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Let's
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PHOBIAS
"My
heart starts beating so fast . . . it feels like it’s
going to explode. My throat closes and I can’t
breathe. I start to choke. My hands start sweating.
I get so dizzy I have to hold onto the furniture or
the wall to keep from falling or fainting. I know I’m
going to die. I want to run, but I don’t know where."
This
reaction describes how people generally feel when they
are suffering from a phobia. 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.
Symptoms
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.
Categories
of Phobias
Phobias
are divided into categories according to the cause of
the reaction and avoidance.
Agoraphobia
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.
Treatment
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.
Other
Resources
Anxiety
Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852-2624
301-231-9350
www.adaa.org
Women
Helping Agoraphobics, Inc.
Constance Fitzpatrick, R.N., Director
P.O. Box 4900
S. Framingham, MA 01701
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
800-969-NMHA
www.nmha.org
NAMI
(National Alliance for the Mentally Ill)
Colonial Place Three
2107 Wilson Blvd. - Suite 300
(703) 524-7600
(703) 524-9094 (fax)
NAMI HelpLine: 1-800-950-NAMI (6264)
www.nami.org
National
Institute of Mental Health
5600 Fishers Lane, Room 7CO2
Mail Stop Code MSC 8030
Bethesda, MD 20892-8030
FACTS ON DEMAND: 301-443-5158
www.nimh.nih.gov
©
Copyright 1999 American Psychiatric Association
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