Monophobia, also called Autophobia, is 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. Similarly to the other types of situational phobias, this condition is usually treated with psychotherapy; medication is added to the treatment plan if needed.
Is the Fear of Being Alone Normal?
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. 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.
Signs of Monophobia
Monophobia is experienced by people of all ages from childhood through senior years. Some individuals 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.
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.1
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.
Symptoms of Monophobia
It is common for the monophobic person to experience 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.
Common symptoms of monophobia 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
Causes & Risk Factors for 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
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: Having an immediate family member with a phobia increases the chances of developing a phobia by 3 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/family member’s 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: An individual who is more sensitive than average has a higher risk of developing a phobia.
Treatment of Monophobia
The treatment and management of monophobia 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/a>
Therapy
The most common forms of therapy for phobias are exposure therapy, systematic desensitization, and cognitive-behavioral therapy. Group therapy may be used to provide added support from others who share the same or similar phobias.
Common Types of Therapies
Many therapy techniques can be used to treat monophobia, but common options include:
- 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) and imagined situations (imaginal exposure).5
- 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 is another effective treatment for phobias and is the most comprehensive therapy. It involves three phases: didactic, cognitive, and behavioral. 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
- 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.
Intended treatment outcome & timeline
The intended outcome of treatment for monophobia has four different forms:
- Habituation-the decrease of fearfulness about being alone. Mild anxiety may still occur, but it becomes manageable and does not interfere with functioning.
- Extinction-breaking the association between being alone and having a bad outcome.
- Self-Efficacy-the awareness that one is able to handle the fear and anxiety and to have some control over these feelings.
- Emotional Processing-occurs as the client changes how they think about the feared situation and adopts more realistic beliefs which are less anxiety-producing.
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 Exposure therapy alone is a short term treatment, expected to take 8 to 12 sessions. The more comprehensive cognitive-behavioral approach may take 12 to 20 sessions or roughly 5 months.
Lifestyle Changes
Simple lifestyle changes which are known to reduce anxiety can help reduce the symptoms of monophobia.
These changes in lifestyle include:6
- Regular exercise, such as daily walks, cycling, or stair climbing
- Eating a healthy, balanced diet
- Getting enough sleep
- Reducing or avoiding caffeine and other stimulants
- Reducing or avoiding the use of alcohol and other drugs4
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 (SSRI’s) are sometimes used to treat phobias.
- Beta-blockers are an alternative to the antidepressants for 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.
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.
The following steps may be considered when 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
The following are some steps for getting help for children:
- Talk to your 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
Monophobia Statistics
All phobias are anxiety disorders and they are grouped into three major categories: specific phobias, social phobias, and agoraphobia.7 Monophobia is one of the five types of specific phobias, and is labelled a situational phobia. Other situational phobias are fear of flying and fear of enclosed spaces. In general, all of the specific phobias are less problematic than the social phobias or agoraphobia because specific phobias are somewhat easier to avoid.
Reliable data on the prevalence of any one specific phobia is unavailable. However, the following information refers to the subgroup of phobias which are “specific”. This subgroup includes animal phobias, fears related to the environment, blood/injury phobias, situational phobias, and random other phobias.
The following statistics were reported by the National Institutes of Mental Health (NIMH):8
- Roughly 12.5% of the US population experiences a specific phobia of some type at least once in their lifetime.
- Approximately 9.1% of adults in the US had at least one specific phobia during the past year.
- Roughly 30 million people experienced a specific phobia in the past year, based upon the US population in 2019.
- About twice as many adult females as males reported having a specific phobia during the past year.
- Of the adults who experienced a specific phobia in the past year, 21.9% had serious impairment.
- An estimated 19.3% of adolescents (ages 13-18) experience a specific phobia during their teen years.
- Prevalence of specific phobias is lower among older adults. Only 5.6% of adults aged 60 and up experienced a specific phobia in the past year.
How to Cope With Monophobia
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 monophobia include:9
- Deep breathing exercises, using diaphragmatic breathing
- Progressive muscle relaxation training
- Guided imagery exercises
- Self-assuring statements
- Self-soothing habits (listen to music, get a massage, meditate)
- Daily exercise for relief of stress and uplifting of mood
- Welcoming humor and the benefits of laughter
Monophobia is experienced as intense fear about being alone, but this fear may have a different meaning for different individuals. 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.
Monophobia & Situational Phobia Tests and Diagnosis
There is no specific test for Monophobia; it is diagnosed via interview with an experienced mental health professional. It is important to see a health professional if you are concerned that you or your child may have monophobia. If you are wondering if your condition may be diagnosed as a phobia, you might take one of the self-tests suggested below. These cannot provide any definitive diagnosis but only allow you to consider your symptoms more thoroughly.
Tests performed by Health Professionals
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
Quizzes and Self-Assessments
While you should always seek guidance for mental health concerns from a licensed professional, these online tests may help you assess whether you have a problem and should ask for help:
- Autophobia Online Test (includes a seven question self-test and links to helpful information)
- Test for Symptoms of Anxiety, Panic, OCD and Phobias (a brief test of anxiety symptoms with one section on specific phobias)
Additional Resources for Monophobia
The following are helpful resources for anyone impacted by monophobia or other forms or anxiety:
