Phobias

Definition

A phobia is fear of an object or situation.

Description

Health professionals generally recognize three types of phobia: simple phobia, social phobia, and agoraphobia (with and without panic attacks). There is a separate diagnosis for people who repeatedly experience severe attacks of panic.

Simple Phobias

The most common of the various phobias is simple phobia, the unreasonable fear of some object or situation. Bees, germs, heights, odors, illness, and storms are examples of the things commonly feared in simple phobias.

If you have a simple phobia, it might have begun when you actually did face a risk that realistically provoked anxiety. Perhaps, for example, you found yourself in deep water before you learned to swim. Extreme fear was appropriate in such a situation. But if you continue to avoid even the shallow end of a pool, your anxiety is excessive and may be of phobic proportions.

Simple phobias, especially animal phobias, are common in children, but they occur at all ages. One study suggests that between 5 and 12 percent of the population have phobic disorders in any 6-month period.

The recognition by most phobics that their fears are unreasonable, does not make them feel any less anxious. Simple phobias do not often interfere with daily life or cause as much subjective distress as most other anxiety disorders.

Social Phobias

The person with a social phobia is intensely afraid of being judged by others. Even at a gathering of many people, the social phobic expects to be singled out and scrutinized. Thus, the person with a social phobia feels compelled to avoid social situations associated with such apprehensions.

If you have a social phobia, you might be afraid to go to a party because you fear that other people will laugh at your clothing or think you are stupid because you will not be able to think of anything to say. Like people with simple phobias, you work hard to avoid these anxiety-provoking situations.

People with social phobias are usually most anxious over feeling humiliated or embarrassed by showing fear in front of others. Ironically, they are often so crippled by the inhibitions resulting from such fears that they, in fact, may have difficulty thinking clearly, remembering facts, or expressing themselves in words. Even success in social situations fails to make them feel more confident. They are likely to think something like, "Next time I'll fall on my face."

Although studies of the incidence of social phobias are so far only preliminary, most experts believe social phobias are not as common as simple phobias. But because they result in considerable distress, people who suffer from them are more likely to seek treatment than are people with simple phobias.

Social phobias tend to begin between the ages of 15 and 20 and, if left untreated, continue through much of the person's life. Often, social phobics suffer from symptoms of depression, and many also become dependent on alcohol.

Panic Disorder

Another group of anxious people are subject to devastating episodes of panic that are unexpected and seemingly without cause.

Such unpredictable panic attacks are marked by an overwhelming sense of impending doom and a host of bodily symptoms. The person's heart races and breathing quickens, as he or she gasps for air. Sweating, weakness, dizziness, and feelings of unreality also are common.

The person having a panic attack fears they will die, go crazy, or at least lose control.

Panic disorder is diagnosed when patients experience repeated episodes of such panic. Although people with simple or social phobias may sometimes experience panic, they are clearly responding to an encounter or an anticipated encounter with the object or situation they fear. Such is not the case with panic disorder, when the fear strikes from nowhere, seemingly "out of the blue."

People with simple and social phobias also can predict that they will feel fear every time they come close to a cat, climb to the roof of a tall building, or encounter whatever else they fear.

People with panic disorder, by contrast, never can predict when they will suddenly be struck by panic. Some situations may seem more "dangerous," especially those that make escape difficult, but an attack does not invariably occur in those situations.

Panic disorder, which runs in families, afflicts over 1.2 million Americans. For most, panic attacks begin sometime between the ages of 15 and 19.

Agoraphobia

Many people who suffer from panic attacks may develop agoraphobia, a severely handicapping disorder that often prevents its victims from leaving their homes unless accompanied by a friend or relative - a "safe" person. The first panic attack may follow some stressful event, such as a serious illness or the death of a loved one. (The agoraphobic often does not make this connection, however.) Fearing more attacks, the person develops a more-or-less continual state of anxiety, anticipating the next attack, avoiding situations where he would be helpless if a panic attack occurred. It is this avoidance behavior that distinguishes agoraphobia from panic disorder.

Two different types of anxiety appear to afflict the person with agoraphobia, panic and the "anticipatory anxiety" engendered by expectations of future panic attacks. If you have agoraphobia, chances are it developed something like this:

One ordinary day, while tending to some chores, taking a walk, driving to work, in other words, just going about your usual business, you were suddenly struck by a wave of awful terror. Your heart started pounding, you trembled, you perspired profusely, and you had difficulty catching your breath. You became convinced that something terrible was happening to you, maybe you were going crazy, maybe you were having a heart attack, maybe you were about to die. You desperately sought safety, reassurance from your family, treatment at a clinic or emergency room. Your doctor could find nothing wrong with you, so you went about your business, until a panic attack struck you again.

As the attacks became more frequent, you spent more and more time thinking about them. You worried, watched for danger, and waited with fear for the next one to hit. You began to avoid situations where you had experienced an attack, then others where you would find it particularly difficult to cope with one, to escape and get help. You started by making minor adjustments in your habits, going to a supermarket at midnight, for example, rather than on the way home from work when the store tends to be crowded. Gradually, you got to the point where you couldn't venture outside your immediate neighborhood, couldn't leave the house without your spouse, or maybe couldn't leave at all. What started out as an inconvenience turned into a nightmare. Like a creature in a horror movie, fear expanded until it covered the entire screen of your life.

To the outside observer, a person with agoraphobia may look no different from one with a social phobia. Both may stay home from a party. But their reasons for doing so are different. While the social phobic is afraid of the scrutiny of other people, many investigators believe that the agoraphobic is afraid of his or her own internal cues. The agoraphobic is afraid of feeling the dreadful anxiety of a panic attack, afraid of losing control in a crowd. Minor physical sensations may be interpreted as the prelude to some catastrophic threat to life.

Agoraphobics may abuse alcohol in an effort to keep the anticipatory anxiety in check. Their pattern of abuse appears to be different from the bingeing characteristic of alcoholism however. The agoraphobic usually takes small amounts of alcohol, avoiding loss of control. Other drugs also may be abused.

Agoraphobia typically begins during the late teens or twenties. The best surveys done to date show that up to 6 percent of the U.S. adult population suffers from agoraphobia. Women are affected two to four times more often than men. The condition tends to run in families.

Recent surveys have found that many people are afraid to leave their homes. Most likely, they are not all suffering from agoraphobia. Some people may stay confined because of depression, fear of street crime, or other reasons. These surveys also show, however, that many agoraphobics may have never suffered a panic attack. This finding suggests that their agoraphobia may have developed in a way different from that outlined above.

Treatment

Phobia treatment programs now exist in many parts of the U.S.. These programs use a variety of behavioral therapy techniques to help clients confront and overcome their fears. In addition, through these programs, drugs may be recommended and prescribed for individuals likely to benefit from them.

In a typical program, phobic individuals work together in groups with a trained group leader. In some programs, family members and friends may also be invited to attend the weekly meetings. Group sessions are used to teach attitudes and skills that are helpful in overcoming phobias.

The person with the phobia also has weekly practice sessions, either alone or in a group, with a therapist who is a mental health professional or a recovered phobic. During these sessions, the client uses his new coping skills in situations he would previously have avoided. With the therapist close by, he or she gradually takes progressively more difficult steps toward the final goal. Setbacks are expected and viewed as opportunities for further practice and gain.

Agoraphobic clients who are housebound sometimes begin their treatment in their own homes. Although organized phobia treatment programs offer many advantages, they do not exist in all areas. Many individual therapists are experienced at working with phobic patients, and some will accompany their patients in fear-producing situations.

Not every form of treatment is appropriate for every patient or client. Nor does every therapist or phobia program offer all forms of treatment, psychotherapy, behavior therapy, and medications. Often, a combination of these treatments is necessary. If you feel that you are not being helped by one clinic, program, or therapist, you may wish to seek help elsewhere.

Questions to Ask Your Doctor

How serious is this?

Should a specialist be consulted?

What type of treatment do you recommend?

How effective is this treatment for a condition such as this?