Phobias - Symptoms, Risk Factors, Treatment of Phobias

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About Phobias

"My heart starts beating so fast . . . it feels like it’s going to explode. My throat closes and I can’t breathe. I start to choke. My hands start sweating. I get so dizzy I have to hold onto the furniture or the wall to keep from falling or fainting. I know I’m going to die. I want to run, but I don’t know where."

This reaction describes how people generally feel when they are suffering from a phobia. Phobia is a term that refers to a group of symptoms brought on by feared objects or situations. People can develop phobic reactions to animals (e.g., spiders), activities (e.g., getting on an airplane), or social situations (e.g., eating in public or simply being out in public at all).

Phobias affect people of all ages, from all walks of life, and in every part of the country. The National Institute of Mental Health has reported that 5.1%–12.5% of Americans have phobias. They are the most common psychiatric illness among women of all ages and are the second most common illness among men older than 25.

Phobias take many forms. Some people are terrified of dogs, even tiny dogs with wagging tails. Some people stiffen with fright at the mere thought of talking in front of a group. Some can't fly. Some tremble and hide at the crack of thunder. Some can't ride an escalator. Some are struck by panic attacks for no apparent reason. And some never leave their homes.

Fears such as these are very common. Millions of Americans are afflicted with phobias or panic disorder. They suffer intensely. To escape their fear, they go to great lengths to avoid the object, place, or situation that provokes it. They change jobs merely to avoid an elevator ride, for example, or cut back their social life. Some wear down their families with their clinging dependency. Nearly all lose out on much of life.

Symptoms of a Phobia

Phobias can interfere with your ability to work, socialize, and go about a daily routine. They may focus on something as common as germs, or they may arise whenever you venture from home. A phobia that interferes with daily living can create extreme disability and should be treated.

Phobias are emotional and physical reactions to feared objects or situations. Symptoms of a phobia include the following:

Feelings of panic, dread, horror, or terror
Recognition that the fear goes beyond normal boundaries and the actual threat of danger
Reactions that are automatic and uncontrollable, practically taking over the person’s thoughts
Rapid heartbeat, shortness of breath, trembling, and an overwhelming desire to flee the situation—all the physical reactions associated with extreme fear
Extreme measures taken to avoid the feared object or situation

Another common symptom experienced by people with phobias is anticipatory anxiety. Anticipatory anxiety can cause people to avoid situations in which they might have a panic attack or to avoid the objects that trigger a response of intense fear and anxiety.

When avoidance causes distress or interferes with the ability to work, socialize, or care for day-to-day needs, a psychiatric evaluation should be sought.

Risk Factors for Phobias

Most individuals with agoraphobia have a history of panic disorder. There is also some evidence that agoraphobia may run in families. Also, a child who suffers separation anxiety (anxiety for being away from home and immediate family) may be predisposed to developing agoraphobia.

There appears to be a link between alcoholism and social phobia. The stress associated with social phobia is thought to create an increased risk for alcohol abuse (e.g., drinking to "calm the nerves"). Similarly, the depression caused by the low self-esteem and social isolation that results from social phobia may predispose a person to alcohol abuse and dependence. Conversely, people with alcoholism tend to withdraw and become inhibited and may develop fear of being embarrassed or humiliated in social situations.

A person who has a particularly frightening or threatening experience with an animal or in certain situations may put a person at risk for developing a specific phobia. Witnessing a traumatic event in which others experience harm or extreme fear is another risk factor for specific phobia. Receiving repeated information or warnings about potentially dangerous situations or animals is also a risk factor.

Categories of Phobias

Phobias are divided into categories according to the cause of the reaction and avoidance.

Agoraphobia

Agoraphobia is the fear of being alone in any place or situation from which it seems escape would be difficult or help unavailable should the need arise.

People with agoraphobia avoid being on busy streets or in crowded stores, theaters, or churches. Some people with agoraphobia become so disabled they literally will not leave their homes. If they do, they do so only with great distress or when accompanied by a friend or family member.

Two-thirds of those with agoraphobia are women. Symptoms develop between the ages of 18 and 35. The onset may be sudden or gradual.

Most people with agoraphobia develop the disorder after first suffering from one or more spontaneous panic attacks—feelings of intense, overwhelming terror accompanied by symptoms such as sweating, shortness of breath, or faintness. These attacks seem to occur randomly and without warning, making it impossible for a person to predict what situation will trigger such a reaction.

The unpredictability of the panic attacks "trains" individuals to anticipate future panic attacks and, therefore, to fear any situation in which an attack may occur. As a result, they avoid going into any place or situation where previous panic attacks have occurred.

(Read: Help for Agoraphobia)

Social Phobia

A person with social phobia fears being watched or humiliated while doing something in front of others. As a result, he or she avoids any situation in which such activity may be required.

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The activity is often as mundane as signing a personal check, drinking a cup of coffee, buttoning a coat, or eating a meal. The most common social phobia is the fear of speaking in public. Many people have a generalized form of social phobia, in which they fear and avoid interpersonal interactions. This makes it difficult for them to go to work or school or to socialize at all.

Social phobias generally develop after puberty and peak after the age of 30. The cause of social phobia is unknown. There is a possibility that altered function of serotonin (a neurotransmitter involved in many behaviors) may be a factor.

(Read: Chat transcript on Coping With Social Phobia, Social Anxiety Disorder)

Specific Phobia

As the name implies, people with a specific phobia generally have an irrational fear of specific objects or situations. The disability caused by this phobia can be severe if the feared object or situation is a common one.

A frightening or threatening experience with an animal or in a particular situation can cause a specific phobia. For instance, someone who has been bitten by a vicious dog may generalize their fear to include all dogs, regardless of the animals' dispositions.

Fear can be learned from others as well. For instance, the child of a parent who responds with intense fear and anxiety whenever they encounter a harmless garden snake learns to respond to snakes with the same fear and anxiety.

The most common specific phobia in the general population is fear of animals—particularly dogs, snakes, insects, and mice. Other specific phobias are fear of closed spaces (claustrophobia) and fear of heights (acrophobia).

Most simple phobias develop during childhood and eventually disappear. Those that persist into adulthood rarely go away without treatment.

Treatment of Phobias

Fortunately, phobias are very treatable. In fact, most people who seek treatment of phobias completely overcome their fears for life. Effective relief can be gained through either behavior therapy or medication.

Many people to from doctor to doctor seeking cures for the physical symptoms that accompany their phobias. Often, even the doctor fails to recognize that stomach pains, high blood pressure, rapid heart beat, and other symptoms may be related to intense fear. Unless questioned, patients may not think to mention their fears. Doctors may not ask. While the bills keep mounting, the medical condition fails to improve.

The many phobic people who think their fears are silly, childish, or trivial often try to conceal them. While hiding from their fears, they hide their phobias from others, further limiting their experience of life.

It is better to tell someone. Much of the pain and disruption - perhaps most of it - can be remedied. New treatments for phobias are remarkably effective. But few people, including doctors, know about them.

In behavior therapy, one meets with a trained therapist and confronts the feared object or situation in a carefully planned, gradual way and learns to control the physical reactions of fear. The person first imagines the feared object or situation, works up to looking at pictures that depict the object or situation, and finally actually experiences the situation or comes in contact with the feared object. By confronting rather than fleeing the object of fear, the person becomes accustomed to it and can lose the terror, horror, panic, and dread he or she once felt.

Medications are used to control the panic experienced during a phobic situation as well as the anxiety aroused by anticipation of that situation and are the treatment of first choice for social phobia and agoraphobia.

Any phobia that interferes with daily living and creates extreme disability should be treated. With proper treatment, the vast majority of phobia patients can completely overcome their fears and be symptom free for years, if not for life.

Other Resources

Anxiety Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852-2624
301-231-9350
www.adaa.org

Women Helping Agoraphobics, Inc.
Constance Fitzpatrick, R.N., Director
P.O. Box 4900
S. Framingham, MA 01701
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
800-969-NMHA
www.nmha.org

NAMI (National Alliance for the Mentally Ill)
Colonial Place Three
2107 Wilson Blvd. - Suite 300
(703) 524-7600
(703) 524-9094 (fax)
NAMI HelpLine: 1-800-950-NAMI (6264)
www.nami.org

National Institute of Mental Health
5600 Fishers Lane, Room 7CO2
Mail Stop Code MSC 8030
Bethesda, MD 20892-8030
FACTS ON DEMAND: 301-443-5158
www.nimh.nih.gov

Source: American Psychiatric Association, 1999