A phobia is an irrational fear, a kind of anxiety disorder in which the sufferer has a relentless dread of a situation, living creature, place or thing.
Individuals with a phobia go to great lengths to avoid a perceived danger which is much greater in their minds than in real life. If confronted with the source of their phobia, the person will suffer enormous distress, which can interfere with their normal function; it can sometimes lead to total panic. For some people, even thinking about their phobia is immensely distressing.
A phobia starts when a person begins organizing their lives around avoiding the object of their fear. A phobia is much more serious than a simple fear. Sufferers have an overpowering need to steer clear of anything which triggers their anxiety.
If the phobia is of something the phobic person very rarely comes into contact with, such as snakes, their daily lives will not be affected. However, some complex phobias are impossible to avoid, such as agoraphobia (fear of leaving home or public places) or social phobia (fear of being among groups of people).
Non-psychological phobias - photophobia means sensitivity to light. For example, if you have conjunctivitis or a migraine your eyes may be particularly sensitive to light. This does not mean the person is afraid of light. One of the symptoms of rabies is hydrophobia, which is the inability to drink water.
Discrimination or prejudice - some words which include the word "phobia" do not refer to fear, but rather to prejudice or discrimination. Homophobia is not an uncontrollable fear of homosexual people; it is a dislike, a discrimination against them. Some older people may dislike youths or teenagers (ephebiphobia). Xenophobia is a dislike of strangers, foreigners or the unknown.
There are three main categories of phobias:
- Specific phobias (simple phobias) - involve a disproportionate fear about specific situations, living creatures, places, activities, or things. Examples include a fear of:
- Dentists (dentophobia)
- Bats (chiroptophobia)
- Dogs (cynophobia)
- Flying (aviophobia)
- Snakes (opidiophobia)
- Birds (ornithophobia)
- Frogs (ranidaphobia) - Social phobia - now called social anxiety disorder. A person with social phobia finds being in social situations difficult and sometimes unbearable. Going to parties, weddings, functions, or exhibitions cause sufferers anxiety; there is fear of being embarrassed or humiliated in public. The ultimate nightmare for a person with social phobia is probably to have to talk in public or act on a stage in front of an audience.
There is a fear of being judged by other people. People affected with social phobia feel that they will be scrutinized and singled out in the crowd, which would be an unbearably embarrassing ordeal. The dread of being laughed at because of their clothes, voice or some feature of their body is so intense that they prefer to avoid social gatherings altogether.
Psychologists say that a high proportion of adults with social phobia started taking measures to avoid social situations during their teenage years. Studies have shown that their progressively isolated lifestyles make them more susceptible to developingdepression. Experts emphasize that social phobia is not the same as shyness.
Obese people may develop social anxiety disorder, simply because of their weight. - Agoraphobia - an individual with agoraphobia is frightened of finding himself/herself in situations where there is no escape; they fear being stuck in a desperate situation with no help. Agoraphobia may include a dread of traveling on buses or trains, going into large shops or shopping malls. When symptoms are severe, the patient may find it unbearable to even step out of their own home.
Sufferers have an 80% risk of also suffering from panic disorder. As with social phobia, crowded and public places are avoided. How common are phobias?
In the industrial nations, phobias are the most common kind of anxiety disorder. Over 50 million people in the USA and 10 million in the UK are thought to live with a phobia. They can affect people of any age, sex, and socioeconomic status.
The National Institute of Mental Health estimated in 2011 that between 8.7% and 18.1% of Americans of all ages suffer from phobias.
A much higher percentage of women suffer from phobias than men.
Simple phobias usually start early on in life - during childhood, and often go away by the time the person reaches late teens. Complex phobias generally start later on.What are the signs and symptoms of phobias?
A symptom is something the patient feels and describes, such as a headache, while a sign is something other people, as well as the patient can detect, as may be the case with a rash, swelling or bruising.
The following symptoms are common across the majority of phobias:- When exposed to the source of the fear there is a sensation of uncontrollable anxiety
- A feeling that at all costs, the source of that fear must be avoided
- The anxiety is so overwhelming when confronted with the source of the fear, that the person is unable to function properly
- It is common for sufferers to acknowledge that their fears are irrational, unreasonable and exaggerated; however, in spite of this, they are unable to control their feelings
- Panic and intense anxiety, which may include:
- sweating
- abnormal breathing (panting, trying to catch your breath)
- accelerated heartbeat
- trembling
- hot flushes or chills
- a sensation of choking
- chest pains, chest tightness
- butterflies in the stomach
- pins and needles
- dry mouth
- confusion and disorientation
- nausea
- dizziness
- headache - A feeling of anxiety when the source of the fear is not there but is simply thought about
- Children may cry, become very clingy, attempt to hide behind a parent's legs or an object, or have tantrums
- Complex phobias
Complex phobias are much more likely to severely affect the patient's wellbeing than specific phobias.
Those who suffer from, for example agoraphobia, may have a number of other associated phobias as well, such as monophobia (fear of being left alone) or claustrophobia (fear of feeling trapped, closed spaces). In severe cases, agoraphobics will rarely leave their homes.What are the causes of phobias?
It is unusual for a phobia to start after the age of 30; most of them begin during early childhood, teenage years or early adulthood. They can be caused by a stressful situation or experience, a frightening event, or a parent or household member who has a phobia which the child becomes progressively aware of.
Common causes for specific (simple) phobias
These usually develop when the child is between four and eight years of age. In some cases it may be the result of something that happened early in life. The trigger might have been an unpleasant experience in a confined space, which festered and developed into claustrophobia over time.
As mentioned above, witnessing a family member's phobia is a common cause for phobias which started during childhood. A kid whose mother suffers from arachnophobia is much more likely to develop the same phobia as well. Experts stress that phobias picked up from parents are learned fears - they are not genetically inherited.
Common causes for complex phobias
The causes of agoraphobia or social phobia are still a mystery, nobody is really sure. Health care professionals believe they are caused by a combination of life experiences, brain chemistry and genetics.
Social phobias are more likely to be caused by an extremely stressful experience than agoraphobia, researchers say.
Phobias and survival - there may be evolutionary explanations to many phobias. In prehistoric environments, remaining in wide open spaces would have increased the risk of being attacked and eaten by a predatory animal. The instinct of staying at home, especially for young children, aids survival.
Young children in their caves and huts would have had to rapidly learn to avoid dangerous snakes and spiders.
Social phobia may have been a useful survival instinct during ancient and prehistoric times. Being among people you do not know, from perhaps another tribe, was much more dangerous than finding yourself among a crowd of strangers in a shopping mall today. - Neurobiology - some areas of the brain - the prefrontal cortex, medial prefrontal cortex, ventromedial prefrontal cortex, and the amygdala - store and recall dangerous or potentially deadly events. In future occasions, if a very similar event is confronted, those areas retrieve that same memory and the body reacts is if there were a recurrence. With some people, the event may feel as if it is repeating itself many times.
Some effective treatments manage to get the brain to replace the memory and reactions with something more rational. Phobias are irrational phenomena - the brain overreacts to a stimulus. Unfortunately, the brain areas that deal with fear and stress keep retrieving the frightening event inappropriately.
Neuroscience researchers have found that phobias are often linked to the amygdala, which lies behind the pituitary gland. The amygdala can trigger the release of "fight-or-flight" hormones, which put the body and mind in a highly alert and stressed state. How are phobias diagnosed?
People with a phobia nearly always know they have it, and are not defensive when discussing their symptoms with a doctor. This helps diagnosis enormously. Even so, millions of sufferers never discuss their fears with a health care professional. This is unfortunate, because there are effective treatments available today.
Diagnosing agoraphobia - Anxiety UK, a British charity, has a Do-it-Yourself diagnosis, which consists of a list of questions. People who answer "Yes" to most of the questions below, most likely are affected and should see a doctor:- Do any of the situations below make you anxious?
- Leaving the house
- Standing in long queues (lines)
- Going on the subway (underground), a tunnel or any confined space
- Being on your own at home
- Being in wide, open spaces, such as a park or a field
- Being with many people, such as a crowd
- Do you deliberately avoid the situations mentioned above?
- An intense fear of embarrassment or humiliation in at least one social situation. The fear is persistent. The fear is typically with people they are unfamiliar with, or when they are being scrutinized closely.
- Feared situations trigger severe anxiety; even panic attacks.
- The fear is acknowledged, but it makes no difference, the patient is unable to control it.
- The patient avoids social situations, as well as situations where he/she has to appear in front of people and perform (public speaking, being on a stage in front of an audience)
- Social phobia symptoms affect the patient's life severely. Their ability to work, take part in social activities, and function in relationships are badly affected.
- Other possible explanations for the phobia have been ruled out, such as an illness or condition, a psychological disorder, or the side-effect of a medication.
- In social situations the child shrinks away, cries, has tantrums, or freezes still.
- The child is unable to acknowledge that their fear is irrational and unreasonable
- Their fear persists for over six months
Additional criteria for children with social phobia:
- Diagnosing specific (simple) phobias - the doctor will determine...:
- Whether a situation, event, living creature, place or thing triggers intense and unreasonable fear
- Whether this fear is persistent
- Whether the patient responds with anxiety as soon as they are confronted with the source of their phobia
- Whether the patient acknowledges that their fear is unreasonable and irrational, but can do nothing about it; they cannot control it (children are too young to understand their fear)
- Whether the patient avoids confronting source of the fear at all costs
- If the patient has to confront the source of the fear and cannot get away, whether they do so with severe anxiety
- Other possible factors have been ruled out, such as the side effect of a long-term medication, an illness or condition, or another psychological disorder.
- In children - whether the symptoms have persisted for over six months
If the GP suspects or believes there is a phobia, and it is severe enough to affect the patient's ability to function, they will be referred to a psychiatrist or psychologist, who have specialized interviewing techniques and assessments tools to evaluate the patient. What are the treatment options for phobias?
If the phobia does not cause severe problems, most patients find that by simply avoiding the source of their fear is enough to stay in control.
Some phobias are not possible to avoid, as may be the case with aviophobia (fear of flying). In such cases professional help should be sought.
The good news is that with proper treatment, most phobias can be cured. Treatment needs to be tailored to the patient for it to work - no single treatment works for everybody.
The doctor, psychiatrist and/or psychologist may recommend behavior therapy, medications or a combination of both. Therapy is aimed at reducing the symptoms of fear and anxiety, and to help patients manage their reactions to the source of their fear.
Medications The following medications have been shown to be effective for the treatment of phobias:- Beta blockers - primarily used for high blood pressure and some cardiovascular conditions. Beta blockers can help reduce the symptoms of palpitations, as well as trembling limbs. Many patients comment that they also help their voice quiver less. People with uncontrollable stage fright may find this type of drug helpful.
Side effects may include stomach upsets, fatigue, problems sleeping, and cold fingers. - Antidepressants - SSRI's (serotonin reuptake inhibitors) are commonly prescribed for people with phobias. They impact on serotonin levels in the brain, which results in better moods. Serotonin is a neurotransmitter; a brain chemical that facilitates communication between neurons (brain cells).
Paroxetine (Seroxat, Paxil) is commonly used for social phobia, while Citalopram (Celexa, Cipramil) and escitalopram (Lexapro, Cipralex) are used for panic disorder. Venlafaxine (Effexor) is sometimes used for treating GAD (generalized anxiety disorder).
SSRIs may initially cause nausea, sleeping problems and headaches.
A tricyclic antidepressant (TCA), such as clomipramine (Anafrani) has also been found to help phobia symptoms. Initial side effects may include sleepiness, blurred vision, constipation, urination difficulties, irregular heartbeat, dry mouth, and tremors.
If the SSRI does not work, the doctor may prescribe a monoamine oxidase inhibitor (MAOI) for social phobia, an example is moclobemide (Manerix). Patients on an MAOI may have to avoid certain types of food. Side effects initially may include dizziness, stomach upsets, restlessness, headaches and problems sleeping. - Tranquilizers (sedatives) - benzodiazepines may help reduce anxiety symptoms. Examples include lorazepam (Ativan), alprazolam (Xanax or Niravam), diazepam (Valium), or chlordiazepoxide (Librium). Patients should be monitored carefully because sedatives can become addictive. Patients with a history of alcoholism should not be given sedatives.
Curing phobias by watching others - investigators at the Karolinska Institute in Sweden believe phobias may be cured by watching others interact with the source of the fear. Their study and findings were published in the journal Psychological Science.
Cognitive behavioral therapy - the therapist helps the sufferer learn different ways of perceiving the source of their phobia, so that they may find it easier to cope. Alternative views about the fear(s) are taught. The patient is taught about the impact a wrong approach may have on quality of life, and how a new one may change things. Most importantly, those with phobias learn to become masters of their own feelings and thoughts.
A study carried out by British researchers found that cognitive behavioral therapy is effective in helping people with dentophobia(fear of dentists).Treating phobias as we dream
A team of researchers at Northwestern University explained in the journal Nature Neuroscience that emotional memory can be manipulated while we sleep, which could eventually lead to new phobia treatments administered as we dream.
Katherine Hauner and colleagues explained that previous studies had shown how motor sequence learning as well as spatial learning could be enhanced during sleep. They wondered whether the same could be done with emotional memory.
The researchers recruited 15 "healthy" volunteers. They were all given mild electric shocks while looking at two different faces. They were also exposed to some scents, including mint, new sneaker and clove while looking at each face and receiving electric shocks.
The aim was to get them to make an association between the faces they saw, the smells they sensed, and fear.
While the participants were asleep, they were exposed to just one of the scents. However, this time there were no faces or electric shocks. The scent was released during the slow wave stage of sleep - this is when "memory consolidation" occurs.
Hauner said "While this particular odorant was being presented during sleep, it was reactivating the memory of that face over and over again, which is similar to the process of fear extinction during exposure therapy."
When the volunteers woke up, they were shown both faces. The researchers noticed that there fear levels were considerably lower when looking at the face that was linked to the odorant they smelled during their sleep.- Beta blockers - primarily used for high blood pressure and some cardiovascular conditions. Beta blockers can help reduce the symptoms of palpitations, as well as trembling limbs. Many patients comment that they also help their voice quiver less. People with uncontrollable stage fright may find this type of drug helpful.
What are the most common phobias?
The ten most common phobias in the United Kingdom and the USA are:- Social phobia - fear of being in places with a lot of people
- Agoraphobia - fear of being somewhere with no support, away from home, open spaces
- Claustrophobia - fear being in constricted, confided spaces
- Aerophobia - fear of flying
- Arachnophobia - fear of spiders. A single session helped people with a fear of spiders. Researchers from Northwestern University Feinberg School of Medicine reported that a one-off therapy session for adults with lifelong arachnophobia (fear of spiders) resulted in long-term changes in the participants' response to fear. Their therapy was so effective, that the volunteers, all living with arachnophobia, were able to touch and hold a tarantula in their hands without the use of gloves six months after treatment.
- Driving phobia - fear of driving a car
- Emetophobia - fear of vomiting
- Erythrophobia - fear of blushing
- Hypochondria - fear of becoming ill
- Zoophobia - fear of animals
The two cateogories below, social phobia and agoraphobia are known as complex phobias. They are linked to a deep-rooted fear or anxiety about certain situations, incidents or circumstances, which make them much more disabling than simple phobias.
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