Phobia

A phobia is an intense fear of an object or situation that is far out of proportion to the actual danger presented by the object or situation. The disproportionality is a distinguishing feature of phobia, and why phobias are considered irrational. Adults with specific phobias realize that these fears are irrational. When phobias interfere with daily living, they can be classified as a mental illness; however, many people recognize phobias in themselves as being of only minor significance.

Other Names

Phobias are sometimes given more specific names by attaching a prefix (usually derived from a Greek word) to the -phobia suffix, or are referred to as simply fear of an object or situation.

Types

Given the scope of human experiences and personal histories, there are hundreds of phobias related to situations and objects that may be encountered. Some phobias are far more prevalent than others—the fear of snakes (ophidiophobia) is almost universal and may have a strong basis in evolution^[1], whereas other "phobias" are vanishingly rare or entirely speculative.

Common phobias include arachnophobia (fear of spiders), acrophobia (fear of heights), claustrophobia (fear of closed-in places) and xenophobia (fear of strangers).^[2] Social phobia is another type of phobia that is classified differently.

Prejudice as phobia

Many words incorporating the term “phobia” are used to describe negative attitudes towards groups of people or ideals. These words include “homophobia” (for homosexuals) or “chemophobia” (favoring natural compounds over artificial or manmade ones). These terms do not reflect true phobias, but rather represent prejudice. These “fears” are the result of ignorance or social and political issues and are distinct from clinical phobias.

Symptoms

In adults, phobias are intense, irrational fears. They often find that facing, or even thinking about facing, the feared object or situation generates severe anxiety. These fears can also lead to panic attacks. If the feared situation or object is easy to avoid, people with specific phobias may not seek help. However, when avoidance interferes with careers or personal life, it can become disabling and treatment is usually pursued.

Causes

The basis for some types of phobias may be genetic, since an instinctive fear of things or situations that are inherently dangerous offers a clear survival advantage. Examples include a phobias related to dangerous animals such as snakes and spiders, and phobias related to the sight of blood or to receiving an injection. Additional evidence suggests that a tendency to develop phobias may also be inherited.^[3]

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is used as the standard of classification of mental disorders in the United States.^[4]

The diagnostic criteria for specific phobia are the following:

• Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
• The person recognizes that the fear is excessive or unreasonable. Some children, however, may not recognize this.
• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
• The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
• In individuals under age 18 years, the duration is at least six months.
• The anxiety, panic attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as obsessive-compulsive disorder (for example, fear of dirt in someone with an obsession about contamination), or separation anxiety disorder (for example, avoidance of school).

Treatment

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. Any coexisting conditions, such as depression or substance abuse, must also be diagnosed. Often the effects of alcoholism, depression, or other coexisting conditions are so strong that they must be treated before the anxiety disorder can be addressed.

Not everyone responds to the same medication or the same dosage. Medications often require several weeks to produce adequate effects. Taking a medication for too short a time or at too low a dosage may lead a person to feel as if they have "failed" treatment. In fact, it is common to try several different treatments or combinations of treatments before an effective regimen is found.

Holistic and alternative treatments

A 2001 study in the American Journal of Psychiatry reported that approximately half of anxiety sufferers used complementary and alternative therapies.^[5]

Stress management

Stress management techniques and meditation can be very calming and may enhance the effects of therapy. There is some evidence that aerobic exercise may also have a calming effect. Caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders. Although alcohol initially has a calming effect, it can actually worsen anxiety over time.

Support

Family support can be very important in the recovery of a person with an anxiety disorder. Support is more effective if it does not perpetuate anxiety symptoms. The disorder is not trivial and may not respond immediately to support efforts.

Many people with anxiety disorders benefit from joining a self-help or support group, which helps them share their problems and achievements with others. Internet chat rooms can also be useful. However, any advice received over the Internet should be used with caution. Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support.

Psychotherapy

Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms. Specific phobias respond very well to carefully targeted psychotherapy.

Cognitive-behavioral therapy

Cognitive behavioral therapy(CBT) is very useful in treating anxiety disorders. Cognitive refers to understanding the thinking patterns that underlie anxious fears. Addressing the behavioral part helps people change the way they react to anxiety-provoking situations. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.

Exposure-based behavioral therapy has been used for many years to treat specific phobias. In this approach, the feared object or situation is gradually re-introduced, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist accompanies the person to a feared situation to provide support and guidance.

CBT works best with a person's full commitment and cooperation. As such, a person must be fully ready to undertake the therapy. To be effective, the therapy must be directed at the person’s specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.

CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Once treated, a disorder may go into remission. However, if it recurs, the same therapy is often equally successful a second time.

Living with Phobia

Anxiety disorders have significant effects on the lives of those suffering from them.

Clinical Trials

Lists of clinical trials are available at the following sites:

• NIMH Clinical Trials
• ClinicalTrials.gov
• Anxiety Disorders Association of America

Research

The National Institutes of Mental Health (NIMH) supports research into the causes, diagnosis, prevention, and treatment of anxiety disorders. Scientists are looking at what role genes play in the development of these disorders. They are also investigating the effects of environmental factors such as pollution, physical and psychological stress, and diet. In addition, studies are being conducted on the “natural history” (what course the illness takes without treatment) of many anxiety disorders, combinations of anxiety disorders, and anxiety disorders accompanied by other mental illnesses such as depression.

Several parts of the brain are key actors in the production of fear and anxiety. Using brain imaging technology and neurochemical techniques, scientists have discovered that the amygdala and the hippocampus play significant roles in most anxiety disorders.

The amygdala is an almond-shaped structure deep in the brain. The amygdala is believed to be a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret these signals. The amygdala can alert the rest of the brain that a threat is present and trigger an anxiety response. It appears that emotional memories are stored in the central part of the amygdala and may play a role in anxiety disorders involving distinct fears, such as those of dogs, spiders, or flying.

By learning more about how the brain creates fear and anxiety, scientists may be able to devise better treatments for anxiety disorders. For example, if specific neurotransmitters are found to play an important role in fear, drugs may be developed that will block them and decrease fear responses.

Epidemiology

Specific phobias affect an estimated 19.2 million adult Americans and are twice as common in women as men. They usually appear in childhood or adolescence and tend to persist into adulthood. The causes of phobias are not well understood, but there is some evidence that the tendency to develop them may run in families.^[6]

Prevalence

According to a study in the Archives of General Psychiatry, the prevalence of specific phobias in the population in a given year is 8.7%. Approximately 40 million Americans suffer from an anxiety disorder.^[7]

Other Resources

If an anxiety disorder is suspected, the first person seen is often a family doctor. A physician can determine whether the troublesome symptoms are due to an anxiety disorder, another medical condition, or both.

If an anxiety disorder is diagnosed, the next step usually is to see a mental health professional. Practitioners trained in cognitive-behavioral therapy and medication therapy may be helpful in anxiety disorders.

Most insurance plans, including health maintenance organizations (HMOs), cover treatment for anxiety disorders. The Health and Human Services division of county governments may offer mental health care at a public mental health center for those who are uninsured. In such a case, people are often charged according to how much they are able to pay. Those on public assistance may be able to get care through state Medicaid plan.

References

1. ↑ Ohman A. The role of the amygdala in human fear: automatic detection of threat. Psychoneuroendocrinology. 2005 Nov;30(10):953-8. Abstract
2. ↑ Pull CB. Recent trends in the study of specific phobias. Curr Opin Psychiatry. 2008 Jan;21(1):43-50. Abstract
3. ↑ Villafuerte S, Burmeister M. Untangling genetic networks of panic, phobia, fear and anxiety. Genome Biol. 2003;4(8):224. Abstract |Full Text | PDF
4. ↑ American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 449-450. Link
5. ↑ Kessler RC, Soukup, J, Davis R, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry. 2001 Feb;158(2):289-94. Abstract | Full Text
6. ↑ Kendler KS, Walters EE, Truett KR, et al. A twin-family study of self-report symptoms of panic-phobia and somatization. Behav Genet. 1995 Nov;25(6):499-515. Abstract
7. ↑ Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)]. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. Abstract | Full Text | PDF

External Links

National Institute of Mental Health

Anxiety Disorders Association of America

United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration: National Mental Health Information Center

American Psychiatric Association: Let's Talk Facts About Anxiety Disorders (PDF)