Mel,

I practiced clinical psychology for many years - and saw a lot of folks who sound very much like your family relation. While I would never make a definitive diagnosis on someone who I have never seen, I will offer an opinion.

She sounds like she suffers from a classic case of agoraphobia. There seems to be a lot of misinformation about this perplexing and usually vexing (for the person afflicted) disorder. Agoraphobia literally means fear of open spaces, but that is hardly ever the exact symptom manifested in this condition. And while it has a phobic component, it is not a phobia in the way that we normally think of a phobia as it does not involve the fear of a discrete object.

So agoraphobia can best be described as a combination of severe anxiety, with phobic elements, and repetitive avoidant behavior. Agoraphobia usually starts when a person experiences anxiety and then it recurs in the same situation. After awhile, the individual becomes afraid or "phobic" of the anxiety returning so they start the avoiding places they fear could trigger it. For some, the avoidant behavior becomes so generalized and strong that they end up as virtual shut-ins within their homes.

Many agoraphobics have unresolved conflicts around loss of control (of course, who doesn't - I know I have some - and if I didn't, getting this PN would have created them). The symptoms become an expression of this conflict and the fear of loss of control intensifies - it is kind of a very negative spiral that can truly make life a living nightmare for some.

As with other psychological problems, agoraphobia has a wide range of severity. Most are probably similar to your relative, that is, they manage to work and most people around them are unaware of the problem. But from there, the problem can be moderate or even severe, progressing to complete withdrawal from ordinary life activities.

I hope she is getting adequate help. In some cases, the symptoms prove quite intractable. But fortunately most folks are able to be significantly helped.

rafi