Phobias

A phobia is an intense, unrealistic fear, which can interfere with the ability to socialize, work, or go about everyday life, that is brought on by an object, event or situation.

Just about everyone is afraid of something--an upcoming job interview or being alone outside after dark. But about 18% of all Americans are tormented by irrational fears that interfere with their daily lives. They aren't "crazy"--they know full well their fears are unreasonable--but they can't control the fear. These people suffer from phobias.

Phobias belong to a large group of mental problems known as "anxiety disorders" that include obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder. Phobias themselves can be divided into three specific types:

  • Specific phobias (formerly called "simple phobias")
  • Social phobia
  • Agoraphobia.

As its name suggests, a specific phobia is the fear of a particular situationor object, including anything from airplane travel to dentists. Found in 1 out of every 10 Americans, specific phobias seem to run in families and are roughly twice as likely to appear in women. If the person doesn't often encounter the feared object, the phobia doesn't cause much harm. However, if the feared object or situation is common, it can seriously disrupt everyday life. Common examples of specific phobias, which can begin at any age, include fear of snakes, flying, dogs, escalators, elevators, high places, or open spaces.

People with social phobia have deep fears of being watched or judged by others and being embarrassed in public. This may extend to a general fear of social situations--or be more specific or "circumscribed," such as a fear of giving speeches or of performing ("stage fright"). More rarely, people with socialphobia may have trouble using a public restroom, eating in a restaurant, orsigning their name in front of others.

Social phobia is not the same as shyness. Shy people may feel uncomfortable with others, but they don't experience severe anxiety, they don't worry excessively about social situations beforehand, and they don't avoid events that make them feel self-conscious. On the other hand, people with social phobia maynot be shy--they may feel perfectly comfortable with people except in specific situations. Social phobias may be only mildly irritating, or they may significantly interfere with daily life. It is not unusual for people with socialphobia to turn down job offers or avoid relationships because of their fears.

Agoraphobia is the intense fear of feeling trapped and having a panic attackin a public place. It usually begins between ages 15-35, and affects three times as many women as men--about 3% of the population.

An episode of spontaneous panic is usually the initial trigger for the development of agoraphobia. After an initial panic attack, the person becomes afraid of experiencing a second one. Sufferers literally "fear the fear," and worry incessantly about when and where the next attack may occur. As they begin to avoid the places or situations in which the panic attack occurred, their fear generalizes. Eventually the person completely avoids public places. In severe cases, people with agoraphobia can no longer leave their homes for fear of experiencing a panic attack.

Experts don't really know why phobias develop, although research suggests thetendency to develop phobias may be a complex interaction between heredity and environment. Some hypersensitive people have unique chemical reactions in the brain that cause them to respond much more strongly to stress. These people also may be especially sensitive to caffeine, which triggers certain brainchemical responses.

While experts believe the tendency to develop phobias runs in families and may be hereditary, a specific stressful event usually triggers the developmentof a specific phobia or agoraphobia. For example, someone predisposed to develop phobias who experiences severe turbulence during a flight might go on todevelop a phobia about flying. What scientists don't understand is why some people who experience a frightening or stressful event develop a phobia and others don't.

Social phobia typically appears in childhood or adolescence, sometimes following an upsetting or humiliating experience. Certain vulnerable children who have had unpleasant social experiences (such as being rejected) or who have poor social skills may develop social phobias. The condition also may be related to low self-esteem, unassertive personality, and feelings of inferiority.

A person with agoraphobia may have a panic attack at any time, for no apparent reason. While the attack may last only a minute or so, the person remembersthe feelings of panic so strongly that the possibility of another attack becomes terrifying. For this reason, people with agoraphobia avoid places wherethey might not be able to escape if a panic attack occurs. As the fear of anattack escalates, the person's world narrows.

While the specific trigger may differ, the symptoms of different phobias areremarkably similar: e.g., feelings of terror and impending doom, rapid heartbeat and breathing, sweaty palms, and other features of a panic attack. Patients may experience severe anxiety symptoms in anticipating a phobic trigger. For example, someone who is afraid to fly may begin having episodes of pounding heart and sweating palms at the mere thought of getting on a plane in two weeks.

A mental health professional can diagnose phobias after a detailed interviewand discussion of both mental and physical symptoms. Social phobia is often associated with other anxiety disorders, depression, or substance abuse.

People who have a specific phobia that is easy to avoid (such as snakes) andthat doesn't interfere with their lives may not need to get help. When phobias do interfere with a person's daily life, a combination of psychotherapy andmedication can be quite effective. While most health insurance covers some form of mental health care, most do not cover outpatient care completely, andmost have a yearly or lifetime maximum.

Medication can block the feelings of panic, and when combined with cognitive-behavioral therapy, can be quite effective in reducing specific phobias and agoraphobia.

Cognitive-behavioral therapy adds a cognitive approach to more traditional behavioral therapy. It teaches patients how to change their thoughts, behavior,and attitudes, while providing techniques to lessen anxiety, such as deep breathing, muscle relaxation, and refocusing.

One cognitive-behavioral therapy is "desensitization" (also known as "exposure therapy"), in which people are gradually exposed to the frightening objector event until they become used to it and their physical symptoms decrease. For example, someone who is afraid of snakes might first be shown a photo of asnake. Once the person can look at a photo without anxiety, he might then beshown a video of a snake. Each step is repeated until the symptoms of fear (such as pounding heart and sweating palms) disappear. Eventually, the personmight reach the point where he can actually touch a live snake. Three fourthsof patients are significantly improved with this type of treatment.

Another more dramatic cognitive-behavioral approach is called "flooding," which exposes the person immediately to the feared object or situation. The person remains in the situation until the anxiety lessens.

Several drugs are used to treat specific phobias by controlling symptoms andhelping to prevent panic attacks. These include anti-anxiety drugs (benzodiazepines) such as alprazolam (Xanax) or diazepam (Valium). Blood pressure medications called "beta blockers," such as propranolol (Inderal) and atenolol (Tenormin), appear to work well in the treatment of circumscribed social phobia,when anxiety gets in the way of performance, such as public speaking. Thesedrugs reduce overstimulation, thereby controlling the physical symptoms of anxiety.

In addition, some antidepressants may be effective when used together with cognitive-behavioral therapy. These include the monoamine oxidase inhibitors (MAO inhibitors) phenelzine (Nardil) and tranylcypromine (Parnate), as well asselective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox).

In all types of phobias, symptoms may be eased by lifestyle changes, such as:

  • Eliminating caffeine
  • Cutting down on alcohol
  • Eatinga good diet
  • Getting plenty of exercise
  • Reducing stress.

Treating agoraphobia is more difficult than other phobias because there are often so many fears involved, such as open spaces, traffic, elevators, and escalators. Treatment includes cognitive-behavioral therapy with antidepressantsor anti-anxiety drugs. Paxil and Zoloft are used to treat panic disorders with or without agoraphobia.

Phobias are among the most treatable mental health problems; depending on theseverity of the condition and the type of phobia, most properly treated patients can go on to lead normal lives. Research suggests that once a person overcomes the phobia, the problem may not return for many years--if at all.

Untreated phobias are another matter. Only about 20% of specific phobias willgo away without treatment, and agoraphobia will get worse with time if untreated. Social phobias tend to be chronic, and without treatment, will not likely go away. Moreover, untreated phobias can lead to other problems, includingdepression, alcoholism, and feelings of shame and low self-esteem.

While most specific phobias appear in childhood and subsequently fade away, those that remain in adulthood often need to be treated. Unfortunately, most people never get the help they need; only about 25% of people with phobias ever seek help to deal with their condition.

There is no known way to prevent the development of phobias. Medication and cognitive-behavioral therapy may help prevent the recurrence of symptoms oncethey have been diagnosed.

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