“I must not fear. Fear is the mind-killer,” reminds the protagonist from the movie Dune. However, fear is not necessarily a bad thing. It is a powerful emotion that has evolved in humans as a survival mechanism. But when fear becomes overwhelming, irrational, and persistent, it leads to a condition called ‘phobia’. This article explores the meaning, symptoms, causes, and most importantly, the treatments of phobias.
Understanding Phobias
A phobia is a severe and debilitating fear of a particular object, person, or situation. It is categorized as a type of anxiety disorder. If one has a phobia, they may experience a deep sense of dread or panic when they encounter the source of fear. The difference between a general anxiety disorder and a phobia is that the latter usually develops around something specific.
Unlike fear, phobias are more pronounced and can impact a person’s daily life negatively. They develop when a person has an exaggerated sense of danger about a situation or object. In extreme cases of phobia, a person may organize their life entirely around avoiding the thing that triggers their anxiety. The impact of a phobia can range from mildly annoying to severely disabling. It can interfere with work, school, and personal relationships. People with phobias are often aware of the fact that their fear in response to the object or situation is disproportionate, yet, they find themselves helpless and unable to overcome it.
Generally, it is understood that phobias develop when the fear produced during an initial threatening experience is transferred to other similar situations. The initial fear may be repressed and forgotten, but it leaves the association between the trigger and the anxiety behind. For example, an irrational fear of closed spaces may stem from an early childhood experience of getting stuck in a dark elevator.
Although specific phobias can emerge at any age, they usually begin in childhood or adolescence. The symptoms may last lifelong. As per the DSM-5, women suffer from the condition twice as often as men. Phobias are known to increase the risk of an adult developing other kinds of psychiatric illnesses, especially other anxiety disorders, depression and substance abuse.
Symptoms of Phobia
Symptoms of phobia are generally not experienced until the person comes in contact with the source of their anxiety. However in some cases, merely the thought of the trigger also results in anxiety and panic for the sufferer. This is termed ‘anticipatory anxiety‘. The commonly observed symptoms of phobia are:
- Excessive, intense, and constant feelings of fear, anxiety, and panic that get triggered by specific objects, activities, or circumstances. For example, fear of snakes.
- Irrationality of fear. The feelings of a person with a phobia are usually unreasonable compared to the actual threat that the source poses. For example, anybody might be scared of being in a strange place in the dark, but a phobia of darkness may look like a person being anxious about turning off the lights even while they sleep.
- Avoidance of the source of the phobia. People with phobias look to avoid their triggers because of anticipatory anxiety as well as feelings of embarrassment.
- Physical symptoms characteristic of anxiety disorders: People with phobias may experience tremors, palpitations, sweating, shortness of breath, dizziness, nausea and other such symptoms upon exposure to the source of their phobia.
Types of phobia
The list of objects or situations in which one can develop a phobia is expansive. Phobias may be very specific, such as a fear of clowns (coulrophobia). In such cases, patients can mostly lead an anxiety-free life as the chances of contact with their source of fear are extremely low and avoiding it is relatively easy. On the other hand, other phobias are more difficult to avoid. Examples include fear of crowds (en ochlophobia) or that of going to the dentist (dentophobia). Phobias are divided into two main categories:
In some extreme cases, the phobia may be such that it could dictate the person’s day-to-day life. Acrophobia, or the fear of heights, may be triggered very easily, such as while standing on the balcony of a high building, driving over a bridge, or sitting on a flight. It may prove to be a huge limitation in a person’s employment, location of work, driving route, recreational activities, or home environment.
1. Specific or Simple phobias
These phobias revolve around a particular object, animal, situation or activity. These phobias are very common and often develop during childhood or adolescence. They usually become more manageable as one gets older. These conditions are known to be at least partly genetic. According to the DSM-5, specific phobias are divided into five categories:
- Fear of Animals (such as spiders, wasps, or insects)
- Fear of the natural environment (such as flooding or thunderstorms)
- Fear of blood, injury, and injections (such as needles or surgical procedures)
- Situational fears (such as flying or using elevators)
- Other fears (such as vomiting or choking)
2. Complex phobias
Complex phobias are more disabling than simple phobias. They usually develop in adulthood and are often related to a deep-rooted fear of a specific circumstance. The two complex phobias are:
a. Agoraphobia
The term ‘agoraphobia’ means a fear of open spaces. But, it is more complex than just that. Simply described, agoraphobia is the fear of places or situations from which a person may find it difficult to escape. Agoraphobic people feel anxious being alone and in crowded places such as a movie theatre, public transport, a concert, or busy restaurants. Thus, they avoid such places and prefer to stay in their homes. Many people suffering from this condition also develop a panic disorder and are afraid they might have a panic attack in a situation they can’t escape from. Often, those with chronic health problems have agoraphobia, as they fear they may have a medical emergency in public spaces where there is no help available.
b. Social Anxiety Disorder
this disorder, formerly termed “social phobia”, is the fear of social situations, particularly when unfamiliar people are involved. A person with social phobia may feel anxious while speaking in public. This stems from a fear of humiliating themselves in front of other people or being judged by them. The phobia may be generalized so that a person avoids common social interactions such as eating in public or placing an order over call. Or, it may only surface during performance, wherein the fear is limited to speaking in front of an audience.
Read More about Social Anxiety Disorders
In more severe cases of the disorder, the anxiety can become so debilitating that a person avoids even everyday social interactions such as meeting friends or going to their workplace. It can result in self-isolation. People who have had negative social experiences in their childhood or were shy as children run a higher risk of developing this condition.
Causes
There is no single set of causes that lead to the development of phobias, but there are certain associated factors. Evidence suggests that phobias may be genetic – people with close relatives with anxiety disorders are more at risk of developing the same. It has been found that some people are born with a tendency to have more anxiety as compared to others. Another explanation of a phobia may be found in environmental factors.
Phobias can be learned emotional responses arising out of negative and traumatic experiences. Distressing incidents in one’s life, such as almost drowning, being stuck in a confined space, exposure to extreme heights, and animal or insect bites can become sources of phobia. A third factor is other ongoing medical conditions. People with other health concerns are often known to develop phobias, especially after traumatic brain injuries. Substance abuse and depression are also associated with phobias.
Treatments
Most phobias can be treated. Depending upon the type of phobia one is suffering from, the treatment usually involves a combination of psychotherapy and medication.
- Specific phobias: The most effective treatment is found to be Cognitive-behavioral therapy can help, especially a procedure called desensitization therapy. This therapy, also referred to as exposure therapy, focuses on identifying and changing fear responses, dysfunctional beliefs, and negative thoughts to the trigger of the phobia. The technique is to gradually increase a person’s exposure to what they are afraid of, at a pace they are comfortable with, under controlled circumstances. They learn to master their fear through anxiety-reduction strategies like relaxation and breathing control or other anxiety-reducing strategies.
- Social anxiety disorder: If a person’s social anxiety is performance-related, doctors may prescribe a medication called a beta-blocker such as propranolol. This medicine works by dampening the physical symptoms of anxiety such as a pounding heart or trembling fingers. It can be taken right before the performance. A more long-term solution for social phobia is antidepressants, which usually include SSRIs (selective serotonin reuptake inhibitors). If they are not as effective as desired, one may be prescribed anti-anxiety medication.
- Agoraphobia: Agoraphobia treatment is similar to the treatment for panic disorders. Drug treatment again includes SSRIs and a variety of other types of antidepressants. Psychotherapy, especially CBT, is also helpful.
Conclusion
Although phobias may seem extremely distressing, they are not insurmountable. The first step towards effectively overcoming phobias is to understand the psychology behind them and find out their root cause. Help from a qualified mental health professional and the wide array of treatment options available, coupled with a strong support system consisting of family and friends can enable a person to conquer their phobias with ease.
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