What Rachael told me in answer to my questions:
- Kaye avoids leaving the ranch and gets anxious even thinking about it
- When she does have to take a trip into town, she has a panic attack when something unexpected happens, even though it's minor
- She is hyperaware of her surroundings when she's not at the ranch
- Her fear of leaving the ranch sometimes involves thoughts of her mother
- Agoraphobia (and then I'd have to figure out if it's accompanied by Panic Disorder)
- Posttraumatic Stress Disorder (PTSD)
The other possibility, Agoraphobia, includes the following symptoms:
- Anxiety about being in places/situations where escape is difficult or in which help would be unavailable in the event of a panic attack or panic symptoms. Feared situations often include traveling in cars, being in crowds, and being in public alone.
- The feared situations are avoided or endured with intense distress/panic (the person often requires a companion to get through it)
- Symptoms aren't better accounted for by another anxiety disorder (including PTSD)
- It's more likely to be Agoraphobia if Kaye is most afraid of panicking or of being unable to escape and get back to her house.
- It's more likely to be PTSD if Kaye is most afraid of being reminded of her mother's death AND is showing other symptoms of traumatization.
And why is it important to figure out what she's afraid of? Because the treatment for the two disorders is (somewhat) different.
BOTH treatments would probably involve some cognitive behavioral therapy to help Kaye change the way she thinks.
- If Agoraphobia, her therapist would help her interpret her physical symptoms in a way that helps her avoid a full-blown panic attack, and help her identify and challenge her fearful thoughts about leaving the ranch.
- If PTSD, her therapist would help her understand how certain thoughts about the trauma (her mother's death) might increase her stress and fear (like blaming herself).
That's because it involves exposing yourself to the very thing you fear.
- If Kaye has Agoraphobia, she's gonna have to leave the house and cope with being out in public.
- If she has PTSD, she's gonna have to expose herself to the MEMORIES of the trauma.
Treatment for Agoraphobia can be a little tricky because the person may have trouble coming to appointments. This is where insurance-funded treatment can be so frustrating--insurance companies usually won't pay for treatment that doesn't take place in an office. The exposure therapists I know like to do their work in the field whenever possible. They get out there with their clients and expose them to what they fear until it's not so scary anymore. It's totally fascinating to hear them talk about it. Seriously, one of them had a client who was really afraid of farting in public ... so guess what the treatment was? Anyone interested in a post on exposure therapy?
On the Sisterhood of the Traveling Blog front, check out Lydia's post on critique.