As you grow older, you may someday find yourself feeling lonely. Since we are social creatures by nature, we seek to form connections with other people. To some extent, feeling alone is quite natural, as our social needs cannot always be met, making it a normal human experience.

However, some individuals have an abnormal and irrational fear of being isolated or alone. This condition is known as autophobia (au·​to·​pho·​bia), sometimes also referred to as monophobia. This refers to instances when an individual’s fear of being alone is so severe that it prevents them from proceeding through their daily routine.¹ This should not be confused with loneliness, because whilst both hold similarity, loneliness is described as an emotional condition which results in feeling alone even in a crowded setting. It is an intrinsic uncomfortable phenomenon that can occur at any stage of life to anyone.² 

In contrast, autophobia is a severe and disabling mental health condition associated with fear. This is triggered when an individual suffering from this phobia is alone, or they feel lonely. They believe that safety is only ensured when they are surrounded with other people, and are more prone to staying in toxic or unhealthy relationships. Being alone, even in familiar surroundings, can cause anxiety relating to all the "what-ifs" that could occur. Even if they are certain that they are physically safe, they may be terrified of the possibility of sudden strangers or intruders, rejection, unexpected events, running into a crisis without support, or being abandoned. Those with autophobia who attend school or work, may also face disruptions in their ability to focus on their own, and are more likely to seek constant reassurance and companionship. Consequently, this can lead to strained relationships with their peers and loved ones. 

Individuals can experience this fear to varied degrees. Depending on how afflicted they are, autophobia can manifest into other severe mental health issues such as depression, borderline personality disorder (BPD), and social anxiety.³

What is a phobia?

When it comes to phobias, you probably have heard of arachnophobia (fear of spiders), or agoraphobia (the fear of being in public or in a crowded space). However, there are a lot more phobias than you could possibly imagine, as phobias develop around an object or a specific situation. Phobias are considered an anxiety disorder, resulting in distress and a variety of symptoms such as nausea, irrational anxiety, or being extra “panicky” when coming in contact with the source of fear.⁴

Causes of autophobia

Some of the most common mental health issues include specific phobias such as autophobia. It is estimated that 7.4% of individuals encounter a phobia at some point in their lives. For women, the rate is higher, as almost 10% of them experience a specific type of phobia.⁵

The causes of phobias differ from one phobic disorder to the next. Many specific phobias originate as a result of past traumatic situations. In regards to autophobia, establishing a cause is challenging due to a lack of research and understanding from scientists and doctors. However, risk factors have been identified, including origins from childhood trauma, underlying mental health issues, traumatic events which transpired when being left alone, and biopsychological components. 

Feeling abandoned during childhood

Children who have lost their connection to a parent or primary carer face emotional and physical separation, losing the ability to rely on this person as a safe and secure source of comfort. The child may have difficulty self-regulating and self-soothing, which can persist through adulthood.⁶ There are numerous types of situations that might lead to attachment trauma and the acquisition of autophobia, including:

• General neglect
• Parental divorce
• Poor mental status of the parents
• Substance abuse in parents
• Sexual or physical abuse
• Persistence of poverty in families
• Losing a family member

Mental health

As mentioned previously, people may exhibit other underlying mental health conditions alongside autophobia. These are known as comorbidities. Some common autophobia commorbidities include:

• Depression
• Bipolar disorder
• Substance use disorders
• Personality disorders
• Somatoform disorders⁷

Biopsychological factors

Autophobia evokes a trigger response from your body's fight or flight system, which leads you to believe that you are in immediate danger. Some individuals are at a higher risk of developing phobias because of their genetics. This means that if a family member has a specific phobia, there is also a chance that you may develop this phobia.⁸ In addition, changes to the brain structures and neurotransmitters (which are chemicals that allows brain cells to communicate efficiently) due to lifestyle habits or substance use, can also increase the likelihood of developing a specific phobia. Comparably, if a child observes a family member being afraid of something, such as being by themselves, it is possible they will start to fear the same thing.

Symptoms

Autophobia may manifest itself through psychological, behavioural, or physical symptoms. These symptoms can impair a person's ability to perform optimally. Each person is impacted to a different extent, but may encounter an abundance of the following:

Psychological and behavioural

• Avoidance of being alone, and experiencing intense anxiety or fear when this cannot be avoided. This can escalate into panic attacks
• Feeling abandoned or unsafe when they are by themselves
• Making a significant effort to stay with others, or being clingy
• Seeking validation from others
• Fear of any loud noises when left alone
• Feeling of loneliness
• Mood swings
• Children experiencing autophobia may act out by throwing fits, clutching, sobbing, or refusing to leave their parent's side
• Feeling detached from one’s body (depersonalisation)
• Feeling as if everything around them is not real (derealisation)

Physical 

When a person with autophobia experiences an anxiety or panic attack, the physical symptoms become more noticeable.

• Palpitations (feeling like your heart is “pounding” or “racing”)
• Dizziness or fainting
• Hot flashes or chills
• Hyperventilation
• Nausea or vomiting
• Chest pain
• Shaking or sweating⁹

Diagnosis

The diagnosis of autophobia is not straightforward. This is due to a lack of specific tests for this condition. It is best to speak with your healthcare practitioner if you believe that you or someone you know has this health condition. You may be asked to provide a thorough medical history and questions about your fear, its duration and triggers, your emotions, and its influence on your everyday life. Your healthcare practitioner will run some tests to rule out any physical health issues and other mental health disorders. 

As autophobia falls under the category of a specific phobia, a mental health professional will follow the International Classification of Diseases, 11th Revision (ICD-11) as a verified assessment tool to carry out a diagnosis. They may check for the following statements: 

• Cannot function in day-to-day life due to the fear of solitude
• Go to great lengths to avoid being alone with high anxiety and distress
• Have been experiencing this fear for 6 months or longer
• Acknowledge that the fear is excessive
• Symptoms that cannot be explained by other mental health illnesses
• Have panic attacks about the thought or possibility of being alone¹⁰

Treatment options

The treatment goal for all phobias is to relieve the unreasonable anxieties that underlie them. In order to lessen the frequency and intensity of your episodes, treatment focuses on improving your ability to identify and comprehend your phobia.

Cognitive behavioural therapy (CBT) 

Cognitive behavioural therapy (CBT) is a form of talking therapy based on the idea that our emotions, thoughts, and actions are interrelated. The therapy operates by assisting patients in recognising, exploring, and disputing illogical ideas associated with their fear of being alone. People can lessen the severity of their fearful reactions by adopting better cognitive patterns and altering their behaviour through a series of personalised sessions.^9,11

Exposure therapy

Also known as systematic desensitisation, exposure therapy is commonly used to treat phobias, a behavioural and evidence-based therapy. A psychologist creates a safe and controlled environment so that you are gradually introduced to the frightening circumstance of being alone by yourself. This safe-place exposure to the scenario contributes to a reduction in avoidance behaviours and fear. Each session results in an increased exposure, meaning that throughout the sessions the time that you spend alone may increase, until you build resilience and confidence. Exposure treatment comes in various forms: in vivo exposure, which involves real-life experiences, virtual reality (VR) exposure, and imaginary exposure, which involves imagined situations.¹¹

Medications

If the symptoms persevere throughout treatment and do not improve using any of the aforementioned approaches, your GP may prescribe medication depending on your symptoms and your medical history. 

Lifestyle mechanisms

Aside from therapy sessions, therapists or professionals assist individuals in creating customised coping mechanisms for their daily life. Among those strategies are the following ones:

• Yoga: Incorporating light movements with mindful breathing
• Deep breathing: Using slow, soothing breaths to help overcome the physical symptoms of anxiety by paying attention to your breath while sitting or lying down in a quiet, comfortable area
• Meditation: Help people become more aware of their body, thoughts, and feelings while also calming their minds by emphasising breathing and mindfulness⁹

Summary

Autophobia is a type of specific phobia, where an individual’s fear of being alone is so severe that it prevents them from proceeding through their daily activities. Being dependable on your peers, anxious to the brim of panic attacks about the thought of being alone, and feeling unwanted/unloved in solitude are major effects that this phobia has on an individual that suffers from this phobia. Whilst this condition is not fully understood and requires further research, healthcare experts are able to assist and aid to overcome this fear through coping mechanisms, CBT, exposure therapy, and medications. If you, or someone that you know, have difficulty with autophobia and its associated symptoms, please contact your nearest GP for further assistance.