Monophobia (Fear of Being Alone): Signs, Symptoms, & Treatments

What Is Monophobia?

Monophobia, also called autophobia, eremophobia, or isolophobia, is a specific phobia involving an abnormal fear of being alone. A person is said to have monophobia if their fear of being alone is severe enough that it interferes with their daily functioning. Monophobia is experienced as an overwhelming and irrational anxiety that is not based on a real threat. The person with monophobia often realizes that there is no threat but still feels a desperate need to end their solitude.

Sometimes there are social concerns, such as the fear of being physically harmed by strangers and needing the presence of a particular person to feel safe. It may be a fear of physical accident or injury and needing to know that someone is nearby to help as needed.

What’s the Difference Between Autophobia and Loneliness?

Being lonely is an emotional state where you feel alone or disconnected from others, even when you are in a room full of people. Loneliness is a temporary, but typical level of discomfort that people can feel in common life situations. Autophobia is an intense and debilitating mental health condition that relates to a deep fear of being alone.

Is the Fear of Being Alone Normal?

During childhood, the fear of being left alone is common and normal. For most children this fear is outgrown before adulthood. It is only considered to be abnormal if the fear becomes persistent and extreme to the point that the child cannot function at home or at school during brief periods of being alone.

Although many adults and seniors prefer to not be alone, most are still able to function and complete their daily routines without excessive anxiety about being alone. When the level of anxiety or fear prevents a person from functioning daily, the person is experiencing monophobia.

Twice as many women as men report having phobias, with many people trying to manage on their own and never reporting symptoms to a healthcare professional. It is assumed that phobias are underreported due to feeling embarrassed or thinking that a person should be able to manage phobias without help, so autophobia may be more common than we think.¹

What Are Signs of Monophobia?

Some people with monophobia feel the need to be in the same room with another person, while others just need to have another present in the same home or building. Monophobia is experienced by people of all ages from childhood through senior years.

Common signs that a person has monophobia include:²

• Increased anxiety when the likelihood of being alone increases
• Avoidance of being alone and extreme anxiety or fear when it cannot be avoided
• Difficulty getting things done when required to be alone
• Observable physical changes such as sweating, difficulty breathing, and/or trembling
• Going to great effort to avoid being alone
• In children, monophobia may be expressed through tantrums, clinging, crying, or refusing to leave a parent’s side.

Autophobia Symptoms

It is common for the monophobic person to experience anxiety symptoms when they are alone and when they are faced with the chance of being alone. Symptoms include obsessive thoughts, physical changes, and vague fear or anxiety. In the worst situations, the person may feel terror and a desire to flee, or potentially even a panic attack.

Common symptoms of autophobia include:³

• A sudden feeling of intense fear when left alone
• Intense fear or anxiety when thinking about being alone
• Worrying about being alone and thinking of what could occur (intruders, medical emergencies)
• Anxiety about feeling unloved or unwanted
• Fear of unexpected noises when alone
• A sense of being detached from one’s own body
• Shaking, sweating, chest pain, dizziness, heart palpitations, hyperventilating, or nausea
• Sense of extreme terror, panic, or dread
• Strong desire to flee the situation

What Causes Monophobia?

There is still much to learn about the causes of specific phobias. It is believed that a variety of factors contribute to their development. These factors include genetics, brain function, learned behavior and trauma. Additional risk factors are age, temperament, and behavior of family members in similar situations.²

Risk Factors

Common risk factors for monophobia include:

• Age: Specific phobias usually appear by age 10 (although they can develop at any age).
• Traumatic experiences: A frightening negative experience associated with being alone is a risk factor for development of monophobia.
• Genes: Genetics play a role in anxiety, and having an immediate family member with a phobia increases the chances of developing a phobia by three times.¹
• Brain function: Changes in brain functioning due to mood disorders, substance abuse, or other lifestyle habits may contribute to the development of a phobia.
• Learned behavior: Children sometimes learn to fear being alone by watching a family member’s reaction to being left alone.
• Learning about a bad experience of someone left alone: Hearing or reading about another person’s negative experience of being alone can lead to development of monophobia.
• Temperament: Someone who is more sensitive than average has a higher risk of developing a phobia.

Common Comorbidities With Autophobia

People with specific phobias, like autophobia, tend to have several comorbid or co-occurring disorders. Some disorders that often accompany autophobia include:

• Other anxiety disorders
• Depressive disorders
• Bipolar disorder
• Substance use disorders
• Personality disorders, like avoidant personality disorder
• Somatic symptom disorders

Social Impacts of Autophobia

Autophobia will have powerful impacts on a person’s relationships. Their family, friends, and coworkers will all feel the influence of the condition. At first, people may be comforted by the idea of closeness, but over time, the togetherness will start to feel excessive and problematic. All healthy relationships need space, but autophobia may not allow it.

How Is Monophobia Diagnosed?

Monophobia is diagnosed by a mental health professional through an interview in which questions are asked about symptoms as well as any medical problems which may contribute to the symptoms. There is no blood test or other laboratory test for monophobia. The diagnosis is based upon meeting certain criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the manual used by most mental health providers for reliable and valid diagnoses of all mental health problems.⁷

Treatment for Autophobia

The treatment and management of autophobia includes therapy, lifestyle changes, and possibly medication. Medical treatment is often necessary when the phobic person is using alcohol or other drugs to escape from the intense anxiety of the moment. Since these substances can actually make the anxiety worse, it is important to address any substance use early in treatment.⁴

The most common forms of therapy for phobias are:

Exposure Therapy

Exposure therapy is a behavioral and evidence-based therapy frequently used in the treatment of phobias. A safe environment is set up by a psychologist so that the client can be gradually exposed to the fearful situation of being alone. This exposure to the feared situation while in a safe place helps to decrease the fear and avoidance behaviors. There are several different types of exposure therapy, including real-life situations (in vivo exposure), virtual reality exposure, and imagined situations (imaginal exposure).⁵ Exposure therapy alone is a short term treatment, expected to take 8 to 12 sessions.

Systematic Desensitization

Systematic desensitization is one variant of exposure therapy which is very slowly paced. The exposure is combined with relaxation exercises so that the feared situation becomes associated with being relaxed.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is another effective treatment for phobias and is the most comprehensive therapy. It involves three phases: The didactic phase sets out the expectations for treatment outcomes, while the cognitive phase addresses the thoughts which contribute to the feelings of fear or anxiety. The behavioral phase often includes relaxation exercises and systematic desensitization.¹ The more comprehensive cognitive-behavioral approach may take 12 to 20 sessions or roughly 5 months.

Group Therapy

Group therapy involves regular meetings with peers who also struggle with monophobia. Group members share their challenges as well as provide each other with emotional support and encouragement.

EMDR

Given its short-term focus, eye movement desensitization and reprocessing (EMDR) for PTSD could be a good option for monophobia as well. The treatment is frequently done individually with an exposure-based approach that confronts the fears, rather than avoiding them.⁸

All of these changes allow the person with monophobia to tolerate being alone with less anxiety and to feel greater control over their situation.⁵

Medication

Medication may be used alone or along with the types of therapy noted earlier. It may be prescribed by a physician, psychiatrist, or a clinical psychologist who has prescription privileges.

The most commonly prescribed medications for monophobia are antidepressants, beta-blockers, and benzodiazepines:¹

• Antidepressants which act as Selective Serotonin Reuptake Inhibitors (SSRIs) are sometimes used to treat phobias.
• Beta-blockers are an alternative to antidepressants for the treatment of phobias. These work by blocking the physical symptoms of anxiety, such as increased heart rate, trembling and sweating. Propranolol (Inderal) is a commonly prescribed beta-blocker.
• Benzodiazepines act as sedatives and promote relaxation. They are highly addictive and therefore should only be used under a physician’s oversight.

How to Get Help for Monophobia

Monophobia may be diagnosed by a variety of healthcare professionals including psychologists, psychiatrists and social workers. Most often, the client starts with the primary care doctor. They will need to rule out physical causes for the symptoms of anxiety. It is not unusual for phobias to occur along with other anxiety disorders which share some of the same symptoms.

The primary care physician will likely refer the client to a psychiatrist, psychologist, or other psychotherapist for therapy. That provider will make recommendations about the form of therapy as well as lifestyle changes, and whether medication should be considered. Another way to find a therapist for anxiety is to search an online therapist directory and filter for someone with a specialty in phobias in your area.

How to Get Help for a Loved One

When a loved one suffers from monophobia, it may be helpful to provide information which relieves their embarrassment about the fears. It requires more than willpower to overcome a phobia. Most people with monophobia have both mental and physical symptoms which are difficult to overcome without professional help.

Here are some actions to consider when you’re trying to help a loved one:

• Encourage them to speak to a physician or a mental health professional
• Offer them assistance in finding a qualified therapist to work with them
• Offer to remind them of appointments
• Offer to accompany them to an appointment
• Acknowledge that their symptoms are challenging but can be overcome with professional help
• Encourage them to be honest with the health professional about how they currently deal with the symptoms, such as use of alcohol or other drugs.

How to get Help for a Child

As noted earlier, it is not unusual for children to have a fear of being alone. It is actually a reasonable fear, particularly for young children who are relatively helpless in the face of danger. Most children outgrow the fear of being alone. However, for some children, that fear causes the child extreme anxiety and inability to get through their days without great distress. For those children, it is important to get help as early as possible. Early treatment tends to be easier than delayed treatment.²

Here are some steps for getting help for children:

• Talk to your child’s physician about the symptoms and circumstances
• Provide reassurance to your child about feeling better after getting help
• Encourage your child to participate in treatment
• Choose a health care provider whom you trust to be both caring and effective
• Show your child that you are confident in their ability to get through treatment and to feel better soon

Coping With Autophobia

Regardless of the specific fears about being alone, symptoms usually include anxiety and depression or obsessive thinking. In addition to seeking help through therapy, a variety of anxiety management skills can be helpful in managing the symptoms.

Ways of coping with autophobia include:^4,6,9

Relaxation Training

Relaxation training includes any exercise that helps calm the mind or body. Options like deep breathing, progressive muscle relaxation, guided imagery, or autogenic training can increase the baseline anxiety and help manage phobic symptoms.

Journaling About Your Fears & Triggers

Avoidance only reinforced anxiety so journaling about your fears and triggers can be a great way to expose yourself to the discomfort. Along the way, you can learn more about people, places, and situations that worsen your experience.

Mindfulness Meditation

Mindfulness meditation is a type of relaxation training that deserves special attention. With mindful meditation, you can learn to become aware and accepting of your bodily sensations and thoughts to reduce your fears.

Stress Management

Daily life is stressful, but by learning ways to better manage your ongoing stressors, you can find ways to combat monophobia. Communication skills, proper nutrition, sleep, and exercise are all key components of stress management.

What’s the Outlook for Autophobia?

Like other specific phobias, autophobia may resolve on its own with enough time, but for those interested in alleviating symptoms as quickly as possible, treatment options can be effective. By acknowledging the issue as a problem and taking swift action with professional mental health treatment, symptoms can improve and well-being can be restored.