Phobia

A phobia is an irrational fear, a kind of anxiety disorder in which the sufferer has a relentless dread of a situation, living creature, place or thing. People 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. Sufferers have an overpowering need to steer clear of anything which triggers their anxiety.

If the phobia is of something 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 public places) or social phobia (fear of being among groups of people).

Non-psychological phobias - photophobia means sensitivity to light. For example, if you have conjunctivitis or a migraine your eyes may be particularly sensitive to light. This does not mean the person is afraid of light. One of the symptoms of rabies is hydrophobia, which is the inability to drink water.

Discrimination or prejudice - some words which include the word "phobia" do not refer to fear, but rather to prejudice or discrimination. Homophobia is not an uncontrollable fear of homosexual people; it is a dislike, a discrimination against them. Some older people may dislike youths or teenagers (ephebiphobia). Xenophobia is a dislike of strangers, foreigners or the unknown.

There are three main categories of phobias:
• Specific phobias (simple phobias) - involve 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 (opidiophobia) - Birds (ornithophobia) - Frogs (ranidaphobia)

The two cateogories 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 - 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. The ultimate nightmare for a person with social phobia is probably to have to talk in public or act on a stage of front of an audience.

There is 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, which would be an unbearably embarrassing ordeal. The dread of being laughed at because of their clothes, voice or some feature of their body is so intense that they prefer to avoid social gatherings altogether.

Psychologists say that a high proportion of adults with social phobia started taking measures to avoid social situations during their teenage years. Studies have shown that their progressively isolated lifestyles make them more susceptible to developingdepression. 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 himself/herself 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, going into large shops or shopping malls. When symptoms are severe, the patient may find it unbearable to even step out of their own home.

How common are phobias?

In the industrial nations, phobias are the most common kind of anxiety disorder. Over 50 million people in the USA and 10 million in the UK are thought to live with a phobia. They can affect people of any age, sex, and socioeconomic status.

The National Institute of Mental Health estimated in 2011 that between 8.7% and 18.1% of Americans of all ages suffer from phobias.

A much 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.

What are the signs and symptoms of phobias?

A symptom is something the patient feels and describes, such as a headache, while a sign is something other people, as well as the patient can detect, as may be the case with a rash, swelling or bruising.

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 when the source of the fear is not there but is simply thought about

• 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 severely affect the patient's wellbeing 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.

What are the 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 between four and eight years of age. 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 which started during childhood. A kid whose mother suffers from arachnophobia is much more likely to develop the same phobia as well. 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 really sure. Health care professionals 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 to 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 of staying at home, especially for young children, aids survival.

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

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 - 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 and the body reacts is if there were a recurrence. 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.

How are phobias diagnosed?

People with a phobia nearly always know they have it, and 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 health care professional. This is unfortunate, because there are effective treatments available today.

Diagnosing agoraphobia - Anxiety UK, a British charity, has a Do-it-Yourself diagnosis, which consists of a list of questions. People who answer "Yes" to most of the questions below, most likely are affected and should see a doctor:

Do any of the situations below make you anxious?

• Leaving the house
• Standing in long queues (lines)
• Going on the subway (underground), a tunnel or any confined space
• Being on your own at home
• Being in wide, open spaces, such as a park or a field
• Being with many people, such as a crowd
• Do you deliberately avoid the situations mentioned above?
Diagnosing social phobia - the doctor will try to determine where there is:
• An intense fear of embarrassment or humiliation in at least one social situation. The fear is persistent. The fear is typically with people they are unfamiliar with, or when they are being scrutinized closely.

• Feared situations trigger severe anxiety; even panic attacks.

• The fear is acknowledged, but it makes no difference, the patient is unable to control it.

• The patient avoids social situations, as well as situations where he/she has to appear in front of people and perform (public speaking, being on a stage in front of an audience)

• Social phobia symptoms affect the patient's life severely. Their ability to work, take part in social activities, and function in relationships are badly affected.

• Other possible explanations for the phobia have been ruled out, such as an illness or condition, a psychological disorder, or the side-effect of a medication.

Additional criteria for children with social phobia:

• In social situations the child shrinks away, cries, has tantrums, or freezes still.

• The child is unable to acknowledge that their fear is irrational and unreasonable

• Their fear persists for over six months
For a doctor to be able to diagnose social phobia, it is important that the source of the fear is caused by anxiety, and not secondary symptoms of another disorder, such as delusional or obsessive disorders. The anxiety must be caused by being in the social situation and nothing else. A prominent feature of the patient's condition must be the avoidance of social situations.