Greenberger of the Anxiety and Depression Center in Newport Beach, California. Even now, Greenberger says, people can get groceries delivered to their homes by Amazon, maintain a sense of social connection through Facebook and Skype, and use the Internet to support themselves with relative ease.

Of course, agoraphobia—like all mental disorders—isn’t a “just add water” phenomenon. No one, even if they have underlying anxiety issues, will necessarily become agoraphobic simply by working at home. And fortunately, panic disorders and agoraphobia tend to have the best prognosis of all mental disorders, according to Greenberger—but that’s only if individuals seek help, like I did.

I still work from home today, but after months of self-guided therapy exercises and taking SSRIs, I can say that I’m “recovering.” I read books and did exposure therapy and no longer need to carry a bottle of Xanax around everywhere for comfort. This year, I got on the train to attend my younger sister’s college graduation and flew more than 6,000 miles to visit my grandparents in Guam. But I still feel most proud when I do something pitifully normal, like buying bread at the store without worrying about falling apart.

My world is getting bigger again.

(Image via Apostolos Mastoris/Shutterstock.com)