Difference between revisions of "Phobia" - New World Encyclopedia

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[[File:Little Miss Muffet 2 - WW Denslow - Project Gutenberg etext 18546.jpg|thumb|300px|Fear of [[spider]]s is one of the most common phobias]]
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The term '''phobia,''' from the [[Greek language |Greek]] ''φόβος'' meaning "fear," is a strong, persistent, and irrational fear or [[anxiety]] of certain situations, objects, activities, or persons. A phobia disorder is defined by an excessive, unreasonable desire to avoid the feared subject. Phobias are generally believed to emerge following highly traumatic experiences. Many individuals suffering from certain phobias are believed to transfer the fear of an original situation to other situations experienced in or reoccurring throughout everyday life, while the original fear is often left forgotten. Such an example can be seen in near-[[drowning]] incidents; an individual may often develop an irrational fear of [[water]], despite minimizing the original fear of drowning.
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[[Behavior therapy]], or the gradual exposure of an individual to certain objects of their most irrational fears, is generally accepted as the best method for overcoming certain phobias. However, the origin and continued recurrence, generation after generation, has yet to be solved.
  
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==Overview==
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'''Phobias,''' or phobic disorders, are defined as an intense, irrational fear that often leads to the extreme avoidance of the object or situation feared. The word "phobia" comes from the Greek: φόβος (phóbos), meaning "aversion," "fear." or "morbid fear."
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{{readout||right|250px|The term "phobia" comes from the Greek word meaning fear.}}
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Phobias are common and believed to originate in childhood or [[adolescence|adolescent]] experiences, although some common phobias have been suggested as being inborn, such as fear of heights or [[snake]]s.
  
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The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' ([[DSM-V]]),
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classifies phobias into three major categories: [[specific phobias]], [[social phobias]], and [[agoraphobia]].
  
A '''phobia''' (from the [[Greek language |Greek]] ''φόβος'' "fear"), is a strong, persistent fear of situations, objects, activities, or persons. The main symptom of this disorder is the excessive, unreasonable desire to avoid the feared subject. When the fear is beyond one's control, or if the fear is interfering with daily life, then a diagnosis under one of the [[anxiety disorders]] can be made. <ref>Edmund J. Bourne, ''The Anxiety &amp; Phobia Workbook, 4th ed'', New Harbinger Publications, 2005, ISBN 1-57224-413-5</ref>
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===Specific phobias===
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[[Specific phobias]] are defined as a fear of a particular situation or object, and are the most common types of phobic disorders experienced. Specific phobias are believed to be [[hereditary]] and are common among family members. Some specific phobias include the fear of [[snake]]s, flying, [[dog]]s, [[elevator]]s, and [[spider]]s. Specific phobias are a type of [[anxiety disorder]].  
  
== Prevalence ==
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===Social phobia===
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[[Social phobia]], also known as [[Social anxiety disorder]], is defined by a fear of being watched or judged by others, and can include a deep fear of public [[embarrassment]]. A social phobia may also encompass a general fear of social situations, and a subsequent experience of severe [[anxiety]] when in them. Individuals experiencing social phobia may worry excessively about upcoming social situations, and may avoid events in which they may feel self-conscious. In extreme cases, individuals experiencing such phobia may deny job offers or avoid relationships due to their fears. Social phobia is also a type of [[anxiety disorder]]
  
Phobias (in the clinical meaning of the term) are the most common form of [[anxiety disorder]]s. An [[United States|American]] study by the [[National Institute of Mental Health]] (NIMH) found that between 8.7% and 18.1% of Americans suffer from phobias. <ref>Kessler etal, ''Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication'', June 2005, Archive of General Psychiatry, Volume 20</ref> Broken down by age and gender, the study found that phobias were the most common [[mental illness]] among women in all age groups and the second most common illness among men older than 25.
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===Agoraphobia===
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[[File:Agora of the Competaliasts 01 (cropped).jpg|thumb|400px|An ancient [[agora]] in Delos, Greece—one of the public spaces after which the condition is named]]
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[[Agoraphobia]], often believed to be the fear of open spaces, is actually the fear of feeling trapped and having a [[panic attack]] within a public space. These situations can include open spaces, public transit, shopping centers, or simply being outside their home. Agoraphobia is strongly linked with [[panic disorder]] and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. Individuals suffering from agoraphobia often develop to avoidance behaviors. For example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home.
  
== Other uses of term ==
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Agoraphobia is believed to develop between the ages of 15 and 35 and is most prevalent in women. Agoraphobia often develops from an initial panic attack; after such an attack, an individual may deeply fear having another. Patients suffering from agoraphobia may incessantly fear when the next attack may occur, often generalizing their fear with one of public spaces and social settings. In its most extreme form, a patient may be unable to leave their home.
  
'''Phobia''' is also used in a non-medical sense for aversions of all sorts. These terms are usually constructed with the suffix [[-phobia]]. A number of these terms describe negative [[attitude (psychology)|attitude]]s or [[prejudice]]s towards the named subjects. See [[#Non-clinical uses of the term|Non-clinical uses of the term]] below.
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==Symptoms==
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Most individuals experiencing a phobic disorder experience an anxious phobic reaction when encountering the feared object or situation. Though the triggers of certain phobias are often different, individuals dealing with phobias often face similar [[symptoms]]. Such symptoms include a feeling of terror of impending doom, rapid heartbeat and breathing, and sweaty palms. Such reactions can also consist of extreme fearfulness, elevated [[blood pressure]], physical shaking, hot or cold flashes, [[nausea]], and irrational cognitive [[reasoning]]. Once the individual is removed from the feared situation, these effects quickly subside; this degree of relief is believed by [[psychologist]]s to reinforce the phobia and to further strengthen the avoidance of the individual to the feared object or situation. In more extreme cases, a "phobic trigger" may occur; someone struggling with a fear of [[water]] may experience episodes of panic attacks weeks before a planned vacation to the beach.  
  
==Clinical phobias==  
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==Causes==
Most [[psychologist]]s and [[psychiatrist]]s classify most phobias into three categories: [http://allpsych.com/journal/phobias.html] [http://www.nimh.nih.gov/publicat/numbers.cfm]
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Research on phobic disorders has suggested the development of certain phobias to be both [[hereditary]] and situational. While specific phobias are often believed to be hereditary, many [[psychologist]]s also identify a link with certain phobias and negative past experiences. For example, prolonged flight [[turbulence]] may trigger a subsequent [[fear of flying]].  
  
* [[Social phobia]]s &ndash; fears involving other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others, such as eating in public. The symptoms may extend to psychosomatic manifestation of physical problems. For example, sufferers of [[paruresis]] find it difficult or impossible to urinate in reduced levels of privacy. That goes beyond mere preference. If the condition triggers, the person physically cannot empty their bladder.
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Most social phobias are believed to originate in a childhood or [[adolescence|adolescent]] experience. Certain individuals who have experienced repeated rejection, especially during formative years, may subsequently develop poor social skills, low levels of [[self esteem]], and an ensuing social phobia.  
* [[Specific phobia]]s &ndash; fear of a single specific panic [[Post-traumatic_stress_disorder|trigger]] such as spiders, dogs, elevators, [[Aquaphobia|water]], flying, catching a specific illness, etc.
 
* [[Agoraphobia]] &ndash; a generalized fear of leaving home or a small familiar 'safe' area, and of the inevitable [[panic attack]]s that will follow.  Agoraphobia is the only phobia regularly treated as a medical condition.
 
  
In Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ([[DSM-IV]]), social phobia, specific phobia, and agoraphobia are sub-groups of [[anxiety disorder]].
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More is known about conditions of [[agoraphobia]]. Because panic attacks may develop spontaneously, an individual may often develop a gripping fear of when his or her next attack may be. This can lead to the avoidance of places where an individual may feel he or she could not escape if a panic attack did occur.
  
Many of the [[specific phobia]]s, such as fear of dogs, heights, spider bites and so forth, are extensions of fears that a lot of people have.  People with these phobias specifically avoid the entity they fear.
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==Mechanism==
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[[File:PTSD stress brain.gif|thumb|350px|Regions of the brain associated with phobias<ref>]]
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[[File:Blausen 0614 LimbicSystem.png|thumb|400px|Anatomical components of the limbic system]]
  
Many specific phobias can be traced back to a specific triggering event, usually a [[Psychological trauma|traumatic]] experience at an early age. Social phobias and agoraphobia have more complex causes that are not entirely known at this time. It is believed that heredity, genetics, and brain chemistry combine with life-experiences to play a major role in the development of anxiety disorders and phobias.  
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=== Limbic system ===
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Beneath the lateral fissure in the [[cerebral cortex]], the insula, or [[insular cortex]], of the brain has been identified as part of the [[limbic system]], along with the [[Cingulate cortex|cingulated gyrus]], [[hippocampus]], [[corpus callosum]], and other nearby cortices. This system has been found to play a role in emotion processing, and the insula, in particular, may contribute to maintaining [[Autonomic nervous system|autonomic functions]].
  
Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer only relatively mild anxiety over that fear. Others suffer fully-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 initial panic reaction.
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In the frontal lobes, other cortices involved with phobia and fear are the [[anterior cingulate cortex]] and the [[medial prefrontal cortex]]. The [[ventromedial prefrontal cortex]] has been said to influence the [[amygdala]] by monitoring its reaction to emotional stimuli or even fearful memories. Most specifically, the [[Prefrontal cortex|medial prefrontal cortex]] is active during the extinction of fear and is responsible for long-term extinction. Stimulation of this area decreases conditioned fear responses, so its role may be in inhibiting the amygdala and its reaction to fearful stimuli.
  
===Treatment===
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The [[hippocampus]] is a horseshoe-shaped structure that plays an essential part in the brain's [[limbic system]]. This is because it forms memories and connects them with emotions and the senses. When dealing with fear, the hippocampus receives impulses from the amygdala that allow it to connect the fear with a certain sense, such as a smell or sound.
Some therapists use [[virtual reality]] or imagery exercise to [[desensitize]] patients to the feared entity.  These are parts of [[systematic desensitization]] therapy.
 
  
[[Cognitive therapy|Cognitive behavioral therapy]] (CBT) can be beneficial. Cognitive behavioral therapy lets the patient understand the cycle of negative thought patterns, and ways to change these thought patterns. 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 and to make a continuous effort over a long period of time.
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=== Amygdala ===
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The [[amygdala]] is an almond-shaped mass of nuclei located deep in the brain's medial temporal lobe. It processes the events associated with fear and is linked to [[Social anxiety disorder|social phobia]] and other anxiety disorders. The amygdala's ability to respond to fearful stimuli occurs through [[fear conditioning]]. Like [[classical conditioning]], the amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear response often seen in phobic individuals. The amygdala is responsible for recognizing certain stimuli or cues as dangerous and plays a role in the storage of threatening stimuli to [[memory]]. The basolateral nuclei (or [[basolateral amygdala]]) and the hippocampus interact with the amygdala in-memory storage. This connection suggests why memories are often remembered more vividly if they have emotional significance.
  
Anti-anxiety or [[selective serotonin reuptake inhibitor|anti-depression]] medications can be of assistance in many cases. [[Benzodiazepines]] could be prescribed for short-term use.
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In addition to memory, the amygdala also triggers the secretion of [[hormone]]s that affect [[fear]] and [[aggression]]. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an "alert" state, which prepares the individual to move, run, fight, etc. This defensive "alert" state and response are known as the [[fight-or-flight response]].
  
These treatment options are not mutually exclusive. Often a therapist will suggest multiple treatments.
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However, inside the brain, this stress response can be observed in the [[hypothalamic-pituitary-adrenal axis]] (HPA). This circuit incorporates the process of receiving stimuli, interpreting them, and releasing certain hormones into the bloodstream, ultimately stimulating the release of [[cortisol]]. In relation to anxiety, the amygdala activates this circuit, while the hippocampus is responsible for suppressing it. [[Glucocorticoid receptor|Glucocorticoid]] receptors in the hippocampus monitor the amount of cortisol in the system and through negative feedback can tell the hypothalamus to stop releasing CRH. People with phobias, therefore, may have high amounts of cortisol present, or low levels of [[glucocorticoid receptor]]s.
  
===Non-psychological conditions===
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==Treatment==
The term ''[[hydrophobia]]'', or fear of water, is usually not a psychological condition at all, but another term for the disease [[rabies]], referring to a common symptom. Likewise, [[photophobia]] is a physical complaint. Aversion to light due to inflamed [[eye]]s or excessively dilated pupils does not necessarily indicate photophobia.
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[[File:140930-A-DO086-644 (15454639691).jpg|thumb|300px|A soldier stomping his foot to put out the fire rising up his leg during military fire-phobia training]]
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Phobias may be treated by various forms of [[therapy]], ranging from techniques based on [[behavior therapy]], such as [[systematic desensitization]], to more [[cognitive therapy|cognitive therapies]], such as [[exposure therapy]].  
  
==Non-clinical uses of the term==
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Systematic desensitization is a type of behavioral therapy used to help effectively overcome phobias and other [[anxiety]] disorders. More specifically, it is a type of [[Ivan Pavlov|Pavlovian]] therapy developed by [[South Africa]]n [[psychiatry|psychiatrist]], [[Joseph Wolpe]]. To begin the process of systematic desensitization, one must first be taught relaxation skills in order to control fear and anxiety responses to specific phobias. Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established [[hierarchy]] of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy. Systematic desensitization is sometimes called "graduated exposure therapy."
{{main|-phobia}}
 
It is possible for an individual to develop a phobia over virtually anything. The name of a phobia generally contains a Greek word for what the patient fears plus the suffix ''[[-phobia]]''. Creating these terms is somewhat of a [[word game]]. Few of these terms are found in medical literature. However, this does not necessarily make it a nonpsychological condition.
 
  
===Terms indicating prejudice or class discrimination===
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Many phobias are treated through exposure therapy, or the gradual exposure of the feared object to the individual in successively longer time periods. Exposure therapy is believed to be the best approach for certain phobias as the individual is placed in an environment of comfort at all times when exposed to the object. Exposure therapy is a [[cognitive behavioral therapy]] technique for reducing fear and anxiety responses, especially phobia, and is based on the principles of [[habituation]] and [[cognitive dissonance]]. It is similar to Systematic desensitization, though it works more quickly and produces more robust results. It is also very closely related to [[Exposure and response prevention]], a method widely used for the treatment of [[Obsessive-compulsive disorder]]. Three fourths of patients show significant improvement from this treatment.  
A number of terms with the suffix [[-phobia]] are primarily understood as negative [[attitude (psychology)|attitude]]s towards certain categories of people or other things, used in an [[analogy]] with the medical usage of the term. Usually these kinds of "phobias" are described as fear, dislike, disapproval, [[prejudice]], [[hatred]], [[discrimination]], or hostility towards the object of the "phobia". Often this attitude is based on prejudices and is a particular case of general [[xenophobia]].
 
  
Class discrimination is not always considered a phobia in the clinical sense because it is believed to be only a symptom of other psychological issues, or the result of ignorance, or of political or social beliefs. In other words, unlike clinical phobias, which are usually qualified with disabling fear, class discrimination usually have roots in social relations.
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Cognitive therapy is also used in the treatment of phobic disorders and involves an analysis of one’s thoughts and beliefs in phobic situations. By helping individuals recognize the relationship between one’s thoughts and one’s anxiety, and that the majority of feared outcomes are unlikely, [[psychologist]]s help phobic individuals to gain more control over their feared situation.  
  
The main difference between a fear and a phobia is that a fear is something a person is afraid of and can handle being around it without fainting or having panic attacks. A fear becomes a phobia when it starts to interfere with one's life. An example is if a person was walking on one side of a street and this person has homophobia (the fear of homosexuals) and a homosexual couple is coming up. If that person goes to the other side of the street to avoid them even if their destination is just few feet behind the couple, their fear of homosexuals is now a phobia because it interfered with that person's daily life.
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Some [[medication]]s can be prescribed in the treatment of phobias. [[Beta-adrenergic]] blocking agents help to lower heart rate and reduce physical tremors, and help to reduce general anxiety within phobic patients. [[Antidepressant]]s are also believed to affect certain regions of the [[brain]] in which fear is mediated, further helping to reduce anxiety in panic-prone patients. Other prescriptions involve life-changes such as the elimination of [[caffeine]], [[alcohol]], and stress, and maintaining a healthy diet and exercise.
  
Below are some examples:
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==Prognosis==
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Most phobias are highly treatable and individuals can often go on leading normal lives. Research has shown that once a person is rid of a phobia, it is less likely, if ever likely, to return. In matters where certain phobias are left untreated, an individual may be inflicted for life. In some cases, untreated phobias can lead to other problems and disorders, including [[depression (psychology)|depression]], low [[self-esteem]], and social avoidance. Psychologists suggest most adult phobias to be treated; however only 25 percent of people experiencing phobias are believed to seek help.
  
* [[Islamophobia]], fear or dislike of [[Islam|Muslims]]
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==Examples of phobias==
* [[Homophobia]], dislike of [[homosexuality|homosexual]] people.
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There exist more than 600 recognized phobias, many without treatment. Several common examples are detailed below.  
* [[Transphobia]],  fear or dislike of [[transgender]] or [[transsexual]] people.
 
* [[Xenophobia]], fear or dislike of strangers or the unknown, often used to describe [[nationalist]]ic [[politics|political]] beliefs and movements
 
* [[Ephebophobia]], irrational fear of [[Adolescence|adolescents]] gaining more rights or showing behavioral, emotional or social emancipation
 
  
See also [[List of anti-ethnic and anti-national terms]].
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===Acrophobia===
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[[Acrophobia]], a specific phobia from the [[Greek language|Greek]] word {{polytonic|ἄκρος}}, meaning "summit" is an extreme or irrational [[fear]] of [[height]]s. Acrophobia can prove dangerous, as sufferers may often experience a [[panic attack]] in a high place and become unable to get themselves down safely. Some acrophobics also suffer from urges to throw themselves off high places, despite not being [[suicide|suicidal]].  
  
== Other uses of term ==
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The most widely accepted explanation is that acrophobia stems from the fear of falling and being injured or killed. This is classified as a normal and rational fear that most people have.
  
'''Phobia''' is also used in a non-medical sense for aversions of all sorts. These terms are usually constructed with the suffix [[-phobia]]. A number of these terms describe negative [[attitude (psychology)|attitude]]s or [[prejudice]]s towards the named subjects. See [[#Non-clinical uses of the term|Non-clinical uses of the term]] below.
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===Arachnophobia===
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[[Arachnophobia]] is an intense and unreasonable fear of [[spider]]s and other [[arachnid]]s such as [[scorpion]]s. People with arachnophobia tend to feel uneasy in any area they believe could harbor spiders or that has visible signs of their presence, such as webs. If arachnophobes see a spider, they may not enter the general vicinity until they have overcome the panic attack that is often associated with their phobia. Some people run away, scream, cry, have emotional outbursts, experience trouble breathing, sweat, have increased heart rates, or even faint when they come in contact with an area near spiders or their webs. In some extreme cases, even a picture or a realistic drawing of a spider can trigger intense fear. Treatment is typically by exposure therapy, where the person is presented with pictures of spiders or the spiders themselves.
  
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===Aviophobia===
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[[Aviophobia]] is a strong fear of flying, or a fear of air travel. It is also sometimes referred to as "aviatophobia" or "aviophobia." Though commercial flight has become an prevalent part of modern life, flying continues to cause a significant proportion of the public to feel anxious.
  
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Some people who are afraid of flying manage their fears well enough that they are able to fly, but may still spend considerable time and [[emotion]]al energy thinking about the dangers that may befall them during flight. In extreme cases individuals are nearly incapable of getting on an [[airplane]], and must use other means of [[transportation]] to achieve long distance travel. 
  
==External links ==
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Like many phobias, fear of flying may "generalize" to cause fear of flight-related situations or stimuli. Many individuals with a strong fear of flying report anxious symptoms or panic attacks when discussing air travel, when seeing airplanes overhead, when visiting airports, or when watching [[television]] programs or [[film]]s that depict air travel.
  
* [http://www.behavenet.com/capsules/disorders/socphob.htm Diagnostic criteria for social phobia] in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]]
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===Claustrophobia===
* [http://www.behavenet.com/capsules/disorders/specphob.htm Diagnostic criteria for specific phobia] in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]]
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[[Claustrophobia]] is an [[anxiety]] disorder that involves the fear of enclosed or confined spaces. Those suffering from claustrophobia may suffer from [[panic attack]]s, or fear of having a panic attack, in situations such as being in [[elevator]]s, [[train]]s, or [[aircraft]].
* [http://www.behavenet.com/capsules/disorders/anxietydis.htm List of anxiety disorders] in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]], which includes several agoraphobic disorders.
 
* [http://www.phobics-society.org.uk National Phobics Society]
 
* [http://www.phobialist.com/ The Phobia List] Unofficial list with phobias and their technical names.
 
  
==Notes==
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Conversely, people who are prone to having panic attacks will often develop claustrophobia. If a panic attack occurs while they are in a confined space, then the claustrophobe fears not being able to escape the situation. Those suffering from claustrophobia might find it difficult to breathe in closed auditoriums, theaters, and elevators. Claustrophobia can be treated in similar ways to other anxiety disorders, with a range of treatments including [[cognitive behavior therapy]] and the use of anti-anxiety medication.
<references />
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===Xenophobia===
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[[Xenophobia]] denotes a phobic [[attitude]] towards strangers or of the unknown. It comes from the [[Greek language|Greek]] words ξένος ''(xenos)'', meaning "foreigner," "stranger," and φόβος ''(phobos)'', meaning "fear."  The term is typically used to describe fear or dislike of [[alien (law)|foreigner]]s.
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Xenophobia implies a belief, accurate or not, that the target is in some way foreign. [[Prejudice]] against women cannot be considered xenophobic in this sense, except in the limited case of all-male clubs or institutions. The term [[xenophilia]] is used for the opposite behavior, attraction to or love for foreign persons.
  
 
==References==
 
==References==
* Lynne L. Hall, ''Fighting Phobias, the Things That Go Bump in the Mind'', FDA Consumer Magazine, Volume 31 No. 2, March 1997 [http://www.fda.gov/fdac/features/1997/297_bump.html]
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*American Psychiatric Association. ''Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5''. American Psychiatric Publishing, 2013. ISBN 978-0890425558
 
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*Bear, Mark, Barry Connors, and Michael A. Paradiso. ''Neuroscience: Exploring the Brain.'' Jones & Bartlett Learning, 2020. ISBN 978-1284211283
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*Whalen, Paul J., and Elizabeth A. Phelps (eds.). ''The Human Amygdala''. The Guilford Press, 2009. ISBN 978-1606230336
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*Wolpe, Joseph. ''The Practice of Behavior Therapy''. Allyn & Bacon, 1992. ISBN 0205145140
  
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==External Links ==
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All links retrieved November 23, 2022.
  
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*[http://www.phobialist.com/ The Phobia List] Phobias & their Technical Names.
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*[https://enhancehealthgroup.com/virtual-anxiety-treatment/ Online Treatment for Anxiety] ''Enhance Health Group''.
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*[https://www.healthline.com/health/list-of-phobias Common and Unique Phobias Explained] ''Healthline''.
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*[https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias Phobias] ''Johns Hopkins Medicine''.
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*[https://medlineplus.gov/phobias.html Phobias] ''Medline Plus''.
  
{{Credit1|Phobia|72110996|}}
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{{Credit7|Phobia|72110996|Acrophobia|85867526|Specific_phobia|86092695|Fear_of_flying|85868355|Claustrophobia|85059510|Xenophobia|86005002|Agoraphobia|86098470|}}

Latest revision as of 17:25, 23 November 2022


Fear of spiders is one of the most common phobias

The term phobia, from the Greek φόβος meaning "fear," is a strong, persistent, and irrational fear or anxiety of certain situations, objects, activities, or persons. A phobia disorder is defined by an excessive, unreasonable desire to avoid the feared subject. Phobias are generally believed to emerge following highly traumatic experiences. Many individuals suffering from certain phobias are believed to transfer the fear of an original situation to other situations experienced in or reoccurring throughout everyday life, while the original fear is often left forgotten. Such an example can be seen in near-drowning incidents; an individual may often develop an irrational fear of water, despite minimizing the original fear of drowning.

Behavior therapy, or the gradual exposure of an individual to certain objects of their most irrational fears, is generally accepted as the best method for overcoming certain phobias. However, the origin and continued recurrence, generation after generation, has yet to be solved.

Overview

Phobias, or phobic disorders, are defined as an intense, irrational fear that often leads to the extreme avoidance of the object or situation feared. The word "phobia" comes from the Greek: φόβος (phóbos), meaning "aversion," "fear." or "morbid fear."

Did you know?
The term "phobia" comes from the Greek word meaning fear.

Phobias are common and believed to originate in childhood or adolescent experiences, although some common phobias have been suggested as being inborn, such as fear of heights or snakes.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), classifies phobias into three major categories: specific phobias, social phobias, and agoraphobia.

Specific phobias

Specific phobias are defined as a fear of a particular situation or object, and are the most common types of phobic disorders experienced. Specific phobias are believed to be hereditary and are common among family members. Some specific phobias include the fear of snakes, flying, dogs, elevators, and spiders. Specific phobias are a type of anxiety disorder.

Social phobia

Social phobia, also known as Social anxiety disorder, is defined by a fear of being watched or judged by others, and can include a deep fear of public embarrassment. A social phobia may also encompass a general fear of social situations, and a subsequent experience of severe anxiety when in them. Individuals experiencing social phobia may worry excessively about upcoming social situations, and may avoid events in which they may feel self-conscious. In extreme cases, individuals experiencing such phobia may deny job offers or avoid relationships due to their fears. Social phobia is also a type of anxiety disorder

Agoraphobia

An ancient agora in Delos, Greece—one of the public spaces after which the condition is named

Agoraphobia, often believed to be the fear of open spaces, is actually the fear of feeling trapped and having a panic attack within a public space. These situations can include open spaces, public transit, shopping centers, or simply being outside their home. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. Individuals suffering from agoraphobia often develop to avoidance behaviors. For example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home.

Agoraphobia is believed to develop between the ages of 15 and 35 and is most prevalent in women. Agoraphobia often develops from an initial panic attack; after such an attack, an individual may deeply fear having another. Patients suffering from agoraphobia may incessantly fear when the next attack may occur, often generalizing their fear with one of public spaces and social settings. In its most extreme form, a patient may be unable to leave their home.

Symptoms

Most individuals experiencing a phobic disorder experience an anxious phobic reaction when encountering the feared object or situation. Though the triggers of certain phobias are often different, individuals dealing with phobias often face similar symptoms. Such symptoms include a feeling of terror of impending doom, rapid heartbeat and breathing, and sweaty palms. Such reactions can also consist of extreme fearfulness, elevated blood pressure, physical shaking, hot or cold flashes, nausea, and irrational cognitive reasoning. Once the individual is removed from the feared situation, these effects quickly subside; this degree of relief is believed by psychologists to reinforce the phobia and to further strengthen the avoidance of the individual to the feared object or situation. In more extreme cases, a "phobic trigger" may occur; someone struggling with a fear of water may experience episodes of panic attacks weeks before a planned vacation to the beach.

Causes

Research on phobic disorders has suggested the development of certain phobias to be both hereditary and situational. While specific phobias are often believed to be hereditary, many psychologists also identify a link with certain phobias and negative past experiences. For example, prolonged flight turbulence may trigger a subsequent fear of flying.

Most social phobias are believed to originate in a childhood or adolescent experience. Certain individuals who have experienced repeated rejection, especially during formative years, may subsequently develop poor social skills, low levels of self esteem, and an ensuing social phobia.

More is known about conditions of agoraphobia. Because panic attacks may develop spontaneously, an individual may often develop a gripping fear of when his or her next attack may be. This can lead to the avoidance of places where an individual may feel he or she could not escape if a panic attack did occur.

Mechanism

Regions of the brain associated with phobias<ref>
Anatomical components of the limbic system

Limbic system

Beneath the lateral fissure in the cerebral cortex, the insula, or insular cortex, of the brain has been identified as part of the limbic system, along with the cingulated gyrus, hippocampus, corpus callosum, and other nearby cortices. This system has been found to play a role in emotion processing, and the insula, in particular, may contribute to maintaining autonomic functions.

In the frontal lobes, other cortices involved with phobia and fear are the anterior cingulate cortex and the medial prefrontal cortex. The ventromedial prefrontal cortex has been said to influence the amygdala by monitoring its reaction to emotional stimuli or even fearful memories. Most specifically, the medial prefrontal cortex is active during the extinction of fear and is responsible for long-term extinction. Stimulation of this area decreases conditioned fear responses, so its role may be in inhibiting the amygdala and its reaction to fearful stimuli.

The hippocampus is a horseshoe-shaped structure that plays an essential part in the brain's limbic system. This is because it forms memories and connects them with emotions and the senses. When dealing with fear, the hippocampus receives impulses from the amygdala that allow it to connect the fear with a certain sense, such as a smell or sound.

Amygdala

The amygdala is an almond-shaped mass of nuclei located deep in the brain's medial temporal lobe. It processes the events associated with fear and is linked to social phobia and other anxiety disorders. The amygdala's ability to respond to fearful stimuli occurs through fear conditioning. Like classical conditioning, the amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear response often seen in phobic individuals. The amygdala is responsible for recognizing certain stimuli or cues as dangerous and plays a role in the storage of threatening stimuli to memory. The basolateral nuclei (or basolateral amygdala) and the hippocampus interact with the amygdala in-memory storage. This connection suggests why memories are often remembered more vividly if they have emotional significance.

In addition to memory, the amygdala also triggers the secretion of hormones that affect fear and aggression. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an "alert" state, which prepares the individual to move, run, fight, etc. This defensive "alert" state and response are known as the fight-or-flight response.

However, inside the brain, this stress response can be observed in the hypothalamic-pituitary-adrenal axis (HPA). This circuit incorporates the process of receiving stimuli, interpreting them, and releasing certain hormones into the bloodstream, ultimately stimulating the release of cortisol. In relation to anxiety, the amygdala activates this circuit, while the hippocampus is responsible for suppressing it. Glucocorticoid receptors in the hippocampus monitor the amount of cortisol in the system and through negative feedback can tell the hypothalamus to stop releasing CRH. People with phobias, therefore, may have high amounts of cortisol present, or low levels of glucocorticoid receptors.

Treatment

A soldier stomping his foot to put out the fire rising up his leg during military fire-phobia training

Phobias may be treated by various forms of therapy, ranging from techniques based on behavior therapy, such as systematic desensitization, to more cognitive therapies, such as exposure therapy.

Systematic desensitization is a type of behavioral therapy used to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy developed by South African psychiatrist, Joseph Wolpe. To begin the process of systematic desensitization, one must first be taught relaxation skills in order to control fear and anxiety responses to specific phobias. Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy. Systematic desensitization is sometimes called "graduated exposure therapy."

Many phobias are treated through exposure therapy, or the gradual exposure of the feared object to the individual in successively longer time periods. Exposure therapy is believed to be the best approach for certain phobias as the individual is placed in an environment of comfort at all times when exposed to the object. Exposure therapy is a cognitive behavioral therapy technique for reducing fear and anxiety responses, especially phobia, and is based on the principles of habituation and cognitive dissonance. It is similar to Systematic desensitization, though it works more quickly and produces more robust results. It is also very closely related to Exposure and response prevention, a method widely used for the treatment of Obsessive-compulsive disorder. Three fourths of patients show significant improvement from this treatment.

Cognitive therapy is also used in the treatment of phobic disorders and involves an analysis of one’s thoughts and beliefs in phobic situations. By helping individuals recognize the relationship between one’s thoughts and one’s anxiety, and that the majority of feared outcomes are unlikely, psychologists help phobic individuals to gain more control over their feared situation.

Some medications can be prescribed in the treatment of phobias. Beta-adrenergic blocking agents help to lower heart rate and reduce physical tremors, and help to reduce general anxiety within phobic patients. Antidepressants are also believed to affect certain regions of the brain in which fear is mediated, further helping to reduce anxiety in panic-prone patients. Other prescriptions involve life-changes such as the elimination of caffeine, alcohol, and stress, and maintaining a healthy diet and exercise.

Prognosis

Most phobias are highly treatable and individuals can often go on leading normal lives. Research has shown that once a person is rid of a phobia, it is less likely, if ever likely, to return. In matters where certain phobias are left untreated, an individual may be inflicted for life. In some cases, untreated phobias can lead to other problems and disorders, including depression, low self-esteem, and social avoidance. Psychologists suggest most adult phobias to be treated; however only 25 percent of people experiencing phobias are believed to seek help.

Examples of phobias

There exist more than 600 recognized phobias, many without treatment. Several common examples are detailed below.

Acrophobia

Acrophobia, a specific phobia from the Greek word ἄκρος, meaning "summit" is an extreme or irrational fear of heights. Acrophobia can prove dangerous, as sufferers may often experience a panic attack in a high place and become unable to get themselves down safely. Some acrophobics also suffer from urges to throw themselves off high places, despite not being suicidal.

The most widely accepted explanation is that acrophobia stems from the fear of falling and being injured or killed. This is classified as a normal and rational fear that most people have.

Arachnophobia

Arachnophobia is an intense and unreasonable fear of spiders and other arachnids such as scorpions. People with arachnophobia tend to feel uneasy in any area they believe could harbor spiders or that has visible signs of their presence, such as webs. If arachnophobes see a spider, they may not enter the general vicinity until they have overcome the panic attack that is often associated with their phobia. Some people run away, scream, cry, have emotional outbursts, experience trouble breathing, sweat, have increased heart rates, or even faint when they come in contact with an area near spiders or their webs. In some extreme cases, even a picture or a realistic drawing of a spider can trigger intense fear. Treatment is typically by exposure therapy, where the person is presented with pictures of spiders or the spiders themselves.

Aviophobia

Aviophobia is a strong fear of flying, or a fear of air travel. It is also sometimes referred to as "aviatophobia" or "aviophobia." Though commercial flight has become an prevalent part of modern life, flying continues to cause a significant proportion of the public to feel anxious.

Some people who are afraid of flying manage their fears well enough that they are able to fly, but may still spend considerable time and emotional energy thinking about the dangers that may befall them during flight. In extreme cases individuals are nearly incapable of getting on an airplane, and must use other means of transportation to achieve long distance travel.

Like many phobias, fear of flying may "generalize" to cause fear of flight-related situations or stimuli. Many individuals with a strong fear of flying report anxious symptoms or panic attacks when discussing air travel, when seeing airplanes overhead, when visiting airports, or when watching television programs or films that depict air travel.

Claustrophobia

Claustrophobia is an anxiety disorder that involves the fear of enclosed or confined spaces. Those suffering from claustrophobia may suffer from panic attacks, or fear of having a panic attack, in situations such as being in elevators, trains, or aircraft.

Conversely, people who are prone to having panic attacks will often develop claustrophobia. If a panic attack occurs while they are in a confined space, then the claustrophobe fears not being able to escape the situation. Those suffering from claustrophobia might find it difficult to breathe in closed auditoriums, theaters, and elevators. Claustrophobia can be treated in similar ways to other anxiety disorders, with a range of treatments including cognitive behavior therapy and the use of anti-anxiety medication.

Xenophobia

Xenophobia denotes a phobic attitude towards strangers or of the unknown. It comes from the Greek words ξένος (xenos), meaning "foreigner," "stranger," and φόβος (phobos), meaning "fear." The term is typically used to describe fear or dislike of foreigners.

Xenophobia implies a belief, accurate or not, that the target is in some way foreign. Prejudice against women cannot be considered xenophobic in this sense, except in the limited case of all-male clubs or institutions. The term xenophilia is used for the opposite behavior, attraction to or love for foreign persons.

References
ISBN links support NWE through referral fees

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. American Psychiatric Publishing, 2013. ISBN 978-0890425558
  • Bear, Mark, Barry Connors, and Michael A. Paradiso. Neuroscience: Exploring the Brain. Jones & Bartlett Learning, 2020. ISBN 978-1284211283
  • Whalen, Paul J., and Elizabeth A. Phelps (eds.). The Human Amygdala. The Guilford Press, 2009. ISBN 978-1606230336
  • Wolpe, Joseph. The Practice of Behavior Therapy. Allyn & Bacon, 1992. ISBN 0205145140

External Links

All links retrieved November 23, 2022.

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