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Tuesday Structured Recovery Group: Closed 16, 23, 30 December. Re-opens 6 January 2015
Fear of being alone - Monophobia
Monophobia is an acute fear of being alone and having to cope without a specific person, or perhaps any person, in close proximity. This 'closeness' might mean in the same house or flat or even in the same room. Anxiety Care has encountered monophobics who cannot use the lavatory without another person being in the room with them.
Monophobia is often seen as part of the agoraphobic cluster. According to research, there are no particular personality differences between agoraphobics and members of the general population. 'Fear of fear' (fear of a panic attack) seems to be a component of the agoraphobia (and a major part of monophobia), but there are many other factors that lead to the avoidance central to the disorder and not all agoraphobics experience panic attacks. People with agoraphobia typically suffer from a 'cluster' of phobias as mentioned and Monophobia may be one. Generally agoraphobics will find it very difficult or impossible to carry out certain activities. These could be going into crowded or public places, lifts, public transport or simply anywhere away from home where 'escape' or immediate access to help is not possible. They will probably also fear standing in queues, going on bridges or sitting in any place where they feel 'trapped', such as at a hairdresser's or dentists. A companion for outings is often sought and rapidly becomes essential. There can also be additional fears, predominantly 'social' ones such as a fear of blushing, trembling, talking eating or writing in front of people and of being stared at. (These latter fears can also be part of social phobia or separate specific phobias and don't necessarily mean that someone suffering in this way is agoraphobic or monophobic.) There may also be obsessional and depressive symptoms. If the person becoming agoraphobic was significantly depressed before onset, which is more common when the problem appears later in life, this could be the disorder that is treated first.
It can be seen from this that agoraphobia tends to reduce self-confidence and the belief that activities can be carried out alone. It can be a short step from here to a belief that being alone at all is not safe. A person suffering from Panic Disorder might also believe that he or she will die or collapse or do something terrible when panic strikes and this too might make having a trustworthy person present seem as if it is essential, so leading to monophobia. Some people with social difficulties might also believe that a trustworthy companion is vital before they enter social situations. And children or young adults suffering from Separation Anxiety have also discussed feeling very isolated and alone at times and experiencing the need to have a parent or trusted companion present before undertaking activities. However, in the latter case, the focus is usually on one specific person (a parent) and being alone for short periods is usually not mentioned as a major problem. However, when it is, monophobia might be considered as part of the problem.
Anxiety Care has encountered monophobic people who have few typical agoraphobic or social symptoms, retaining the ability to function in virtually any situation as long as they have somebody with them at all times. In fact the 'pure' monophobic may be indistinguishable from the general population, perhaps even more outgoing than most, when accompanied by a trusted companion.
Anecdotal evidence seems to suggest that the monophobic person's feeling of being unsafe, is probably the main focus. This has been seen, within the charity, to occur out of severe self-doubt: even resulting in the needed companion being a parent rather than the life partner. It might be argued here that falling back into a childlike need for a parent is statistically more likely to work, both emotionally and financially, than not allowing the life partner to leave the house. Anxiety Care has encountered monophobics, married to partners who cannot easily take time off from their jobs, literally clinging to that partner as he or she tried to leave the house; begging and crying; with this happening virtually every working day. A parent might be more available and might more easily fall back into the mode of looking after this adult as a needy child again.
Feeling dangerous is often an 'obsessional thinking' problem (see the article on this website) and the charity has encountered people fearing their own violence in this way who have insisted on having a companion with them at all times in order to prevent them harming people. However, people with this problem would usually feel just as safe if they were locked in a room alone, so monophobia would not be their main difficulty.
As with any anxiety disorder, monophobics cannot be talked or bullied out of their problem. The anxiety is not trying to cause harm, it is mistakenly trying to help: telling them, wrongly, that they are in terrible danger when alone. This anxiety does not have a lot of sense, it is operating on the intellectual level of a young child rather than an adult and the way to prove to it that being alone is not dangerous is by experiencing the fact, not talking about it, as with a child. This means working out a structured recovery programme where this person is alone for gradually increasing periods. If this proves totally impossible: the perceived anxiety is too high, then medication might be needed before such a programme could be attempted (See the booklet 'self-treatment for phobias'.)
'Alone' can obviously be interpreted in many ways: from being the only person in a room when the house is full of people, through to being the only person on a remote island. The monophobic and his or her companion/s will have to work out a gradually increasing ladder of steps, based on the individual's reality: starting with what can just be managed with some anxiety through to being entirely alone for significant periods. The first step might be the companion walking out of the house or flat and standing a few yards away for an agreed period. The distance and time could then be increased over a period of a few weeks. The agreement would have to be met by both sides: being away for two minutes doesn't mean three or four and the sufferer would have to agree not to beg the companion not to go, or to come back more quickly. This work would need to be done every day.
As discussed above, 'being alone' may mean very different things to different people and it will be essential, if this recovery work is done without professional help, to work out what the fear comprises of. That is, if there are any social elements, or fear of personal violence; or if the focus is on one particular person or type of person rather than the need to have a warm body in immediate proximity. For example, one monophobic was found to be much more amenable to recovery work when he knew that the houses in his immediate area had people in them. He resisted being alone when he wasn't sure about that.
If these personalised difficulties are not looked at, the sufferer might be in the position of the cat phobic who worked only with a ginger tom and thereafter had no difficulty with cats of this colour but was still phobic about the rest. In that situation, the work left to do (all sorts of cats) was easier because one aspect had worked well, but it could have been avoided if it had been done right in the first place.
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