PHOBIAS


Phobias are the most common form of anxiety disorders.
In one National Institute of Mental Health study phobias were
found to be the most common psychiatric disorder among women
in all age groups and the second most common among men older
than twenty five. Simply put, a phobia is an irrational
fear. A phobia can be so mild that it hardly effects a
person's life. For example, the feared object or situation
may enter the person's life so rarely that the phobia does
not interfere with their ability to work, socialize, or
perform daily routines. But other phobias can focus on
common day to day activities such as when a person ventures
away from home. A phobia that interferes with daily living
can create extreme problems and is an indication that this
individual should seek treatment. Phobias are defined by
their psychological and physical reactions to the object or
situations feared rather than the object itself. Symptoms of
phobias are as follows:

1. Sudden and persistent irrational fear, panic, dread,
horror over situations that are normally harmless.

2. The person may realize that the fear goes beyond normal
boundaries and actual threat of danger, however, they are
unable to control it.

3. The phobic reaction tends to be uncontrollable,
pervasive, and automatic.

4. Physical symptoms usually accompany the extreme fear;
rapid heartbeat, shortness of breath, trembling, and an
overwhelming need to escape from the situation. In
children, the anxiety may be expressed by crying, tantrums,
freezing, or clinging.

5. The individual recognizes the fear is excessive or
unreasonable. *Note: In children this feature may
be absent.

5. The person goes out of his or her way to avoid the feared
situation. This avoidance causes distress and interferes
with their ability to work, socialize, care for day to
day needs.

There are different categories of phobias. Phobias can
develop as a result of a panic attack that seemed to appear
out of nowhere. Panic attacks push some people into fearing
and avoiding situations or objects associated with an attack,
however, other phobic patients may never experience a panic
attack even when they are confronted with the object or
situation that they fear.

Specific types:

Animal Type: The fear is cued by animals or insects. This type
usually has a childhood onset.

Natural Environmental Type: The fear is cued by natural events or
object in the environment, such as storms, heights, water etc.
This type usually has a childhood onset.

Blood-Injection-Injury Type: This fear is cued by seeing blood,
on an injury, or an injection or other invasive medical procedure.

Situational Type: This fear is triggered by specific situations
such as bridges, tunnels, public transportation, flying, driving,
or enclosed places.

Other Type: These fears are triggered by specific stimuli which
is not any of the above, such as choking, loud sounds, etc.

There are different categories of phobias. Phobias can
develop as a result of a panic attack that seemed to appear out of
nowhere. Panic attacks push some people into fearing and avoiding
situations or objects associated with an attack, however, other
phobic patients may never experience a panic attack even when they
are confronted with the object or situation that they fear. Some of
the most common phobias are listed below.

AGORAPHOBIA DSM IV 300.22

This is the most common phobic disorder. Agoraphobia
literally means fear of outside spaces. The agoraphobic
fears being alone in public places. These people avoid being
on busy streets, crowded stores, theaters, churches. Normal
activities become restrictive because the person avoids these
situations. Many agoraphobic victims become so disabled that
they literally will not leave their homes. Two thirds of
those suffering from agoraphobia are women. Most of these
women develop symptoms between ages eighteen and thirty five
and the onset can be sudden or gradual. Many agoraphobia
victims develop the disorder after first suffering a series
of panic attacks in public places. 

These attacks seem to occur randomly without warning.                                         The unpredictability of these panic attacks trains the victims to                        anticipate future panic attacks and, therefore, to fear situations in which a
panic attack may occur. As a result, they avoid going out
into the public, becoming a social phobic. A social phobia
is an irrational fear and avoidance of being in a situation
where a person's activities can be watched by others and is a
form of performance anxiety, however, a social phobia causes
symptoms that go well beyond the normal nervousness that a
person may experience. For example, before an "on stage"
appearance. A person suffering from social phobia fears
being humiliated while doing something in front of others.
As a result, they avoid situations which place them in social
situations. The most common social phobia is the fear of
speaking in public, either in front of an audience or in
front of a small group. Social phobias can occur equally
among men and women, generally develop after puberty, and
usually peak after age thirty.

SIMPLE PHOBIA

Individuals suffering from simple phobia generally have
an irrational fear of a specific object. When the feared
object rarely appears in a person's life the phobia may not
create serious disability. If the object is common, however,
the disability can be severe. The most common simple phobia
in the general population is a fear of animals, particularly
dogs. However, snakes, insects, mice, and other animals also
produce irrational fear in some individuals. Other simple
phobias include claustrophobia which is a fear of closed
spaces and acrophobia which is a fear of heights. Most
simple phobias develop during childhood and, eventually,
disappear. Those that persist into adulthood rarely go away
without treatment.

TREATMENT

With proper treatment the majority of phobic patients
completely recover or show significant improvement. Moreover,
research indicates that once a person successfully overcomes
a phobia, he will be free of symptoms for years if not for
life. Research also indicates, however, that if phobias go
untreated they tend to become "expansive" and to generalize
to less specific areas. For example, an individual may first
start to experience social phobia which gradually increases,
limiting their ability to go out in social situations to a
greater and greater extent until they have developed a severe
agoraphobia and cannot leave their home. There are two basic
types of treatment for phobia disorders. Both of these rely
on exposing the person to the feared object or situation
until they gradually learn to realize that there is nothing
to dread. The most common form of treatment is called
systematic desensitization. In systematic desensitization
the individual is gradually exposed through therapy in a
series of steps to the feared object. The person first
learns relaxation control to help them get through the
physical reactions to their fears. This is often done with
use of hypnosis or imagery, however, can also be done in
successful steps working directly with the feared situation.
Behavioral research has shown that the individual's reaction
to the feared situation increases the closer that they get in
physical distance and/or time to the feared object. By
gradually leading them closer and closer into these feared
situations and then allowing them to gain composure and learn
to control their physical reactions they gradually learn that
the feared object cannot actually hurt them. Each successful
occurrence helps them develop confidence and greater control
over their fears. The second type of treatment is referred
to as "implosion" or "flooding". With implosion the person
is exposed directly and immediately to the most feared object
or situation and is forced to stay in that situation until
his or her anxiety subsides. 

This form of treatment tends to be successful, however,                                          requires longer sessions (two hours per session) and can be difficult                     depending on the intensity of the individual's phobic reaction. It is                             similar to the old method of being "thrown into the water to learn how to
swim". Individuals begin to realize that they cannot be
harmed by the feared object or situation. Other forms of
behavior therapy are very similar. The purpose of all of
them is to force the individual to confront the source of the
phobia without allowing them to flee. Research has shown
that behavior therapy is highly effective in reducing or
completely ending phobic reactions and in follow up studies
treatment has been shown to last for at least seven years
after discontinuing therapy. Behavior therapy, however, is
likely to fail if the person attempts it only halfheartedly
and if interpersonal or family problems interfere with the
therapy. In some cases an individual may, in addition to
being phobic, be severely depressed which can also.