Phobia

What Is It?

A phobia is a persistent, excessive, unrealistic fear of an object, person, animal, activity or situation. It is a type of anxiety disorder. A person with a phobia either tries to avoid the thing that triggers the fear, or endures it with great anxiety and distress.

Some phobias are very specific and limited. For example, a person may fear only spiders (arachnophobia) or cats (galeophobia). In this case, the person lives relatively free of anxiety by avoiding the thing he or she fears. Some phobias cause trouble in a wider variety of places or situations. For example, symptoms of acrophobia (fear of heights) can be triggered by looking out the window of an office building or by driving over a high bridge. The fear of confined spaces (claustrophobia) can be triggered by riding in an elevator or by using a small restroom. People with these phobias may need to alter their lives drastically. In extreme cases, the phobia may dictate the person's employment, job location, driving route, recreational and social activities, or home environment.

There are three major types of phobia:

• Specific phobia (simple phobia) With this most common form of phobia, people may fear specific animals (such as dogs, cats, spiders or snakes), people (clowns, dentists, doctors), environments (dark places, thunderstorms, high places) or situations (flying in a plane, riding on a train, being in a confined space). Although the cause of specific phobias remains a mystery, these conditions are at least partly genetic (inherited), and seem to run in families.
• Social phobia (social anxiety disorder) People with social phobia fear social situations where they may be humiliated, embarrassed or judged by others. They become particularly anxious when unfamiliar people are involved. The fear may be limited to performance, such as giving a lecture, concert or business presentation. Or it may be more generalized, so that the phobic person avoids many social situations, such as eating in public or using a public restroom. Social phobia seems to run in families. People who have been shy or solitary as children, or who have a history of unhappy or negative social experiences in childhood, seem more likely to develop this disorder.
• Agoraphobia Agoraphobia is a fear of being in public places where it would be difficult or embarrassing to make a sudden exit. A person with agoraphobia may avoid going to a movie or a concert, or traveling on a bus or train. In many cases, he or she also has repeated, unexpected panic attacks (intense fear and a set of uncomfortable physical symptoms trembling, heart palpitations, sweating and hot flushes).

Childhood phobias occur most commonly between the ages of 5 and 9, and tend to be short term. Most phobias begin later in life, especially in people in their 20s. Adult phobias tend to last for many years, and are less likely to go away on their own. Without proper treatment, untreated phobia can increase an adult's risk of other types of psychiatric illness, especially other anxiety disorders, depression and substance abuse.

Symptoms

The symptoms of phobia are:

• Excessive, unreasonable, persistent feelings of fear or anxiety that are triggered by a particular object, activity or situation The feelings are either irrational or out of proportion to any actual threat. For example, while anyone may be afraid of an unrestrained, menacing dog, it is not reasonable to run away from a calm, quiet animal on a leash.
• Anxiety-related physical symptoms These can include tremors, palpitations, sweating, shortness of breath, dizziness, nausea or other symptoms that reflect the body's "fight or flight" response to danger.
• Avoidance of the object, activity or situation that triggers the phobia Because people who have phobias recognize that their fears are unreasonable, they are often ashamed or embarrassed about their symptoms. To prevent anxiety symptoms or embarrassment, they avoid the triggers for the phobia.

Diagnosis

In addition to the routine questions, a mental health professional will ask about your current symptoms, and your family's history, particularly whether other family members have had phobias. He or she will also ask about any experience or trauma that may have set off the phobia for example, a dog attack leading to a fear of dogs.

You may find it helpful to discuss how you react your thoughts, feelings and physical symptoms when you are confronted with the thing you fear. Also, you should describe what you do to avoid fearful situations, and how the phobia affects your daily life, including your job and your personal relationships.

Your doctor will ask about depression and substance use because many people with phobias have these problems as well.

Expected Duration

In children, specific phobias can be short-term problems that disappear within a few months. In adults, about 80% of new phobias become chronic (long-term) conditions that do not go away without proper treatment.

Prevention

There is no way to prevent a phobia from starting. However, if you already have a phobia or any other anxiety disorder, you may be able to reduce your anxiety levels by avoiding stimulants, such as caffeine (in coffee, tea and cola drinks), chocolate and nicotine (in tobacco).

Treatment

Treatment usually includes some combination of psychotherapy and medication:

• Specific phobia Cognitive-behavioral therapy can help, especially a procedure called desensitization therapy, also called exposure therapy. This technique involves gradually increasing your exposure to the thing you fear, at your own pace, under controlled circumstances. As you are exposed to the object, you are taught to master your fear through relaxation, breathing control or other anxiety-reducing strategies. For short-term treatment of phobias, your doctor may prescribe an antianxiety medication, such as lorazepam (Ativan). If the phobia is confronted only occasionally, as in a fear of flying, the use of medication can be limited.
• Social phobia If your social phobia centers on one particular performance (for example, giving a lecture or playing in a concert), your doctor may prescribe a medication called a beta-blocker such as propranolol (Inderal). This medicine can be taken just prior to the performance. It dampens the physical effects of anxiety (pounding heart or trembling fingers), but usually does not affect the mental sharpness needed for speaking or the physical dexterity needed for playing an instrument. For more generalized or long-term forms of social phobia, your doctor may prescribe an antidepressant, usually an SSRI (selective serotonin reuptake inhibitor) such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac). If an SSRI is not effective, your doctor may prescribe an alternative antidepressant or antianxiety medication. Cognitive-behavioral therapy also works well for many people with social phobia, in both individual and group settings.
• Agoraphobia The treatment for this disorder is similar to the treatment for panic disorder. Drug treatment includes antianxiety medications, such as clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan); SSRI antidepressants or older antidepressants, such as clomipramine (Anafranil) and imipramine (Tofranil). Psychotherapy is also helpful, particularly cognitive-behavioral therapy.

When To Call A Professional

Make an appointment to see your doctor as soon as possible if you are troubled by fears or anxieties that are disturbing your peace of mind, interfering with your personal relationships, or preventing you from functioning normally at home, school or work.

Prognosis

The outlook is very good for people with specific phobia or social phobia. According to the U.S. National Institute of Mental Health, about 75% of people with specific phobias overcome their fears through cognitive-behavioral therapy, while 80% of those with social phobia find relief from medication, cognitive-behavioral therapy or a combination.

When agoraphobia occurs with panic disorder, the prognosis is also good. With appropriate treatment, 30% to 40% of patients become free of symptoms for extended periods, while another 50% continue to experience only mild symptoms that do not significantly affect daily life. Only 10% to 20% of patients do not improve.

Additional Info

American Psychiatric Association

1000 Wilson Blvd.

Suite 1825

Arlington, VA 22209-3901

Phone: (703) 907-7300

Toll-Free: (888) 357-7924

E-Mail: apa@psych.org

http://www.psych.org/

National Institute of Mental Health

Office of Communications

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Phone: (301) 443-4513

Toll-Free: (866) 615-6464

TTY: (301) 443-8431

Fax: (301) 443-4279

E-Mail: nimhinfo@nih.gov

http://www.nimh.nih.gov/

Anxiety Disorders Association of America

8730 Georgia Ave.

Suite 600

Silver Spring, MD 20910

Phone: (240) 485-1001

Fax: (240) 485-1035

http://www.adaa.org/

American Academy of Family Physicians (AAFP)

11400 Tomahawk Creek Parkway

Leawood, KS 66211-2672

Phone: (913) 906-6000

Toll-Free: (800) 274-2237

E-Mail: email@familydoctor.org

http://www.familydoctor.org/

American Psychological Association

750 First St., NE

Washington, DC 20002-4242

Phone: (202) 336-5510

Toll-Free: (800) 374-2721

TTY: (202) 336-6123

http://www.apa.org/

National Mental Health Association

2001 N. Beauregard St., 12th Floor

Alexandria, VA 22311

Phone: (703) 684-7722

Toll-Free: (800) 969-6642

TTY: (800) 433-5959

Fax: (703) 684-5968

http://www.nmha.org/

Freedom From Fear, Inc.

308 Seaview Ave.

Staten Island, NY 10305

Phone: (718) 351-1717

Fax: (718) 980-5022

E-Mail: contactfff@aol.com

http://www.freedomfromfear.org/

National Alliance for the Mentally Ill

Colonial Place Three

2107 Wilson Blvd.

Suite 300

Arlington, VA 22201-3042

Phone: (703) 524-7600

Toll-Free: (800) 950-6264

TTY: (703) 516-7227

Fax: (703) 524-9094

http://www.nami.org/

Association for Advancement of Behavior Therapy

305 7th Ave.

16th Floor

New York, NY 10001

Phone: (212) 647-1890

Fax: (212) 647-1865

http://www.aabt.org/