Autophobia

Autophobia or the fear of being alone can make a person extremely insecure, anxious, and depressed. If a person fears being alone, he/she may become extremely needy of other people at all times. 


What Is Autophobia?

Also known as monophobia, it is the fear of being alone or lonely. It refers to the condition where a person feels intense anxiety or fear even when he/she is alone in a comfortable space. People with autophobia feel a constant need for another person or other people around to feel safe. The person may experience difficult feelings although they may be in a place where they are safe and secure. They can be afraid of:

  • Strangers
  • Intruders
  • Feeling unloved or unwanted
  • Becoming sick or being in a household accident
  • Hearing sudden unexplained noises

Often the sufferers are aware that their fear is not real and cannot harm them, but they find themselves helpless and unable to stop their thoughts or behaviors. This condition can interfere with the important areas of a person’s life like at school, work, or personal relationships in severe cases, when left untreated. The condition is not recognized as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). However, it falls under the category of specific phobias. According to a 2018 research paper 1 , “Phobias involve both fear and avoidance. For people who have specific phobias, avoidance can reduce the constancy and severity of distress and impairment.” The researchers observed that this type of specific phobias often develops during childhood and tends to “peak” in later adulthood and old age 2 . Autophobia or monophobia can last for a number years and may indicate other underlying conditions, such as other phobias, anxiety disorders, mood disorders & substance use disorders in around 10% to 30% of patients.

Understanding Autophobia

According to a recent 2020 study 3 , fear typically refers to an adverse attitude toward an object, event or experience which triggers out flight, fight or freeze response towards the situation or subject. The study adds “In this sense, the Fear of Loneliness (FL) can be understood as an attitude of avoidance accompanied by worrying thoughts and feelings of abandonment that the individual experiences when she/he is alone.” This specific phobia, often identified as eremophobia or isolophobia, is a paralyzing fear of being isolated or lonely. It is not necessary for the sufferer to be actually alone to experience this specific phobia as simply feeling unloved or ignored can trigger intense anxiety.

The disorder is distinct and separate from agoraphobia (the fear of crowds), social anxiety or even self-hatred. However, it may be associated with the above mentioned conditions in some way. People with such irrational and constant fear of loneliness can experience unwarranted, yet excessive levels of anxiety, even when they know that their fear is unreasonable and non-threatening. The term autophobia is derived from the ancient Greek word ‘autos’, meaning self and ‘phobos,’ meaning fear. However, the condition does not necessarily mean a fear of self. But when the patient is required to spend time alone, they can feel highly stressed and anxious. It is a complex condition that may be related with post-traumatic stress disorder (PTSD), insecure attachment, fear of abandonment and separation anxiety.

Autophobia And Loneliness

It should also be noted that this specific phobia is not similar to loneliness. Loneliness refers to a lack of meaningful connections and social interactions. This phobia generates from the thought of being alone and unwanted. According to a 2010 study 4 , “Loneliness is defined as a distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or especially the quality of one’s social relationships.” It originates from “perceived social isolation” instead of “objective social isolation.” When a person feels lonely, they become increasingly vigilant towards threat with stronger feelings of vulnerability. It can also make them desperately seek company and connect with others, which may appear as being “needy”. However, the state of “hypervigilance for social threat” can alter the person’s psychological processes. Not only this can affect their thoughts, beliefs, perceptions, cognitive abilities and behavior, it can also affect their physical and mental health. Perceived social isolation can adversely affect their sleep quality, physiological functioning, cortisol levels, blood pressure and escalate morbidity and mortality. Furthermore, loneliness and isolation can also cause psychological pain which can be experienced as feelings of emptiness, boredom and sadness.

Autophobia, which arises from this perceived isolation, along with intense feelings of loneliness, can lead to higher levels of “stress, fear of negative evaluation, anxiety, and anger.” It also increases symptoms of depression and reduces self-esteem, motivation and optimism. “We have posited that loneliness is the social equivalent of physical pain, hunger, and thirst; the pain of social disconnection and the hunger and thirst for social connection motivate the maintenance and formation of social connections necessary for the survival of our genes,” adds the study. Further research 5 has also found that perceived and objective social isolation can also lead to suicidal thought and suicidal outcomes.

Signs Of Autophobia

Autophobia can occur to people irrespective of their age. Individuals with this disorder more often may feel the need to be in presence of others to overcome the possible anxiety or panic attack. Both men and women report having phobias, however, instead of seeking professional help, they try to manage the symptoms all by themselves. Common signs that indicate a person with monophobia are:

  • Increased anxiety with an increased likelihood of being alone
  • Avoiding to be alone followed by extreme fear or distress when it cannot be avoided
  • Difficulty in carrying out activities that are required to be done alone
  • Visible physical changes such as sweating, difficulty breathing, and/or trembling
  • Going beyond one’s limit to avoid being alone

In children, autophobia may be observed through tantrums, crying, clinging, or refusing to leave a parent’s side.

Symptoms of Autophobia

A person with this disorder may experience the symptoms when they are by themselves or perceive that they may be left alone. Some of the most common symptoms of autophobia include:

1. Psychological symptoms:

  • A sudden sensation of intense fear when left alone
  • Extreme fear or anxiety with the thought of being alone
  • Anxiety and stress regarding being unwanted or unloved
  • Fear of sudden, unexplained noises
  • Worrying about potential threats (intruders, robberies, medical emergencies etc)
  • Depersonalization or a sense of being detached from their own body
  • Low self-esteem and motivation
  • Depression & suicidal thoughts
  • Intense desire to escape the place or situation

2. Physical symptoms

  • Dizziness & nausea
  • Perspiration
  • Trembling or shaking
  • Heart palpitations
  • Chest pain
  • Hyperventilation
  • Panic attacks & exhaustion
  • Trouble concentrating
  • Dry and sticky mouth
  • Headaches or migraines
  • Poor sleep quality or insomnia

Causes Of Autophobia

Autophobia or the fear of being alone can develop due to various factors. Some of these factors are as follows.

1. Genetics

Genetics 6 are one of the main factors that lead to the onset of specific phobias as these mental disorders may run in families. By analyzing twin studies, one 2013 study 7 confirmed that genetic factors play a contributing role in the risk of developing specific phobias. It has been observed that a person may be more likely to develop monophobia if a first-degree relative or family member is also affected by this or a similar specific phobia. This is perhaps due to similar and shared environmental factors experienced during childhood. However, genetic predisposition 8 tends to influence the onset in adulthood. One 2003 study 9 found that both genetic and environmental causes are interrelated when it comes to self-reported fears. Another 2008 study 10 revealed “Familial influences, especially shared environment, are central to the comorbidity between Specific Phobia and both Separation Anxiety and Social Phobia.”

2. Negative life experiences

A person can develop autophobia if he/she felt abandoned at some point in life, specifically in childhood, which resulted in anxiety, distress, and feelings of unloved or neglected. It can also be where the concerned person was harmed because he/she was alone and vulnerable. According to a 1998 study 11 , predictable yet hard to control childhood experiences, such as childhood abuse, maltreatment or parental violence and unpredictable & uncontrollable situations or events leading to physical harm can cause specific phobias. “Experiential-specific phobia results from an unfortunate experience. It has been suggested that its acquisition is due to classical fear conditioning, while its maintenance is due to operant fear conditioning, which, in turn, reinforces the avoidance behavior,” explains a 2017 study 12 .

Some studies 13 also indicate that women are more prone to developing specific phobias than men.There may be other legitimate reasons to trigger autophobia, such as living in a neighborhood with a high crime rate. Generally, such fears should not determine one’s lifestyle. However, when they start to intervene with day-to-day activities, it rings an alarm of concern.

Diagnosis Of Autophobia

If a person feels that they are suffering from this fear-based psychiatric disorder, then it is best for them to consult a mental healthcare specialist. A general practitioner or psychologist or therapist may ask certain questions to the patient regarding their symptoms, thoughts, emotions and behavior. They may also analyze their medical and family history to get a clearer idea about the sufferer’s physical health conditions and mindset. The doctor may also conduct a psychological evaluation and utilize certain questionnaires, quizzes and self-assessments to better understand how the individual is affected by their fear of being alone. A person may be diagnosed with a specific phobia if the symptoms last over 6 months and affects the sufferers ability to perform important daily functions. However, the doctor may also conduct some additional tests to determine if there are any other underlying physical or psychological conditions. Once a successful diagnosis has been made, the doctor, along with the patient, can devise an effective treatment plan for autophobia.

However, the following diagnostic tools may used by some healthcare experts to determine this condition:

1. Quizzes and Self-Assessments

There are a few online tests that may help one to evaluate whether he/she has any problem and whether it is severe enough to seek professional help:

  • Autophobia Online Test: This includes a set of seven questions to carry out a self-test along with links with helpful information.
  • Test for Symptoms of Anxiety, Panic, OCD, and Phobias: It is a brief test to evaluate anxiety symptoms with one section on specific phobias.

2. Tests Performed by Professionals

The condition can be diagnosed by a mental health professional through an interview where questions are asked about symptoms and other medical problems. Diagnosis of monophobia is devoid of a blood test or other laboratory tests, unlike other disorders.

Treatment Of Autophobia

The treatment and management of autophobia includes therapy, medication, and lifestyle changes. Medical intervention is necessary when the patient is using alcohol or other drugs to avoid moments of anxiety. Since substance use can genuinely make the anxiety worse, it must be addressed early via medical treatment. Here are the treatment options for this condition:

1. Psychotherapy

The popular therapies used for the treatment of this phobia are exposure therapy, systematic desensitization, and cognitive behavioral therapy. Group therapy is also used to provide further assistance from others who share a similar phobia.

A. Exposure Therapy

This is a behavioral and evidence-based therapy that is commonly used to treat phobias. Here, a protected environment is built by the psychologist to expose the client gradually to the fearful situation of being alone. Thus, this exposure technique in a feared situation amidst a safe environment reduces fear and avoidance behavior. According to a 2007 research 14 , exposure therapy has been found to generate positive therapeutic effects in individuals with specific phobias, especially in older adults. Another 2015 study 15 has found that exposure therapy can be effective for the treatment of anxiety related with phobias.

B. Systematic Desensitization

This is a type of exposure therapy defined by a slow paced technique. Systematic desensitization is coupled with relaxation exercises so that patients can associate the feared situation with being relaxed. According to research 16 , behavioral therapy like systematic desensitization and flooding can be “ the most effective treatment for phobias.” This method can teach the sufferer different ways to cope with fear and anxiety through cognitive approaches, breathing control and relaxation.

C. Cognitive Behavioral Therapy (CBT)

CBT is one of the most effective and extensive therapies for treating autophobia. In this therapy, there are three phases, namely didactic, cognitive, and behavioral. The didactic phase outlines the expectations for treatment outcomes, the cognitive phase enhances the thought process of the patient which otherwise results in fear or anxiety and the behavioral phase is a combination of relaxation exercises and systematic desensitization. One 2014 study 17 states that “Cognitive behavioral therapy (CBT) is an efficacious treatment for anxiety disorders (such as specific phobias), OCD and PTSD, with the core therapeutic component being exposure with response prevention.” According to another 2006 study 18 , CBT can help to eliminate or decrease subjective fear, symptoms of specific phobia and behavioral avoidance. “Findings indicate CBT can be effective for treating clinical fears in an individual with developmental disabilities and severe behavior,” adds the study.

D. Group Therapy

Like any other mental disorder, group therapy also helps with this condition. This therapy involves regular meetings with individuals also struggling with monophobia. Here the group members share their challenges, provide tips to deal with the condition along with support and encouragement to each other.

Intended Treatment Outcome & Timeline

The intended outcome of treatment for autophobia has four different stages:.

i. Habituation

The stage marked by reduced fearfulness of being alone, even though a small amount of anxiety may still occur. This is manageable and does not interfere with functioning.

ii. Extinction

A stage where the patient stops connecting the act of being alone with a bad outcome.

iii. Self-Efficacy

The stage where one learns to handle fear and anxiety while controlling these feelings.

iv. Emotional Processing

At this stage, the person’s thinking pattern changes about feared situations while accepting a more realistic belief which is less anxiety-producing.

All of these changes enable a person with their phobia to handle any situation where he/she is alone but with less anxiety.

2. Medication

Medication may be used along with psychotherapy. Medicines for autophobia can be prescribed by a physician, psychiatrist, or clinical psychologist who has prescription privileges. The most commonly prescribed medications are:

A. Antidepressants

Antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) which are at times used to treat phobias. Studies 19 have found that SSRIs like sertraline, fluvoxamine, fluoxetine and escitalopram “had significantly greater CGI (Clinical Global Impression of Change) response rates compared with placebo,” for anxiety and phobias. According to another 2002 study 20 , SSRIs are highly effective for anxiety disorders and can help with phobias.

B. Beta-Blockers

An alternative to the antidepressants for treating phobias, these medicines block the physical symptoms of anxiety, such as increased heart rate, shaking, and excessive sweating. Propranolol 21 (Inderal) is a popularly prescribed beta-blocker as it has been found to be effective. One 2012 study 22 has found that although beta-blockers help with anxiety, “they do not affect the cognitive and emotional symptoms of anxiety.”

C. Benzodiazepines

It acts as a sedative to promote relaxation. These are extremely addictive 23 and should only be used under a physician’s oversight.

Coping With Autophobia

Apart from seeking help through therapy and medication, a variety of anxiety management skills can also assist with managing the symptoms. These include:

  • Deep breathing exercises
  • Guided imagery exercises
  • Progressive muscle relaxation exercise
  • Self-soothing habits
  • Self-assuring statements
  • Regular exercise to relieve stress and uplift mood
  • Welcoming humor and the benefits of laughter

Moreover, certain lifestyle changes can also help to reduce anxiety and symptoms of autophobia, such as:

  • Eating a healthy, balanced diet
  • Getting adequate sleep
  • Meditation and yoga
  • Limiting or avoiding caffeine along with other stimulants
  • Reducing or withdrawing the use of alcohol and other drugs
  • Healthy social interactions with loved ones

Helping A Loved One With Autophobia

It is quite daunting to see a loved one suffering from this disorder. However, as a caregiver, you must provide him/her with useful information to help them cope with the embarrassment about their fear. While it requires willpower to overcome a phobia, most people have both mental and physical symptoms that make it a challenge to overcome this condition. You can consider the following steps in order to help someone with autophobia.

  • Encourage them to speak to a professional without any hesitation
  • Help them to find a qualified and skilled therapist to work with them
  • Help them remember the appointments along with accompanying them as well
  • Confirm them that their symptoms are difficult but are manageable with professional help
  • Encourage them to be honest with the professional and to provide correct information about how they are currently dealing with the symptoms, such as the use of alcohol or other drugs.

Autophobia Is Challenging But Manageable

While autophobia is the intense fear of being alone, the meaning of the fear may vary for different individuals. However, consulting a healthcare professional can help the patient get a proper diagnosis and effective treatment which can enable them to overcome the symptoms. Moreover, the love, care and support of near ones can also help them to manage this mental condition and enjoy life in a normal way.

References:
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