What Is Enochlophobia?

Everyone can feel a bit stressed and overwhelmed when surrounded by big crowds. However, have you ever experienced a fear so intense that it feels like you can’t escape? Does your heartbeat at 500 miles per hour when in big crowds? Do you experience intense stress and anxiety in a crowd? Then, you may be suffering from enochlophobia. But do not worry; this article will tell you all you need to know about this phobia.  

Introduction

Simply put, enochlophobia refers to the intense fear of crowds. It is not just a feeling of discomfort or stress in situations with big crowds, but more an irrational sense of fear and anxiety that does not correlate with the real danger of the situation.¹ Due to the recent social distancing restrictions and lockdown put in place due to the COVID-19 pandemic, enochlophobia has become more common.² It may not seem that serious, but this phobia can be very disturbing and affect day-to-day life significantly. It can lead to you avoiding crowded situations completely or suffering from uncontrollable physical and mental symptoms if ever found in these situations. 

Origins and core characteristics

Enochlophobia is derived from Greek, with ‘ochlo’ meaning ‘crowd’ and ‘Phobos’ meaning ‘fear’.³ The phobia can be triggered when in a situation with large crowds or when thinking about being in a large crowd. This can cause intense feelings of anxiety that are uncontrollable and unexplainable. These feelings can manifest both psychologically and physically, for example, causing increased heart rate, brain fog, and feelings of anger. 

Causes and risk factors

There is no single cause of enochlophobia, but some things have been identified as risk factors.⁴ These include:

• Classic conditioning: Having previously experienced a traumatic experience in a crowd causes a negative association with the latter. For example, getting lost in a large crowd as a child can be a very scary experience and may lead to enochlophobia. 
• Observational learning: Seeing someone else (e.g., a parent) become panicked/extremely fearful in a big crowd has led to you internalising this fear and developing enochlophobia.
• Witnessing someone else experience trauma in a big crowd or hearing about a dangerous situation in the news/on social media
• A predetermined tendency to worry a lot, be anxious or have negative thoughts
• Overprotective parents
• Genetic predisposition

Symptoms and effects

The symptoms of enochlophobia are very closely related to those of other anxiety disorders. In general, a person suffering from enochlophobia will experience physical, cognitive, and behavioural symptoms when exposed to or anticipating large crowds.⁵ 

Psychological symptoms

As mentioned, enochlophobia can lead to high and uncontrollable feelings of stress, fear and anxiety. Additionally, you may feel trapped or overwhelmed, heightening this feeling of anxiety further. People suffering from enochlophobia tend to perceive big crowds as dangerous, hence why they respond in such a way. People will sometimes also experience brain fog, depersonalisation, and feelings of anger or desperation.⁶ 

Physical symptoms

In addition to psychological symptoms, the overwhelming feeling of anxiety experienced by people with enochlophobia can manifest into physical symptoms.⁵ These include:

• Blacking out
• Increased heart rate/heart palpitations
• Headaches/stomach pain
• Dizziness/nausea/vomiting
• Pupil dilation
• Muscle tension
• Shaking/tremors
• Shortness of breath/feeling like you are being suffocated
• Vomiting
• Sweating

Impact on daily life

Suffering from enochlophobia has serious consequences on a person’s daily routine. Phobias often cause avoidance behaviour, which involves staying away from any situation where the anxiety-triggering factor will/is believed to be present.⁷ Enochlophobia leads to avoidance of crowded situations, such as busy trains or concerts. This may have more serious consequences, as it can limit many factors in daily life. School, for example, may be triggering having educational implications. Instead, homeschooling may be a better option. The same can be said for work, as busy offices or cafes would not be the best environment for someone with enochlophobia. Public transport may be another area that is avoided, which can also have implications on someone’s daily routine. Additionally, if suffering from enochlophobia, you may miss out on social occasions, possibly leading to a sense of social isolation and loneliness. 

Diagnosis and assessment

Professional evaluation and diagnostic criteria

Enochlophobia is not recognised as a disorder in either the International Classification of Diseases (ICD-10) or the American equivalent, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). These are the tools generally used to diagnose a person with a specific disorder. Instead, enochlophobia falls under the category of ‘Specific Phobias’, and its diagnosis is made under these criteria:⁸

1. You suffer from a persistent, excessive, and unreasonable fear due to the presence or anticipation of crowds.
2. When exposed to crowds, it nearly always causes an immediate anxiety response, such as a panic attack. In children, this may look like crying, throwing tantrums, excessive clinging, or freezing. 
3. You recognise that this fear is irrational and excessive in comparison to the real danger of the situation, but you still cannot control it. This may not be the case in children.
4. You avoid crowds as much as possible and endure high distress if not. 
5. The avoidance, anxiety, or distress during crowded situations significantly interferes with your daily routine, work/school, social activities, and/or relationships. 
6. The fear has persisted for a minimum of 6 months. 
7. There is no other mental health disorder/medication that can account for anxiety, panic attacks, or avoidance.

If showing all of these symptoms, a mental health professional will likely diagnose you with a “Specific Phobia - Situational Type, Enochlophobia.”

Differential diagnosis

As mentioned, enochlophobia is not recognised as its own disorder, instead falling under the category of “Specific Phobias.” These include all phobias causing irrational and persistent fear of a specific object, situation, activity, or person.⁸ Several other disorders have been related to enochlophobia for example Ochlophobia and Demophobia. These are defined as the fear of mobs and the fear of masses of people, respectively. Agoraphobia, the fear of being in a situation that would be difficult to escape if having a panic attack, is only diagnosed in combination with panic disorder. This is also related to the symptoms of enochlophobia. Lastly, social anxiety disorder involves intense fear and stress about other people’s judgement and has also been associated with enochlophobia.⁹

Self-assessment tools

The first step in self-assessing for enochlophobia is to recognise whether or not the experienced fear is irrational. If it is accepted that the feelings of stress and anxiety are at an unreasonably high level relative to the situation, a consultation with a medical professional is probably best for a complete diagnosis. In addition, it may be beneficial to keep note of which specific situations trigger anxiety and which symptoms you experience throughout these experiences. This will allow you to have a deeper understanding of your symptoms and help you choose the correct type of treatment.⁷

Treatment options

Psychotherapy

1. Exposure Therapy

Exposure therapy involves breaking the avoidance behaviour that comes with phobias. In the case of enochlophobia, exposure therapy will involve exposing yourself to large crowds. This is not just done immediately, however. Instead, a psychologist may set up an individualised exposure program for you. For example, you may start by looking at a picture of a crowd, then a video, and eventually put yourself in the middle of one. It is believed that this will help habituate to the situation, reassure yourself that there is no real threat or danger, and give you confidence to go out into crowds on your own.¹⁰

2. Cognitive Behavioural Therapy (CBT)

CBT is an intervention that involves exposure therapy to target your avoidance behaviours (in this case, from crowds), as well as a cognitive therapy approach aiming to change the way you think. It aims to modify all abnormal beliefs and fears that a person with enochlophobia has and rationalise them. CBT is shown to be highly effective in treating phobias, and these changes persist in the long term.¹¹

Medication

1. Anti-anxiety medication

If the anxiety you experience has a significant impact on your life, you may be prescribed anti-anxiety medication.⁷ Your dosage and length of prescription will vary depending on your symptoms and personal needs. 

2. Beta-blockers

Beta-blockers can also be prescribed as a means of treating your anxiety, but these mainly target the physical symptoms. They were initially developed as a treatment for cardiovascular diseases, so they can mostly help with palpitations or increased heart rate.¹²

Self-help strategies

1. Relaxation techniques

Learning relaxation exercises which can help calm your stress and anxiety during or when thinking about crowds is also advised. This will teach you to cope better with the situation and will make you feel more confident to expose yourself to your fear. These exercises could include yoga, meditation, breathing exercises, and more. You should find what helps you.¹¹ 

Coping strategies

Developing a support system

If you decide to face your phobia and put yourself in situations with big crowds, it may be helpful to bring a friend or family member that you can trust. They should be understanding of your situation, in which case they will be able to help you through it. They may help you relax, rationalise your thoughts, or remove you from the crowd if things get too crazy. Additionally, they could distract you from the situation, taking your mind off of it and reducing your anxiety. 

Mindfulness and meditation

Practising daily mindfulness and meditation can help you learn how to cope with stress and teach you how to slow down your mind. This will be a big help when you do find yourself in the middle of a stressful situation, as slowing your thoughts down can help you rationalise and relax. 

There are many different tools available to help you kickstart your mindfulness and meditation journey. Yoga or meditation classes are an option, but there are now also many online guided meditations, books, applications, and more. 

Lifestyle modifications

Changing your lifestyle by exercising regularly, eating a healthy and balanced diet, and maintaining good sleep patterns can further help control anxiety levels. Some researchers even claim that this can be as beneficial, if not more, than therapy. Things like coffee, processed foods, alcohol, and insufficient sleep or exercise should all be avoided, as they can increase anxiety.¹³ 

Summary

Enochlophobia is defined as the fear of crowds, with the latter causing high levels of stress and anxiety. It is more common than you might think, especially due to the recent COVID-19 lockdown and social distancing restrictions. The anxiety can cause overwhelming and uncontrollable feelings of fear and danger, leading to physical and psychological symptoms. In addition, suffering from enochlophobia may lead to you avoiding any crowded situations and can significantly affect your quality of life. A mental health professional can help find the right treatment for you, whether that is therapy, medication, lifestyle changes, or a combination. The good news is that, no matter how debilitating this phobia may seem, treatment options have been proven very effective, and you will be able to live a fulfilling life beyond enochlophobia.