Fear of Crowds? When You Need Help for Anxiety

While taking a little holiday in Manhattan over the weekend, I breathed in all the sights, sounds, and smells of Fifth Avenue and Central Park. Though I lived in the city 15 years ago, I'd forgotten about the crowds: swarms of people strolling along the sidewalks or clustering around street dancers who were doing flips and moonwalks in tribute to Michael Jackson. While I certainly enjoyed watching all the buff performers—especially those roller-dancing in the park—I found myself yearning for a bit of solitude. Even while wandering through 38 acres of Central Park "wilderness" known as the Ramble, I found I wasn't alone for more than 30 seconds.

Does all this togetherness have detrimental health effects? I decided to do a little digging, and I uncovered scant evidence that crowding is bad for our health. Although a landmark 1962 paper found that rats crammed into overcrowded cages set about killing one another, human studies of urban populations have found no such increase in murder rates or other untoward acts of aggression. And nearly a decade ago, researchers at the Yerkes Primate Center in Atlanta studied more than 100 chimpanzees—our closest animal relative—and found that those groups that had only one-tenth the living space of other groups got along just as well with one another. "If crowding did induce social tensions, our chimpanzees seemed to control them directly," write the authors in Scientific American.

There are, however, certain people (I'm not one of them) who find the feeling of a crowd "pressing in on them" to be extremely stressful, says psychotherapist Jerilyn Ross, president of the Anxiety Disorders Association of America and author of One Less Thing to Worry About. When such a feeling causes a panic attack, that's a sign of the anxiety condition claustrophobia. Feeling panicked by the mere presence of strangers is a condition known as agoraphobia. What's interesting is that women are twice as likely as men to experience such anxiety disorders, Ross says, at least partly because of fluctuating levels of sex hormones like estrogen. Pregnancy, in particular, can have a strong impact. Some women have disorders triggered by pregnancy, whereas others find that their lifelong disorder goes away when they're pregnant. Ditto for menopause. I felt claustrophobic when I was breast-feeding, possibly owing to my low estrogen levels. In fact, I had one particularly bad bout while grounded on a crowded propeller plane for an hour. Fortunately, a sympathetic flight attendant let me wait with my infant son on the tarmac until we were ready to take off.

What distinguishes normal anxiety from a full-blown disorder, says Ross, is how much it disrupts your everyday functioning. Sure, I still sometimes feel a little claustrophobic on crowded airplanes, but I don't avoid air travel. It's also quite normal to feel trapped on a packed subway stalled between stations. But anxiety that prevents you from going out altogether calls for medical treatment. Antianxiety medications can help calm irrational fears, says Ross, but getting therapy to learn how to manage them may benefit you more in the long run. Cognitive behavioral therapy, in particular, can teach you to challenge fears when they pop into your head and expose yourself to triggers to help you overcome them.

[More on dealing with anxiety disorders.]