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  • Understanding Phobias

    IMAGE Marion is so afraid of bugs that her social life has suffered drastically. Whenever friends invite her to go on a picnic or even to a pool party, she finds a reason to say no. Recently, she stopped joining her co-workers for lunch in the cafeteria because one day there was a fly buzzing around their table. She has had this fear since she got a bee sting in fourth grade.
    Brad cannot remember when or why he became so afraid of riding in elevators. But, last month he turned down an excellent job promotion because it would have required moving his office up to the tenth floor. Both Marion and Brad are too embarrassed to tell anyone about their fears. Unfortunately, they do not know they have a treatable disorder—specific phobia.

    What Are Phobias?

    Everyone has at least some fears and situations they try to avoid. What distinguishes phobias from ordinary fears is that the anxiety:
    • Is more intense and persistent
    • Is irrational
    • Usually leads to avoidance of the objects or situations that cause the fear
    • Interferes with everyday routines, work, or relationships, and/or causes significant distress
    Adults with phobias usually realize their fear is irrational. Children, however, may not, which makes it even more difficult to control.
    Let's say, for example, that you are horribly afraid of rats. For most of us, that is a normal fear. They are ugly and can carry disease. Who would not be afraid of them? But if your fear of simply seeing a rat evolves into dreams about rats, or if you stop walking downtown because you might see one, or stay home every day to rat-proof your home for no apparent reason, your fear has evolved into a phobia.
    Phobias are a common type of anxiety disorder. Three types of phobias are:
    • Specific phobia—fear of a specific object, such as insects or blood, or of a specific situation, such as flying in an airplane or riding in an elevator
    • Social phobia—fear of being judged by other people and acting in a way that could cause embarrassment or humiliation
    • Agoraphobia—fear of being "caught" in a public place, especially when having a panic attack
    This article focuses on specific phobias.

    What Are Some Common Specific Phobias?

    Phobias of certain types of animals, such as snakes, insects, and dogs, are especially common. They often begin in childhood and are frequently considered normal fears. If they continue into adulthood and cause significant distress, they are considered specific phobias.
    There are several other common types of specific phobias. For example, fear of the natural environment includes being afraid of storms or heights.
    The blood-injection-injury type of phobia is the fear of seeing blood or an injury or having an injection or other invasive medical procedure. The situational type occurs in a specific type of situation, such as flying or being in a tunnel, elevator, or other enclosed space. Phobias may also occur in situations that could lead to choking, vomiting, or getting a specific illness.
    Specific phobia used to be called "simple phobia" or "single phobia" because it involves an intense fear and avoidance of a single specific object or situation. Direct exposure to the object or situation—and sometimes just imagining it—causes fear that is out of proportion to the actual level of danger. The intensity of the fear may vary from one exposure to another. And people can have more than one specific phobia.
    Phobic fear usually involves physical symptoms that can range from mild panic-like symptoms to a panic attack. Common panic symptoms include:
    • Heart palpitations
    • Sweating
    • Trembling
    • Feelings of dizziness or choking
    • Nausea
    • Fear of losing control or going crazy
    Because these symptoms are so unpleasant, people with phobias do everything possible to avoid the trigger. If avoidance is fairly easy—like a fear of having blood drawn—the phobia may not cause a lot of problems and may not require treatment. But, when the object or situation is encountered often, maintaining a normal life may become difficult.

    What Causes Specific Phobias?

    Most researchers believe specific phobias are caused by a combination of biological factors and life events. Heredity and chemical disturbances in the brain may play a role. So too may traumatic events, such as a previous animal bite, accident, or childhood illness. Some phobias are learned over time, as in a child modeling a parent's phobia. But often, phobias occur without a specific trigger. Avoidance of the feared object or situation keeps the phobia securely in place.

    Are They Treatable?

    Behavior therapy is one of the most effective treatment for people whose phobias have become disruptive to a normal lifestyle. It involves changing and gaining control over unwanted behavior. The type of behavior therapy used with specific phobias is called desensitization, or exposure therapy. First, you are slowly exposed to the feared object or situation. In some cases, exposure begins with you imaging that you are coming into contact with whatever the trigger is. As your fear gradually diminishes, you slowly learn that avoidance is not necessary.
    Cognitive-behavioral therapy (CBT) is a technique that combines changing the way people think about the object of their phobia with changing the way they behave around the object.
    Relaxation techniques may also be used with behavior therapy to help people face their fears.
    Most people with specific phobias benefit from these kinds of professional help. But, some people with minor phobias may find self-help books useful. Keep in mind that most studies show that people usually do not improve without therapy.
    Medicine is generally used for specific phobias only if there is a high level of anxiety at the beginning of exposure therapy. The medicine, usually an antidepressant or tranquilizer, is slowly stopped as the person gains confidence.

    Getting Help

    Like Marion and Brad, many people with phobias do not get help. Perhaps they do not realize they have a treatable condition or are too embarrassed to get help. Jane C., an attorney from Boston, had a phobia about being attacked on a subway. "How ridiculous is that? I am a successful professional woman who is terrified to ride the streetcar. But I am even more afraid of having someone find out."
    Specific phobia is a highly treatable disorder. The success rates with behavioral and cognitive therapy are very good, even with short-term treatment.
    If you suspect you have a specific phobia, get help from a mental health professional. Support groups for people with phobias may also be available. If you know someone who may have a phobia and is not diagnosed or receiving treatment, encourage him to get professional help.

    RESOURCES

    Anxiety Disorders Association of America http://www.adaa.org/

    National Institute of Mental Health http://www.nimh.nih.gov/

    CANADIAN RESOURCES

    Canadian Psychological Association http://www.cpa.ca/

    Mental Health Canada http://www.mentalhealthcanada.com/

    References

    Phobia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 13, 2011. Accessed May 8, 2012.

    Specific phobias. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/phobias. Accessed May 8, 2012.

    Specific phobias. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/anxiety-disorders/specific-phobias.shtml. Accessed May 8, 2012.

    Stinson FS, Dawson DA, Patricia Chou S, et al. The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2007;37:1047-1059.

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