People may experience a persistent fear of leaving the home for a number of reasons, and the conditions underlying these fears can be quite complex. However, with the proper diagnosis and treatment, people can learn to manage their fears, rather than being ruled by them.
A chronic, persistent fear of going outside of one’s home may occur as a result of a number of different conditions or other reasons. This fear can present on its own as in a Specific Phobia (when it relates to one phobic stimulus, such as a fear of being robbed), as a sign of Agoraphobia (characterized by a more complex group of various associated fears), or as an obsession in obsessive-compulsive disorder (OCD), which may involve any number of fears associated with leaving home. It is important to recognize some key differences between OCD, Agoraphobia, and a Specific Phobia to better understand with which you may struggle.
Could it be OCD?
Obsessive-compulsive disorder (OCD) is characterized primarily by two components: obsessions and compulsions. A fear of leaving the home involving intrusive thoughts or worries about contamination, harm, self-control, or similar fears while outside the home are likely related to OCD.
What are Obsessions?
Obsessions are recurring, intrusive thoughts, images, feelings, or urges that bring distress, anxiety, or fear. Someone with OCD focused on a fear of leaving the house may experience persistent obsessions about things that might happen if they leave the house, or even about the feelings they could encounter.
Here are some examples of obsessions related to a fear of leaving home:
- If I leave my house, I will catch a disease
- I will harm someone if I drive or go outside of my house
- Someone will harm me if I leave the house
- What if my house burns down? What if I get robbed?
- What if my family is harmed while I’m gone?
What are Compulsions?
When people with OCD experience obsessions that cause anxiety, they feel a strong urge to engage in compulsions to feel better. Compulsions are done in an attempt to relieve the anxiety that comes from obsessions, or to prevent a feared outcome related to one’s fears, and they can be mental or physical—some may be hard to notice, even for the people engaging in them.
Consider some examples for people with fears of leaving the home:
- Avoiding leaving the home
- Only doing online work
- Only leaving the house for activities that are deemed “safe”
- Excessive cleaning after one has spent time outside the home
- Rituals that allow one to leave the home (masks, gloves, certain clothes)
How can I tell if it’s OCD, Agoraphobia, or something else?
On the other hand, if a person struggles with a fear of leaving the home because they are afraid they won’t be able to escape easily, or they will need help and no one will be there to help them—or if they fear the panic and anxiety symptoms that will arise in these situations—we might be looking instead at Agoraphobia.
People often mistakenly believe that phobias are a form of OCD, but this is not the case. According to the DSM-5-TR, Agoraphobia is a fear that is distinct from other phobias, involving a strong fear or anxiety about several of the following:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
Like someone with OCD, a person with Agoraphobia will avoid the situations that provoke fear and anxiety. However, the condition will likely not involve intrusive thoughts or other intrusive experiences as involved in OCD, and more ritualized compulsive behaviors are also more likely related to OCD.
Specific Phobias can seem very similar to Agoraphobia for obvious reasons, but in any Specific Phobia there is usually only one phobic stimulus—that is, a situation or object that triggers one’s fears. A person who only fears being assaulted while away from home may be diagnosed with Specific Phobia, whereas a person who fears leaving the home,, and being in a crowd would most likely be diagnosed with Agoraphobia.
As with OCD, a person’s life will be significantly affected by their fear, whether from a Specific Phobia or Agoraphobia. Fears in both conditions are usually not proportional to any actual threat, and lead people to avoid their phobic stimulus—in this case, leaving the home. Similar to OCD, people with a phobia may seek reassurance about their fears. However, in a Specific Phobia or Agoraphobia, there is usually an absence of intrusive thoughts underlying one’s fears. A person with a Specific Phobia that keeps them from leaving the home will have a strong reaction to being outside of the home, but it will not be related to the intrusive thoughts that most often characterize OCD.
Another difference that distinguishes the three disorders is that OCD symptoms often wax and wane from their onset. A person may spend only several months consumed by obsessions and compulsions related to their fears, after which their intrusive thoughts and compulsive behavior may focus more on another theme. In a Specific Phobia and Agoraphobia, one’s fears and behaviors usually remain consistent when left untreated.
How the fear of leaving home can be treated
A fear of leaving home—whether a symptom of OCD, Specific Phobia, or Agoraphobia—can be treated with a particular form of therapy called exposure and response prevention (ERP) therapy. This evidence-based treatment has shown to be instrumental in treating all forms of OCD, and highly effective in treating phobias. Most individuals who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears.
In ERP, people will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with an exposure that is predicted to bring about a low level of fear and anxiety and work up to the harder exposures as confidence is built. When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety without relying on compulsions or avoidance to feel better.
Example exposures done to treat OCD/Agoraphobia centered around a fear of leaving the home may include:
- Writing a script about leaving the house
- Watching a video involving being outside
- Standing outside the house for 5 minutes
- Going to a restaurant and not engaging in washing rituals after returning home
- Saying hello to a stranger on the sidewalk
Examples of exposures that may be done to treat Agoraphobia more specifically:
- Riding on city bus
- Standing in line at a cafe
- Leaving the home without a safety person
- Riding on an elevator
- Spending time in an open field
If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.
We look forward to working with you.