Phobias
A phobia is a type of anxiety disorder. It is a strong, irrational fear of something that poses little or no actual danger. There are many specific phobias. Acrophobia is a fear of heights. You may be able to ski the world's tallest mountains but be unable to go above the 5th floor of an office building. Agoraphobia is a fear of public places, and claustrophobia is a fear of closed-in places. If you become anxious and extremely self-conscious in everyday social situations, you could have a social phobia. Other common phobias involve tunnels, highway driving, water, flying, animals and blood.
People with phobias try to avoid what they are afraid of. If they cannot, they may experience
Panic and fear
Rapid heartbeat
Shortness of breath
Trembling
A strong desire to get away
Treatment helps most people with phobias. Options include medicines, therapy or both.
Signs and symptoms
Common phobias include:
Specific phobias. These include a fear of enclosed spaces (claustrophobia); animals, particularly spiders, snakes or mice; heights (acrophobia); flying (pterygophobia); water (hydrophobia); storms; dentists; injections; tunnels; bridges; and not being able to get off public transportation quickly enough. There are many other specific phobias.
Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others.
Fear of open spaces (agoraphobia). Most people who have agoraphobia developed it after having one or more panic attacks. Agoraphobia is a fear of being on your own in a place, such as a mall or an elevator or a room full of people, with no easy means of escape if a panic attack should occur.
Having a phobia may produce the following signs and symptoms:
A persistent, irrational fear of a specific object, activity or situation
An immediate response of uncontrollable anxiety when exposed to the object of fear
A compelling desire to avoid what you fear and taking unusual measures to stay away from what you fear
An impaired ability to function at normal tasks because of the fear
Often, the knowledge that these fears are out of proportion with the stimulus
When facing the object of your phobia, an experience of panicky feelings, such as sweating, rapid heartbeat, avoidance behavior, difficulty breathing and intense anxiety
In some cases, anxious feelings when merely anticipating an encounter with what you fear
Children may develop symptoms of specific phobia as young as age 5, especially phobias related to the natural environment — such as storms or animals — or to bodily injury. Social phobia and situational phobias, such as fear of heights or of closed-in spaces, typically appear by the mid-20s.
Causes
Much is still unknown about phobia causes. However, there may be a strong correlation between your phobias and the phobias of your parents. Children may learn phobias by observing a family member's phobic reaction to an object or a situation. An example of a common learned phobia may be the fear of snakes.
Brain chemicals, genetics and traumatic experiences also appear to influence the development of phobias.
Screening and diagnosis
Your doctor will likely ask you to describe your symptoms, how often they occur and what triggers them.
Sometimes physical disorders occur along with anxiety disorders. You'll probably undergo a complete physical exam so that your doctor can determine whether health conditions other than phobias could be causing your symptoms of anxiety.
Phobias sometimes occur along with other anxiety disorders and may be accompanied by depression, abuse of alcohol or other substances, or eating disorders. Your doctor may try to identify other mental disorders that may exist before suggesting a course of treatment.
Treatment
Medications
Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They block some of the peripheral signs of adrenaline's stimulation and anxiety, including increased heart rate, elevated blood pressure, pounding of the heart, and shaking voice and limbs. These can be very effective for people who have stage fright, but must give a presentation before other people. However, not all beta blockers are effective for this purpose, and they're only available by prescription, so check with your doctor.
Antidepressants. Antidepressants also can reduce anxiety. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). These medications act on the chemical serotonin, a neurotransmitter in your brain that's believed to influence mood. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil) and sertraline (Zoloft). If SSRIs aren't effective or cause intolerable side effects, your doctor may prescribe a monoamine oxidase inhibitor (MAOI), which blocks the chemical monoamine oxidase in the nervous system. MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate).
Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety that you feel. They include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax) and chlordiazepoxide (Librium). Sedatives need to be used with caution because they can be addictive. It's generally safe to use low doses of sedatives infrequently or only for short periods. However, sedatives should be avoided if you have a previous history of abusing alcohol or other drugs.
Behavior therapy
Desensitization or exposure therapy focuses on changing your response to the feared object or situation. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your fear. For example, if you're afraid of flying, your therapy may progress from having you think about flying to looking at pictures of airplanes, to going to an airport, to sitting in an airplane, and to finally taking a flight. Some major airlines offer programs to help you adjust to flying. For example, a group of people with the same fear may all sit in an airplane together, but the airplane won't take off.
Cognitive behavior therapy is a more comprehensive form of therapy. It involves you and your therapist learning ways you can view and cope with the feared object or situation differently. You learn alternative beliefs about the feared object or situation and the impact it has on your life. There's special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.
Treatment choices
Specific phobias usually are treated with behavior therapy. Social phobias may be treated with antidepressants or beta blockers, along with behavior therapy. Agoraphobia, especially when it's accompanied by a panic disorder, is usually treated with SSRIs and behavior therapy.
Coping skills
Many childhood fears are common, such as fear of the dark, monsters or being left alone. Most of the time, your child will outgrow these fears. However, if your child has a persistent, excessive fear of an object or situation, he or she may have a phobia.
Although some phobias are outgrown, they may become worse if they're not addressed. Talk to your child's doctor if your child appears to have a phobia that's limiting his or her ability to function in daily life.
To help your child cope with fears:
Talk to your child about his or her fears. Don't trivialize the problem or belittle your child for having fears. Instead, let your child know that you're there to listen, and to help.
Don't reinforce phobias. Instead, take advantage of opportunities to help your child overcome his or her fears. If your child is afraid of the neighbor's friendly dog, for example, don't go out of your way to avoid the animal. Instead, help your child cope when confronted with the dog. For example, you may offer to be your child's home base, waiting and offering support while your child steps a little closer to the dog and then returns to you for safety. Over time, encourage your child to keep closing the distance.
Pursue positive approaches. Help your child learn to breathe deeply and repeat positive statements such as "I can do this" when facing a fear. Your child also may benefit from rating his or her fear on a scale of 1 to 10. Recognizing that the fear rates only a 5 on the scale, for example, may help your child see the feeling as being less overwhelming.
A phobia is a type of anxiety disorder. It is a strong, irrational fear of something that poses little or no actual danger. There are many specific phobias. Acrophobia is a fear of heights. You may be able to ski the world's tallest mountains but be unable to go above the 5th floor of an office building. Agoraphobia is a fear of public places, and claustrophobia is a fear of closed-in places. If you become anxious and extremely self-conscious in everyday social situations, you could have a social phobia. Other common phobias involve tunnels, highway driving, water, flying, animals and blood.
People with phobias try to avoid what they are afraid of. If they cannot, they may experience
Panic and fear
Rapid heartbeat
Shortness of breath
Trembling
A strong desire to get away
Treatment helps most people with phobias. Options include medicines, therapy or both.
Signs and symptoms
Common phobias include:
Specific phobias. These include a fear of enclosed spaces (claustrophobia); animals, particularly spiders, snakes or mice; heights (acrophobia); flying (pterygophobia); water (hydrophobia); storms; dentists; injections; tunnels; bridges; and not being able to get off public transportation quickly enough. There are many other specific phobias.
Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others.
Fear of open spaces (agoraphobia). Most people who have agoraphobia developed it after having one or more panic attacks. Agoraphobia is a fear of being on your own in a place, such as a mall or an elevator or a room full of people, with no easy means of escape if a panic attack should occur.
Having a phobia may produce the following signs and symptoms:
A persistent, irrational fear of a specific object, activity or situation
An immediate response of uncontrollable anxiety when exposed to the object of fear
A compelling desire to avoid what you fear and taking unusual measures to stay away from what you fear
An impaired ability to function at normal tasks because of the fear
Often, the knowledge that these fears are out of proportion with the stimulus
When facing the object of your phobia, an experience of panicky feelings, such as sweating, rapid heartbeat, avoidance behavior, difficulty breathing and intense anxiety
In some cases, anxious feelings when merely anticipating an encounter with what you fear
Children may develop symptoms of specific phobia as young as age 5, especially phobias related to the natural environment — such as storms or animals — or to bodily injury. Social phobia and situational phobias, such as fear of heights or of closed-in spaces, typically appear by the mid-20s.
Causes
Much is still unknown about phobia causes. However, there may be a strong correlation between your phobias and the phobias of your parents. Children may learn phobias by observing a family member's phobic reaction to an object or a situation. An example of a common learned phobia may be the fear of snakes.
Brain chemicals, genetics and traumatic experiences also appear to influence the development of phobias.
Screening and diagnosis
Your doctor will likely ask you to describe your symptoms, how often they occur and what triggers them.
Sometimes physical disorders occur along with anxiety disorders. You'll probably undergo a complete physical exam so that your doctor can determine whether health conditions other than phobias could be causing your symptoms of anxiety.
Phobias sometimes occur along with other anxiety disorders and may be accompanied by depression, abuse of alcohol or other substances, or eating disorders. Your doctor may try to identify other mental disorders that may exist before suggesting a course of treatment.
Treatment
Medications
Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They block some of the peripheral signs of adrenaline's stimulation and anxiety, including increased heart rate, elevated blood pressure, pounding of the heart, and shaking voice and limbs. These can be very effective for people who have stage fright, but must give a presentation before other people. However, not all beta blockers are effective for this purpose, and they're only available by prescription, so check with your doctor.
Antidepressants. Antidepressants also can reduce anxiety. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). These medications act on the chemical serotonin, a neurotransmitter in your brain that's believed to influence mood. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil) and sertraline (Zoloft). If SSRIs aren't effective or cause intolerable side effects, your doctor may prescribe a monoamine oxidase inhibitor (MAOI), which blocks the chemical monoamine oxidase in the nervous system. MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate).
Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety that you feel. They include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax) and chlordiazepoxide (Librium). Sedatives need to be used with caution because they can be addictive. It's generally safe to use low doses of sedatives infrequently or only for short periods. However, sedatives should be avoided if you have a previous history of abusing alcohol or other drugs.
Behavior therapy
Desensitization or exposure therapy focuses on changing your response to the feared object or situation. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your fear. For example, if you're afraid of flying, your therapy may progress from having you think about flying to looking at pictures of airplanes, to going to an airport, to sitting in an airplane, and to finally taking a flight. Some major airlines offer programs to help you adjust to flying. For example, a group of people with the same fear may all sit in an airplane together, but the airplane won't take off.
Cognitive behavior therapy is a more comprehensive form of therapy. It involves you and your therapist learning ways you can view and cope with the feared object or situation differently. You learn alternative beliefs about the feared object or situation and the impact it has on your life. There's special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.
Treatment choices
Specific phobias usually are treated with behavior therapy. Social phobias may be treated with antidepressants or beta blockers, along with behavior therapy. Agoraphobia, especially when it's accompanied by a panic disorder, is usually treated with SSRIs and behavior therapy.
Coping skills
Many childhood fears are common, such as fear of the dark, monsters or being left alone. Most of the time, your child will outgrow these fears. However, if your child has a persistent, excessive fear of an object or situation, he or she may have a phobia.
Although some phobias are outgrown, they may become worse if they're not addressed. Talk to your child's doctor if your child appears to have a phobia that's limiting his or her ability to function in daily life.
To help your child cope with fears:
Talk to your child about his or her fears. Don't trivialize the problem or belittle your child for having fears. Instead, let your child know that you're there to listen, and to help.
Don't reinforce phobias. Instead, take advantage of opportunities to help your child overcome his or her fears. If your child is afraid of the neighbor's friendly dog, for example, don't go out of your way to avoid the animal. Instead, help your child cope when confronted with the dog. For example, you may offer to be your child's home base, waiting and offering support while your child steps a little closer to the dog and then returns to you for safety. Over time, encourage your child to keep closing the distance.
Pursue positive approaches. Help your child learn to breathe deeply and repeat positive statements such as "I can do this" when facing a fear. Your child also may benefit from rating his or her fear on a scale of 1 to 10. Recognizing that the fear rates only a 5 on the scale, for example, may help your child see the feeling as being less overwhelming.
Ronny T Wirasto
Dept of Psychiatry
Gadjah Mada University
