A phobia is a type of anxiety disorder, defined by a persistent and excessive fear of an object or situation. The phobia typically results in a rapid onset of fear and is present for more than six months.
The affected person will go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. if the feared object or situation cannot be avoided, the affected person will have significant distress. With blood or injury phobia, fainting may occur.
Types of specific phobias include those to certain animals, natural environment situations, blood or injury, and specific situations. The most common are fear of spiders, fear of snakes, and fear of heights.
It is recommended that specific phobias be treated with exposure therapy where the person is introduced to the situation or object in question until the fear resolves. Medications are not useful in this type of phobia.
Social phobia and agoraphobia are often treated with some combination of counseling and medication.
Specific phobias affect about 6–8% of people in the Western world and 2–4% of people in Asia, Africa, and Latin America in a given year. Social phobia affects about 7% of people in the United States and 0.5–2.5% of people in the rest of the world. Agoraphobia affects about 1.7% of people. Women are affected about twice as often as men. Typically onset is around the age of 10 to 17. Rates become lower as people get older. People with phobias are at a higher risk of suicide.
Most phobias are classified into three categories and, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), and such phobias are considered to be sub-types of anxiety disorder. The categories are:
- Specific phobias: Fear of particular objects or social situations that immediately results in anxiety and can sometimes lead to panic attacks. A specific phobia may be further subdivided into five categories: animal type, natural environment type, situational type, blood-injection-injury type, and other.
- Agoraphobia: a generalized fear of leaving home or a small familiar ‘safe’ area, and of possible panic attacks that might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment (social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder) or PTSD (post-traumatic stress disorder) related to a trauma that occurred out of doors.
- Social phobia, also known as social anxiety disorder, is when the situation is feared as the person is worried about others judging them.
Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer relatively mild anxiety over that fear. Others suffer full-fledged panic attacks with all the associated disabling symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override their panic reaction. These individuals often report dizziness, loss of bladder or bowel control, tachypnea, feelings of pain, and shortness of breath.
A specific phobia is a marked and persistent fear of an object or situation which brings about an excessive or unreasonable fear when in the presence of, or anticipating, a specific object; the specific phobias may also include concerns with losing control, panicking, and fainting which is the direct result of an encounter with the phobia. Specific phobias are defined in relation to objects or situations whereas social phobias emphasize social fear and the evaluations that might accompany them.
The DSM breaks specific phobias into five subtypes: animal, natural environment, blood-injection-injury, situation and other.
In children, blood-injection-injury phobia and phobias involving animals, natural environment (darkness) usually develop between the ages of 7 and 9, and these are reflective of normal development. Additionally, specific phobias are most prevalent in children between ages 10 and 13
Unlike specific phobias, social phobias include fear of public situations and scrutiny, which leads to embarrassment or humiliation in the diagnostic criteria.
Informational/instructional fear acquisition is learning to fear something by getting information. For instance, fearing electrical wire after having heard that touching it will result in an electric shock.
A conditioned fear response to an object or situation is not always a phobia. To meet the criteria for a phobia there must also be symptoms of impairment and avoidance. Impairment is defined as being unable to complete routine tasks whether occupational, academic or social. In acrophobia an impairment of occupation could result from not taking a job solely because of its location at the top floor of a building, or socially not participating in a social event at a theme park. The avoidance aspect is defined as behavior that results in the omission of an aversive event that would otherwise occur, with the goal of preventing anxiety.
It is recommended that the terms distress and impairment take into account the context of the person’s environment during diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it is an object or a social situation is absent entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a fear of mice but lives in an area devoid of mice. Even though the concept of mice causes marked distress and impairment within the individual, because the individual does not usually encounter mice, no actual distress or impairment is ever experienced. It is recommended that proximity to, and ability to escape from, the stimulus also be considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an elevator (e.g. anxiety increases at the midway point between floors and decreases when the floor is reached and the doors open).
Cognitive behavioral therapy (CBT) can be beneficial by allowing the patient to challenge dysfunctional thoughts or beliefs by being mindful of their own feelings, with the aim that the patient will realize that his or her fear is irrational. CBT may be conducted in a group setting. Gradual desensitization treatment and CBT are often successful, provided the patient is willing to endure some discomfort.
Eye movement desensitization and reprocessing (EMDR) has been demonstrated in peer-reviewed clinical trials to be effective in treating some phobias. Mainly used to treat post-traumatic stress disorder, EMDR has been demonstrated as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite.
A method used in the treatment of a phobia is systematic desensitization, a process in which the patients seeking help slowly become accustomed to their phobia, and ultimately overcome it. Traditional systematic desensitization involves a person being exposed to the object they are afraid of over time so that the fear and discomfort do not become overwhelming. This controlled exposure to the anxiety-provoking stimulus is key to the effectiveness of exposure therapy in the treatment of specific phobias. It has been shown that humor is an excellent alternative when traditional systematic desensitization is ineffective. Humor systematic desensitization involves a series of treatment activities that consist of activities that elicit humor with the feared object. Previously learned progressive muscle relaxation procedures can be used as the activities become more difficult in a person’s own hierarchy level. Progressive muscle relaxation helps patients relax their muscles before and during exposure to the feared object or phenomenon.
Medications can help regulate the apprehension and fear that come from thinking about or being exposed to a particular fearful object or situation. Antidepressant medications such as SSRIs or MAOIs may be helpful in some cases of phobia. SSRIs (antidepressants) act on serotonin, a neurotransmitter in the brain. Since serotonin impacts mood, patients may be prescribed an antidepressant.
Source: – American Psychiatry Association
Osho Clinic (Psychiatry & Psychology)