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Phobias

A phobia is an irrational fear which takes over the person’s life.

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There are 3 types of phobias:

Agoraphobia – the vast majority of agoraphobics are women. The disorder usually starts in early adulthood.

Social phobias – this is when you are afraid of being embarrassed/humiliated in public. It can take the form of fear of public speaking or being in a place in which many people are together, such as a restaurant. Some people may find it difficult to interact with an authority figure. Most social phobics are women and it is usually first seen in adolescence.

Specific phobias – for example, fear of spiders or a fear of a situation, such as a small enclosed space. There are not any differences between the number of women and men who get these phobias. These phobias usually develop at a young age. However, phobias of cancer and death usually occur in middle age.

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Anxiety Disorder

A phobia (from Greek: φόβος, phobos, "fear"), is an irrational, intense, persistent fear of certain situations, objects, activities, or persons. The main symptom of this disorder is the excessive, unreasonable desire to avoid the feared subject. When the fear is beyond one's control, or if the fear is interfering with daily life, then a diagnosis under one of the anxiety disorders can be made.

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Phobias, age and gender

Broken down by age and gender, it was found that phobias were the most common mental illness among women in all age groups and the second most common illness among men older than 25.

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Causes

It is generally accepted that phobias arise from a combination of external events and internal predispositions.

In a famous experiment, Martin Seligman used classical conditioning to establish phobias of snakes and flowers.

The results of the experiment showed that it took far fewer shocks to create an adverse response to a picture of a snake than to a picture of a flower, leading to the conclusion that certain objects may have a genetic predisposition to being associated with fear.

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Causes

Many specific phobias can be traced back to a specific triggering event, usually a traumatic experience at an early age.

Social phobias and agoraphobia have more complex causes that are not entirely known at this time.

It is believed that heredity, genetics, and brain chemistry combine with life-experiences to play a major role in the development of anxiety disorders and phobias.

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The anatomical side of phobias Phobias are more often than not linked to the

amygdala, an area of the brain located behind the pituitary gland in the limbic system.

The amygdala secretes hormones that control fear and aggression, and aids in the interpretation of this emotion in the facial expressions of others.

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The amygdala

Studies have shown a difference between the response cycles of those facing an object of a phobia and those facing a dangerous object that does not trigger phobia-like responses.

In one case, patients with arachnophobia were shown pictures of a spider (the object of fear) and a snake (a control picture, intended to induce the normal response).

When flashed up, the arachnophobe responded with brief fear to the snake.

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The amygdala

However, when shown the spider, the arachnophobe's amygdala reacted, and then did not stop secreting 'alarm' hormones, even after they had rationalized the situation they were in.

For this reason, a phobia is generally classified as a panic disorder by most psychologists, since it involves an unnatural or illogical functioning of the brain.

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Clinical phobias

Most psychologists and psychiatrists classify most phobias into three categories:

Social phobia, also known as social anxiety disorder - fears involving other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others, such as eating in public. Social phobia may be further subdivided into generalized social phobia, and specific social phobia, which is cases of anxiety triggered only in

specific situations. The symptoms may extend to psychosomatic manifestation of physical problems. For example, sufferers of paruresis find it difficult or impossible to urinate in reduced levels of privacy. That goes beyond mere preference. If the condition triggers, the person physically cannot empty their bladder.

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Specific phobias

Specific phobias or fear of a single specific panic trigger such as spiders, dogs, elevators, water, flying, catching a specific illness, etc.

Agoraphobia - a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. Agoraphobia is the only phobia regularly treated as a medical condition.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), social phobia, specific phobia, and agoraphobia are sub-groups of anxiety disorder.

Many of the specific phobias, such as fear of dogs, heights, spiders and so forth, are extensions of fears that a lot of people have. People with these phobias specifically avoid the entity they fear.

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The severity of phobias

Phobias vary in severity among individuals. Some individuals can simply avoid the

subject of their fear and suffer only relatively mild anxiety over that fear.

Others suffer fully-fledged panic attacks with all the associated disabling symptoms.

Most individuals understand that they are suffering from an irrational fear, but are powerless to override their initial panic reaction.

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Treatments

Some therapists use virtual reality or imagery exercise to desensitize patients to the feared entity. These are parts of systematic desensitization therapy.

Cognitive behavioural therapy (CBT) can be beneficial. Cognitive behavioural therapy lets the patient understand the cycle of negative thought patterns, and ways to change these thought patterns. CBT may be conducted in a group setting. Gradual desensitisation treatment and CBT are often successful, provided the patient is willing to endure some discomfort and to make a continuous effort over a long period of time.

Anti-anxiety or anti-depression medications can be of assistance in many cases. Benzodiazepines could be prescribed for short-term use.

These treatment options are not mutually exclusive. Often a therapist will suggest multiple treatments.

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More on treatment methods

Systematic desensitisation techniques: By presenting milder forms of the stimulus and allowing the

patient to accustom themselves to it gradually, it is then possible to make the stimulus more and more like the original neurosis-producing stimulus.

Eventually the patient becomes de-sensitized to this stimulus, the reaction is lost and the neurosis cured.

For example, if someone is suffering from agorophobia (fear of going out of the house), they can be first taken out for a few minutes every day and gradually the time spent out each day is increased until the sufferer feels confident enough to spend time outside the house on their own.

This is a technique for de-sensitizing the sufferer concerning the original neurotic reaction – ie, fear of open spaces and public places.

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Implosion therapy

The therapist exposes the client to mental images of the feared object in the safety of the therapeutic setting.

This is achieved by the therapist getting the client to imagine the most terrifying form of contact with the feared object.

The therapist uses verbal descriptions of the feared stimulus.

After repeated trials, the stimulus eventually loses its anxiety producing power and the anxiety extinguishes (or implodes) because no harm comes to the individual in the safe setting of the therapists room.

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Flooding therapy

The client is forced to confront the situation that gives rise to the fear response.

For example, a person who has a fear of heights might be taken to a tall building and physically prevented from leaving.

By preventing avoidance of or escape from the feared object or situation, the fear response is eventually extinguished.

Emmelkamp and Wessels, 1975, found that implosion therapy and flooding are effective with certain types of phobias, but for some people, both therapies lead to increased anxiety. Hence, both therapies should be used with considerable caution.

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Gender and phobias

Gender. With the exception of obsessive-compulsive disorder (OCD) and possibly social anxiety, women have twice the risk for most anxiety disorders as men.

A number of factors may increase the reported risk in women, including hormonal factors, cultural pressures to meet everyone else's needs except their own, and fewer self-restrictions on reporting anxiety to physicians.

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Age and phobias

Age. In general, phobias, OCD and separation anxiety show up early in childhood, while social phobia and panic disorder are often diagnosed during the teen years.

Studies suggest that 3% to 5% of children and adolescents have some anxiety disorder.

Indeed, this may be an underestimation, particularly since symptoms in children may differ from those in adults. One study indicated that if such children could be identified as early as two years of age they possibly could be treated to avoid later anxiety disorders.

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Personality and phobias

Personality Factors. Children's personalities may indicate higher or lower risk for future anxiety disorders.

For example, research suggests that extremely shy children and those likely to be the target of bullies are at higher risk for developing anxiety disorders later in life.

Children who cannot tolerate uncertainty tend to be worriers, a major predictor of generalized anxiety.

In fact, such traits may be biologically based and due to a hypersensitive amygdala--the "fear centre" in the brain.

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Family history and phobias

Family History and Dynamics. Anxiety disorders run in families. Genetic factors play a role in some cases, but family dynamics

and psychological influences are also often at work. For example, in a 2002 study, toddlers tended to avoid rubber

snakes or spiders if their mothers indicated a negative response to these objects by their facial expressions.

Girls had a stronger response than did boys. Studies are reporting the anxiety in new mother can affect their

infants. One study reported a higher rate of crying and an impaired ability

to adapt to new situations in infants of mothers who had been stressed and anxious during pregnancy.

In another, infants of mothers with panic disorder had higher levels of stress hormones and more sleep disturbances than other children.