Phobias

What are phobias? 
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. 

What are the symptoms of phobias? 
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

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. 

What causes phobias? 
Phobias are caused by a wide array of psychological and sometimes physiological factors. Because of this, it is difficult to categorize one single cause. Your physician can best determine the nature and origin of a specific phobia. 

What happens to people who have phobias? 
Phobias are divided into categories according to the cause of the reaction and avoidance.

• 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.
• 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. 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.
• 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. 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.

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

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. 

What can I do to help control phobias? 
If you cannot deal with a phobia alone, seek the assistance of a medical professional. 

Where can I get more information about phobias? 
There are several good books about phobias, and several organizations that can provide support, advice and information. Your nurse can provide you with a list of these resources.