I Am Afraid to Be Alone

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Reader’s Question

I’m 24 years old. I have exceptionally bad anxiety. I don’t know what to do anymore and I’m miserable. I don’t want to say “can’t” because I feel like its admitting defeat but, I can’t be alone. I haven’t been alone in my home in about five years. I have terrible panic attacks when I’m the only person at home (which, with great pain and effort, I have managed to keep from happening for a long time). I also have terrible and dangerous panic driving alone. I haven’t done that in almost as long.

My fiancĂ© is growing very impatient with my problem. I’m terrified that if I don’t get over this he’ll leave me, and I love him so much that would just kill me. I make myself sick with worry sometimes and its been getting so bad lately, that even around people I start to panic. That’s a serious problem, because my fear is really only about being alone. Now, however, I don’t even feel safe in a group, which was never the case before.

I really need help. I’m becoming a weight to the people I love. I used to really enjoy doing things for people and just living life, whereas now I may as well be dead. Please say that you can help me. Please say this isn’t as uncommon as I think it is. I’m becoming frantic and desperate.

Psychologist’s Reply

You are not the only one who has experienced these types of fears and panic. Recurrent, unexpected panic attacks, followed by persistent worry about panic attacks and a change in behavior (e.g. not leaving the house) for at least a month are some of the cornerstone criteria for Panic Disorder. According to the Anxiety Disorders Association of America, approximately 6 million Americans experience panic disorder in a given year, and about one in three people with panic disorder also develops agoraphobia. Agoraphobia is defined as the fear of being embarrassed or unable to escape in the case of a panic attack, as well as the avoidance of situations in which this might occur, or the need for a companion in those situations.

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Panic Disorder can occur with agoraphobia or by itself. From your description, although I could not officially give you a diagnosis without meeting with you and knowing more, it would seem that 1) your sense of being unsafe unless you are with a companion, 2) your history of panic attacks, and 3) the efforts you have gone to in the past to avoid panic attacks makes this diagnosis (Panic Disorder with Agoraphobia) one worth considering.

The way this can develop is that once a person has a panic attack, he or she wants at all costs to avoid having another. This is understandable, as dizziness, chest pains, difficulty breathing, vertigo, and other alarming physical sensations that comprise panic attacks are quite uncomfortable. Two things can happen with avoidance; one, the person can begin to avoid situations that he or she thinks could trigger panic attacks (e.g. being alone), and secondly, the person can start to avoid situations in which having a panic attack would be embarrassing (e.g. in a grocery store line in which you are expected to wait) or in which he or she would not be able to escape (e.g. driving over a bridge). As you can imagine, the number of ‘safe’ zones can shrink over time and soon it feels as if there is nowhere to go that is free of anxiety or panic. In your case, having someone with you is the mechanism of avoidance; it is avoidance of being alone, and being alone is the trigger for panic, as you have mentioned.

The ironic thing is that the very act of avoidance that is used to reduce anxiety actually maintains anxiety in the long run. It works in this way: when you are anxious and leave an anxiety-provoking situation (let’s say it is an elevator), your anxiety goes down. The message to your mind is, “I cannot handle elevators; leaving elevators is the answer.” The next time you approach an elevator, this learned response would create anxiety that is just as high as or higher than the last time. Now, if you had stayed in that elevator, your anxiety would have eventually come down over time, because it is physically impossible to sustain panic-levels of anxiety forever. So in fact, staying in that scary situation and tolerating the high anxiety until it comes down on its own sends your mind the message, “I can handle elevators and my anxiety.” The next time you approach an elevator, your anxiety will likely be lower. So, the natural response we have as humans (avoidance) is less helpful in the long run than facing the fear despite the distress.

Again, diagnosing yourself or going by my one-shot post is never as thorough as speaking with a mental health professional. In an in-person meeting, you would go into more depth about relevant background information and what you are experiencing now. A professional could give you diagnostic impressions based on what you share, and form a treatment plan that is personalized for you. In addition, other disorders such as depression, post-traumatic stress disorder, and social phobia could be ruled out or included in the treatment plan. Your comment that you “might as well be dead” caught my eye. If you are experiencing depressive symptoms, including suicidal thoughts, discussing symptoms with a mental health provider could be even more important.

The good news is that anxiety is typically highly treatable, with therapy, anti-anxiety medication, or both. If panic disorder with agoraphobia were the diagnosis, cognitive behavioral therapy (CBT) might be recommended. A cognitive-behavioral therapist could teach you concrete strategies for coping with anxious feelings, physical sensations, and thoughts. You and a therapist would likely collaborate to identify a list of feared situations tailored to you, from one that is fairly easy (e.g. stand inside door of house with fiancé standing outside door) all the way up the hierarchy to the most feared situation (e.g. be alone in your house for an extended period of time). He or she would work with you to begin to do this graded exposure work. You would practice tolerating situations at the bottom of the hierarchy, with the idea that you would move up to more difficult ones at a pace that works for you.

If you are interested in self-help, you might do a quick Internet search on “panic disorder” and see what you find. There are many websites that not only provide information, but self-help resources such as checklists, worksheets, and ideas about how to go about facing your fears. For example, the Anxiety Disorders Association of America has charts entitled, “Facing Panic: Self-Help for People with Panic Attacks.”

You are definitely not alone in this, and I believe you can, as others have, conquer your fears and get back to living the life you enjoy.

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