Asperger’s Adults Who Don’t Leave the House

It’s a well-known fact that adults with Asperger’s (AS) and High-Functioning Autism (HFA) tend to have more than their fair share of anxiety. And sometimes the anxiety is so severe that these individuals receive a diagnosis of anxiety disorder. Agoraphobia is a type of anxiety disorder in which people avoid situations that they are afraid might cause them to panic. They might avoid being alone, leaving their home or any situation where they could feel trapped, embarrassed or helpless if they do panic.

Individuals with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. The fears can be so overwhelming that they may be essentially trapped in your own home.

Agoraphobia treatment can be tough because it usually means confronting one’s fears. But with medications and psychotherapy, adults on the autism spectrum can escape the trap of agoraphobia and live a more enjoyable life.

Agoraphobia is a type of phobia. A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place. Commonly feared places and situations are airplanes, bridges, crowds, elevators, lines of people, public transportation, shopping malls, and sporting events.

Typical agoraphobia symptoms include:

• A sense that one’s body is unreal
• Fear of being alone in any situation
• Fear of being in crowded places
• Fear of being in places where it may be hard to leave (e.g., elevator, train)
• Fear of losing control in a public place
• Inability to leave the house for long periods (i.e., being housebound)
• Over-dependence on others
• Sense of helplessness

In addition, one may also have signs and symptoms similar to a panic attack, including:

• Chest pain
• Dizziness
• Excessive sweating
• Feeling a loss of control
• Flushing
• Feeling light-headed
• Nausea
• Rapid heart rate
• Trouble breathing
• Trouble swallowing
• Upset stomach or diarrhea

Possible agoraphobia risk factors include:

• Being female
• Experiencing stressful life events (e.g., sexual abuse or physical abuse during childhood)
• Having a tendency to be nervous or anxious
• Having an alcohol or substance abuse disorder
• Having panic disorder

Agoraphobia greatly limits a person’s daily activities. In severe cases, one may not even be able to leave the house. Without treatment, some individuals become housebound for years. They may not be able to visit with family and friends, go to school or work, walk their dog, run errands, or take part in other normal daily activities. They may become dependent on others for help (e.g., grocery shopping). Agoraphobia can also lead to depression and anxiety. And individuals with agoraphobia may turn to alcohol or substance abuse to help cope with the fear, guilt, hopelessness, isolation and loneliness.

Antidepressant and anti-anxiety medications are often used to treat agoraphobia and panic symptoms. Adults on the spectrum may have to try several different medications before they find one that works best for them. A doctor is likely to prescribe one of the following:

• Anti-anxiety medication. Also called benzodiazepines, these drugs can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. The doctor will weigh this risk against the potential benefit of this class of drugs. Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include alprazolam (Xanax) and clonazepam (Klonopin).
• Selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac, Prozac Weekly, Sarafem).
• Other types of antidepressants, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.

Several types of psychotherapy or counseling can help agoraphobia. One common therapy that's used is cognitive behavioral therapy. Cognitive behavioral therapy has two parts:

1. The cognitive part involves learning more about agoraphobia and panic attacks and how to control them. Individuals learn what factors may trigger a panic attack or panic-like symptoms and what makes them worse. They also learn how to cope with these symptoms (e.g., breathing exercises, relaxation techniques).
2. The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization (sometimes called exposure therapy). This technique helps one safely face the places and situations that cause fear and anxiety. A therapist may join the client on outings to help her stay safe and comfortable (e.g., trips to the mall, driving a car). The more the person goes to feared places and realizes she is okay, the more her anxiety will lessen.

If one has trouble leaving the home, how can she possibly go to a therapist's office? Therapists who treat agoraphobia will be well aware of this problem. They may offer to see clients first in their home, or they may meet clients in one of their “safe zones.” They may also offer some sessions over the phone or through email. Asperger’s adults with agoraphobia should look for a therapist who can help them find alternatives to in-office appointments, at least in the early part of treatment.

Certain dietary and herbal supplements have calming and anti-anxiety benefits. Before one takes any of these for agoraphobia, she should talk with her health care professional. Although these supplements are available over-the-counter, they still pose possible health risks in some individuals (e.g., the herbal treatment called kava is marketed as a treatment for anxiety, but the supplement has been linked to multiple cases of severe liver damage).

Living with fear of panic attacks can make life difficult for anyone with agoraphobia, no matter how severe it is. Professional treatment of agoraphobia can help people overcome this disorder or manage it effectively so that they don't become a prisoner to their fears. Individuals can also take some steps on their own to cope and care for themselves when they have agoraphobia:

1. Alcohol and illegal drugs can worsen panic or anxiety symptoms. Avoid these substances!
2. If one takes medication or is already in therapy or counseling for panic disorder, she should continue to follow her treatment plan. If she develops any symptoms of agoraphobia, she should get treatment as soon as possible, which will help prevent symptoms from getting worse over time. 
3. If one has experienced panic attacks or has panic disorder, she should get treatment as soon as possible. Because panic disorder and agoraphobia are closely related, getting treatment for panic disorder may prevent the development of agoraphobia. 
4. Individuals with agoraphobia are overwhelmed with worry about losing control or having a panic attack. Working with a health care professional, people can learn how to calm and soothe themselves. They can practice these skills on their own, especially at the first hint of anxiety.
5. Meditation, yoga and imagery are among the simple relaxation techniques that may help — and the person can do them in the comfort of her own home. It’s a good idea to practice these techniques when you aren't anxious or worried, and then put them into action during stressful situations.
6. Consider joining a self-help or support group, where you can connect with others who understand what you're going through.
7. Get enough rest, eat a balanced diet, and try to exercise every day.
8. It may take a couple of weeks to start seeing benefits when you first start a medication, but stick it out. Also, don't stop a medication without first consulting your doctor, because some medications can cause withdrawal-like symptoms.
9. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more places does make them less frightening and anxiety-provoking. Family, friends and your therapist can help you work on this. Anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you.

==> Living With Aspergers: Help for Couples


COMMENTS:

•    Anonymous said… I rarely leave the house... I get angry when my husband points out that I never go out.. I go on defense, though I know he's right... I guess because I know it's an issue and I don't know how to battle it. I've been this way as long as I can remember and no matter how hard I try, I can't seem to beat it.. There are a lot of times I think I should probably seek professional help, but that, in itself, is terrifying for me.
•    Anonymous said… I know it feels hard. Think if your husband didn't love you, he wouldn't push so hard. That being said, you have to feel ready to do it for yourself. What is the worst that could happen seeking professional help...maybe getting unstuck, and better? You may not know how to handle it, and that is where the pro's come in. If you call around a lot of places you can have a therapist visit your home.
•    Anonymous said… I just have a lot of trust issues.. I find it really really hard to open up.. especially verbally. I am not good at talking. My husband made a comment last night about how getting me to open up is like having to get through a difficult maze. He's not wrong. I've been to a therapist before.. and I've had a psychiatrist.. for a long time.. But years ago. I keep thinking I need to start going again.. But somehow, the longer I go, the harder it is to go get help.
•    Anonymous said… You are correct in this diagnosis of Aspies not wanting to leave the house when we don't want to but what is your point? Do you have a solution or formula that makes me want to go out somewhere and socialize? I go out when one of my kids wants to go shopping. I am not going out to hang at a bar or anything like that. I like being home alone. No, I don't have a husband and nor do I want one.
•    Anonymous said… My daughter and I have an understanding that we will go to the BJ's next weekend. Her husband comes over occasionally to get a plate of food when I cook and he's driving for Uber at night.
•    Anonymous said… I don't want to be among people when I don't have to be...oh, wait, maybe it's because I have Aspergers! lol

Post your comment below…

The Genetic Link Between Alcoholism and Autism

According to a 2011 study (found here), alcoholism in some individuals can be linked to a gene (called Autism Susceptibility Candidate 2, or AUTS2) that also causes autism.  The study gathered data from over 26,000 subjects from 12 European populations and tracked how much alcohol each individual consumed daily. The subjects' DNA was then examined for the AUTS2 gene.

The scientists also used mice to investigate whether those with the AUTS2 gene consumed more alcohol. A statistically significant association between alcohol consumption and AUTS2 gene expression was noted. The gene was found to be present in a higher-than-average number of alcoholic individuals, as well as mice.

Researchers estimate that approximately 40% of drinkers carry a genetic predisposition for alcoholism. This study is not the first to describe a high incidence of alcoholism in people with autism (another study can be found here), but the genetic evidence it revealed is new. Knowledge of genetic factors may improve treatment for those who wish to abstain from consuming alcohol.

Adults with Asperger’s (AS) and High-Functioning Autism (HFA) may be more susceptible to alcoholism. Alcohol is often seen as an acceptable way to self-medicate unwanted conditions associated with autism spectrum disorder (ASD)  (e.g., attention problems, sensory issues, depression, anxiety, social difficulties, etc.). 

 

Moving from childhood into adulthood can be very challenging for people on the autism spectrum, and the usual pressure to drink can lead to alcoholism – especially since drinking can seem like a temporary “fix” or an “escape method” for coping with other problems. If a person with ASD has never been successfully diagnosed or treated, this can make addiction to alcohol (and other drugs, including marijuana) an even more likelihood.

 

==> Living With Aspergers: Help for Couples

What to do if your husband on the spectrum drinks too much:

Usually, excessive drinking only stops when the AS husband realizes that the costs of drinking exceed the benefits. A wife could wait until the costs are huge so that her husband can realize the problem more easily. But by that time, his thinking won’t be very clear, and he will have paid a substantial price – possibly to include problems that will endure the rest of his life. So, it’s better to help your husband stop drinking sooner rather than later. 

 

Here’s how:

1. Use yourself as the “reward” for not drinking. Many wives are reluctant to consider themselves as rewards. After all, shouldn’t your husband want to spend time with you without you having to manipulate him? Perhaps, but do you want to argue this philosophical point – or get him to change his drinking pattern? If he eventually spends time with you because he truly enjoys it – and enjoys it more than drinking – don’t worry about the fact that he needed to be guided initially.

2. Rather than persuading your AS husband that the costs of drinking exceed the benefits, you’ll do better by helping him discover that the benefits of non-alcohol related activities exceed the benefits of alcohol-related ones. The end result is the same. He will just be realizing (over time) that the costs of missing out on new (or renewed) sober activities exceed the benefits of drinking. So, help him discover (or recall) activities he truly enjoys that do not involve consuming alcohol, and then find ways to promote and support these activities (perhaps indirectly). Obviously, the more alcohol is a part of his life, the fewer non-alcohol-related activities he may have. But, unless all he does is drink ALL DAY, his life includes other activities.

3. If your husband likes your company socially, stay around only when he is sober (or drinking moderately). Take two cars to events if needed, and be clear about why you are doing it. If it’s just time with him at home, excuse yourself when he is drinking excessively – and make sure to give him lots of verbal and physical attention when he is not. You can even tell him what you are doing (e.g., “I love our time together, and I don’t want it ruined by your drinking too much. When you do, I’m going to excuse myself.”).

4. Create a “landing place” before you ask your ASD husband to “jump.” Many heavy drinkers are reluctant to quit drinking, because they have little sense of how they will spend their time without drinking. All that empty time may frighten them. By creating a landing place, you hope to build a transition (slowly at first) in which other activities come to replace drinking. However, before you try this strategy, you should observe your husband’s behavior for a while to see what activities he engages in that are not alcohol-related. Then you will need to figure out a way to support/promote these activities in a non-confrontational way.

5. Consider activities that your husband might engage in right after work before he starts drinking, or early on a weekend day before he starts drinking. You can probably find ways to do something fun as a family (not something he “should” enjoy, but something he actually enjoys) that would postpone - or even eliminate - his drinking on that day.

==> Online Group Therapy for Couples and Individuals Affected by Autism Spectrum Disorder

==> Living With Aspergers: Help for Couples

==> One-on-One Counseling for Struggling Individuals & Couples Affected by Asperger's and High-Functioning Autism

 

COMMENT: I am a recovering alcoholic and have been sober for over 22 years. I do not, as far as I am aware, have AS or HFA, but I would, as they say, tick quite a few boxes! I work with children on the autistic spectrum in a mainstream school and so I have a reasonable knowledge of the condition. My point is, that I have believed for some time, that there are a higher number of people with AS/HFA in the recovering alcoholic community, than there are in the general population, based on my observations among people like me, who attend a 12 step program.