Phobias: Causes, Symptoms, and Diagnosis

A phobia is an irrational fear, a kind of anxiety disorder in which the individual has a relentless dread of a situation, living creature, place, or thing.

Individuals with a phobia go to great lengths to avoid a perceived danger which is much greater in their minds than in real life.

If confronted with the source of their phobia, the person will suffer enormous distress, which can interfere with their normal function; it can sometimes lead to total panic.

For some people, even thinking about their phobia is immensely distressing.

A phobia starts when a person begins organizing their lives around avoiding the object of their fear. A phobia is much more serious than a simple fear. People with a phobia have an overpowering need to steer clear of anything which triggers their anxiety.

What is a phobia?

The word "phobia" is used for a number of quite different concepts.

If the phobia is of something that the phobic person very rarely comes into contact with, such as snakes, their daily lives will not be affected.

However, some complex phobias are impossible to avoid, such as agoraphobia (fear of leaving home or being in public places) or social phobia (fear of being among groups of people).

There are three main categories of phobias:
Specific phobias (simple phobias)

A disproportionate fear about specific situations, living creatures, places, activities, or things. Examples include a fear of:

    Dentists (dentophobia)
    Bats (chiroptophobia)
    Dogs (cynophobia)
    Flying (aviophobia)
    Snakes (ophidiophobia)
    Birds (ornithophobia)
    Frogs (ranidaphobia)

The two examples below, social phobia and agoraphobia, are known as complex phobias. They are linked to a deep-rooted fear or anxiety about certain situations, incidents, or circumstances, which make them much more disabling than simple phobias.

Social phobia

Social phobias are now called social anxiety disorder. A person with social phobia finds being in social situations difficult and sometimes unbearable. Going to parties, weddings, functions, or exhibitions cause sufferers anxiety; there is fear of being embarrassed or humiliated in public.

It often includes a fear of being judged by other people. People affected with social phobia feel that they will be scrutinized and singled out in the crowd; they prefer to avoid social gatherings altogether.

Psychologists say that a high proportion of adults with social phobia start taking measures to avoid social situations during their teenage years. Studies have shown that their progressively isolated lifestyles make them more susceptible to developing depression. Experts emphasize that social phobia is not the same as shyness.

Obese people may develop social anxiety disorder, simply because of their weight.
Agoraphobia

An individual with agoraphobia is frightened of finding themselves in situations where there is no escape; they fear being stuck in a desperate situation with no help. Agoraphobia may include a dread of traveling on buses or trains or going into large shops or shopping malls. When symptoms are severe, the patient may find stepping out of their own home unbearable.

Sufferers have an increased risk of also suffering from panic disorder. As with social phobia, crowded and public places are avoided.
How common are phobias?

In industrial nations, phobias are the most common kind of anxiety disorder. They can affect people of any age, sex, and socioeconomic status.

An estimated 19 million Americans have a specific phobia, 15 million have a social anxiety disorder, and 1.8 million have agoraphobia.

A higher percentage of women suffer from phobias than men.

Simple phobias usually start early on in life - during childhood, and often go away by the time the person reaches late teens. Complex phobias generally start later on.

Most common phobias
Arachnophobia (fear of spiders) is among the top ten phobias worldwide.

The ten most common phobias are:

    Social phobia - fear of being in places with a lot of people
    Agoraphobia - fear of being somewhere with no support, away from home, open spaces
    Claustrophobia - fear of being in constricted, confined spaces
    Aerophobia - fear of flying
    Arachnophobia - fear of spiders
    Driving phobia - fear of driving a car
    Emetophobia - fear of vomiting
    Erythrophobia - fear of blushing
    Hypochondria - fear of becoming ill
    Zoophobia - fear of animals

Symptoms of phobias

The following symptoms are common across the majority of phobias:

    When exposed to the source of the fear, there is a sensation of uncontrollable anxiety
    A feeling that at all costs, the source of that fear must be avoided
    The anxiety is so overwhelming when confronted with the source of the fear, that the person is unable to function properly
    It is common for sufferers to acknowledge that their fears are irrational, unreasonable, and exaggerated; however, in spite of this, they are unable to control their feelings
        Panic and intense anxiety, which may include:
        Sweating
        Abnormal breathing (panting, trying to catch your breath)
        Accelerated heartbeat
        Trembling
        Hot flushes or chills
        A sensation of choking
        Chest pains, chest tightness
        Butterflies in the stomach
        Pins and needles
        Dry mouth
        Confusion and disorientation
        Nausea
        Dizziness
        Headache
    A feeling of anxiety is produced by simply thinking about the object of the phobia
    Children may cry, become very clingy, attempt to hide behind a parent's legs or an object, or have tantrums

Complex phobias

Complex phobias are much more likely to affect the patient's well-being than specific phobias.

Those who suffer from, for example, agoraphobia, may have a number of other associated phobias as well, such as monophobia (fear of being left alone) or claustrophobia (fear of feeling trapped, closed spaces). In severe cases, agoraphobics will rarely leave their homes.

Causes of phobias

It is unusual for a phobia to start after the age of 30; most of them begin during early childhood, teenage years, or early adulthood. They can be caused by a stressful situation or experience, a frightening event, or a parent or household member who has a phobia which the child becomes progressively aware of.
Common causes for specific (simple) phobias

These usually develop when the child is aged 4-8. In some cases, it may be the result of something that happened early in life. The trigger might have been an unpleasant experience in a confined space, which festered and developed into claustrophobia over time.

As mentioned above, witnessing a family member's phobia is a common cause for phobias that started during childhood. A child whose mother has arachnophobia is much more likely to develop the same phobia.

Experts stress that phobias picked up from parents are learned fears - they are not genetically inherited.
Common causes for complex phobias

The causes of agoraphobia or social phobia are still a mystery; nobody is sure exactly why they appear. Researchers believe they are caused by a combination of life experiences, brain chemistry, and genetics.

Social phobias are more likely to be caused by an extremely stressful experience than agoraphobia, researchers say.

Phobias and survival - there may be evolutionary explanations for many phobias. In prehistoric environments, remaining in wide open spaces would have increased the risk of being attacked and eaten by a predatory animal. The instinct to stay at home, especially for young children, aids survival.

Young children in their caves and huts would have had to learn to avoid dangerous snakes and spiders quickly.

Social phobia may have been a useful survival instinct during ancient and prehistoric times. Being among people you do not know, from perhaps another tribe, was much more dangerous than finding yourself among a crowd of strangers in a shopping mall today.

Neurobiology of phobias

Specific areas of the brain - the amygdala in particular - are associated with phobias. Some areas of the brain - the prefrontal cortex, medial prefrontal cortex, ventromedial prefrontal cortex, and the amygdala - store and recall dangerous or potentially deadly events.

In future occasions, if a very similar event is confronted, those areas retrieve that same memory, causing the body to react as if it was happening again.

With some people, the event may feel as if it is repeating itself many times.

Some effective treatments manage to get the brain to replace the memory and reactions with something more rational. Phobias are irrational phenomena - the brain overreacts to a stimulus.

Unfortunately, the brain areas that deal with fear and stress keep retrieving the frightening event inappropriately.

Neuroscience researchers have found that phobias are often linked to the amygdala, which lies behind the pituitary gland. The amygdala can trigger the release of "fight-or-flight" hormones, which put the body and mind in a highly alert and stressed state.

Tests and diagnosis of phobias

A therapist is seeing a patient.
When diagnosing a phobia, a doctor will aim to determine whether or not an object triggers unreasonable fear.

People with a phobia are nearly always aware that it is present, and they are not defensive when discussing their symptoms with a doctor. This helps diagnosis enormously.

Even so, millions of sufferers never discuss their fears with a doctor. This is unfortunate because there are effective treatments available.
Treating phobias

If the phobia does not cause severe problems, most patients find that by simply avoiding the source of their fear is enough to stay in control.

Some phobias are not possible to avoid, as may be the case with aviophobia (fear of flying). In such cases, professional help should be sought.

The good news is that with proper treatment, most phobias can be cured. Treatment needs to be tailored to the patient for it to work - no single treatment works for everybody.

The doctor, psychiatrist, and/or psychologist may recommend behavior therapy, medications, or a combination of both. Therapy is aimed at reducing the symptoms of fear and anxiety, and to help patients manage their reactions to the source of their fear.

Medications

The following medications have been shown to be effective for the treatment of phobias:

Beta blockers can help reduce some symptoms of phobias.

        Beta blockers - can help reduce the symptoms of palpitations, as well as trembling limbs. Many patients comment that they also help their voice quiver less.

Side effects may include stomach upsets, fatigue, problems sleeping, and cold fingers.

      Antidepressants - SSRI's (serotonin reuptake inhibitors) are commonly prescribed for people with phobias. They affect serotonin levels in the brain, which results in better moods.

SSRIs may initially cause nausea, sleeping problems, and headaches.

A tricyclic antidepressant (TCA), such as clomipramine (Anafranil) has also been found to help phobia symptoms. Initial side effects can include sleepiness, blurred vision, constipation, urination difficulties, irregular heartbeat, dry mouth, and tremors.

If the SSRI does not work, the doctor may prescribe a monoamine oxidase inhibitor (MAOI) for social phobia, an example is moclobemide (Manerix). Patients on an MAOI may have to avoid certain types of food. Side effects initially might include dizziness, stomach upsets, restlessness, headaches, and problems sleeping.

       Tranquilizers (sedatives) - benzodiazepines may help reduce anxiety symptoms. Patients with a history of alcoholism should not be given sedatives.

     Behavior therapy Desensitization (exposure therapy) - if done properly, this can help patients alter their response to the source of their fear. Patients are exposed to the cause of their phobia in gradual progressive steps. Somebody who is afraid of flying on a plane may start off just by thinking about flying, then looking at planes, going to an airport, perhaps sitting in a practice simulated airplane cabin, and then finally getting on a plane.

      Cognitive behavioral therapy - the therapist helps the sufferer learn different ways of perceiving the source of their phobia, so that they may find it easier to cope. Alternative views about the fear(s) are taught. The patient is taught about the impact a wrong approach may have on quality of life, and how a new one may change things. Most importantly, those with phobias learn to become masters of their own feelings and thoughts.

Credit:
Christian Nordqvist