Prince Harry reveals in his new book he struggled with agoraphobia, an anxiety disorder that can cause people to become afraid to leave their home.
“I was an agoraphobe. Which was nearly impossible given my public role,” Harry writes in his memoir, “Spare,” which will officially be published on Jan. 10, but was released early in Spain and translated by NBC News.
He recalls “one speech, which couldn’t be avoided or canceled, and during which I’d nearly fainted” and writes that his older brother, Prince William, came backstage afterwards laughing at him for being “drenched.”
“Him of all people. He’d been present for my very first panic attack. With Kate. We were driving out to a polo match in Gloucestershire, in their Range Rover. I was in the back and Willy peered at me in the rearview. He saw me sweating, red-faced,” Harry writes.
“‘You all right, Harold?’ No, I wasn’t. It was a trip of several hours and every few miles I wanted to ask him to pull over so I could jump out and try to catch my breath.”
What is agoraphobia?
Agoraphobia an anxiety disorder that involves intense fear and anxiety in situations where it would be difficult to escape, says Jacqueline Bullis, Ph.D., a clinical psychologist in Boston who treats adults with anxiety and an instructor in the department of psychiatry at Harvard Medical School.
That might include traveling on a plane or other forms of public transportation, standing in a line, being in a crowd, going to a movie theater or grocery store, or even sitting down for a haircut — places where someone would feel trapped if they felt an urge to leave, Bullis notes.
“Agoraphobia used to be thought of more of this fear of open spaces, but now we really understand it as more of a fear of fear,” Bullis tells TODAY.com.
“It’s more about the fear that they’re going to experience distressing or panic-like symptoms in that situation, and then it would be really hard or really embarrassing to escape from it.”
The symptoms they fear developing can include diarrhea, vomiting, nausea, sweating, chest pain, dizziness and lightheadedness.
When she’s considering diagnosing someone with agoraphobia, Bullis tries to find out if the anxiety is being driven by the anticipation of feeling those panicky symptoms and how that’s impairing a person's ability to live and work.
How does agoraphobia impact a person’s life?
As people avoid more places, it can quickly become very limiting. On the very severe end of agoraphobia, people can become entirely homebound, Bullis says.
“Someone’s world becomes smaller and smaller,” she notes.
People might also seek to keep everything very calm and avoid activities — such as exercise, sex, consuming caffeinated drinks or watching scary movies — that cause a racing heart or other physical sensations that are distressing to them or bring on a strong emotion.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders considers agoraphobia to be a distinct diagnosis that can happen without a history of panic attacks, but it’s common for them to occur together, Bullis says.
How is it possible for a public person, like Prince Harry, to function with agoraphobia?
Prince Harry has always seemed comfortable giving speeches, appearing at public events and interacting with crowds, but looks can be deceiving, says Bullis, who is not treating the prince.
“We oftentimes cannot visibly see the amount of distress that someone is under, which may be the case with Harry in some of these situations,” she notes.
“It’s possible that he’s putting himself in these situations, and it’s just incredibly distressing and draining for him.”
For many people with agoraphobia, being accompanied by a friend, loved one or someone they feel safe with often significantly reduces their anxiety, she adds.
How many people are affected?
It’s estimated 1.3% of U.S. adults experience agoraphobia at some time in their lives, according to the National Institute of Mental Health.
That makes it one of the rarer anxiety disorders. Social anxiety disorder, for example, has been experienced by about 12% of U.S. adults, the NIH notes.
Researchers are still trying to understand what makes one person more vulnerable to develop an anxiety disorder than another. It’s believed to be a combination of biology — being wired to be more emotionally sensitive — along with how we interpret our emotions, Bullis says.
What is the treatment?
Cognitive behavioral therapy is the first line of treatment, Bullis says.
Some people also take beta blockers — a medicine used to treat high blood pressure and heart rhythm disturbances — which can ease the physical sensations. But that can backfire in the long run because it’s teaching people they can’t cope on their own, Bullis says.
The goal is for someone to get more comfortable with those physical sensations through therapy. When people say, “I don’t like that my heart is racing right now,” Bullis wants them to then quickly realize, “That’s OK, I know that it’s not dangerous. I know that I can still give this talk or I can still go into this situation and that I’m safe.”