Within the last six months, I have treated two patients whose visits to my office were among the very few times they had left their homes-in years. They are just a few of the million or more Americans who suffer from anxiety conditions or weight problems or psychotic illnesses that lead them to dread leaving the house. Some are literally houseboundand never venture outside, even confining themselves to a single room or barricading doors and windows. The housebound population is a kind of secret in America, because these folks are often embarrassed about their situation and don't know how to get help for it. House calls, after all, went out of vogue decades ago. Conditions leading people to be housebound include agoraphobia, an intense fear of crowds and being publicly humiliated, and panic disorder, sudden bursts of anxiety often accompanied by a sense of impending doom, rapid heart beat and sweating.
There are many other conditions, however, that can lead to the problem. Severe depression can cause people to become housebound. Body dysmorphic disorder, in which people can believe they are too ugly to be looked upon by others, can, as well. So, too, can paranoia (for example, that one is being followed by the CIA) and obsessive compulsive disorder, which can include an intense and irrational fear of germs. The road to becoming housebound is often a slippery slope. My patients described first limiting their excursions from home, then staying home for longer and longer stretches of time, then for months or years at a time. The availability of the Internet to communicate and shop may be making the problem worse. Often, family members of those who are housebound have become co-dependent-running errands for the housebound individuals, routinely visiting with them (rather than risk losing contact with them entirely) and even providing them with alcohol or other drugs to try to cut through their disabling anxiety. They may keep secret what they know about a housebound relative, feeling the same irrational feelings of humiliation that sons or daughters or spouses of an alcoholic often report. The treatment for those who are housebound often includes antidepressant and anti-anxiety medications. But it also calls for an exploration of the uncontrolled psychological turmoil in their lives-whether in adulthood or during childhood-that led them to inappropriately seek safety in a kind of siege mentality. It may be obvious to the rest of us that building walls of wood and dry wall around oneself cannot keep out the stresses of fractured relationships or emotional trauma or low self-esteem, but it is not obvious to those who are housebound. Consciously or unconsciously, they believe they can shut out their problems by closing their doors and pulling their shades. For my two patients, there were moments when they realized that the "fortresses" they had built to keep others out of their lives had also become prisons. Their anxiety was no longer contained by the four walls of their homes. And, luckily, they reached out. More of those who find themselves unable to leave their houses, who are prisoners of their anxieties, should take that brave first step.
Dr. Keith Ablow is a psychiatry correspondent for Fox News Channel and a New York Times bestselling author. His book, "Living the Truth: Transform Your Life Through the Power of Insight and Honesty" has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be reached at firstname.lastname@example.org.