Phobia

Definition

A phobia (from the 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.

Clinical phobias

Prevalence

Phobias (in the clinical meaning of the term) are the most common form of anxiety disorders. An American study by the National Institute of Mental Health (NIMH) found that between 8.7% and 18.1% of Americans suffer from phobias. 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.

Most psychologists and psychiatrists classify most phobias into three categories: [1] [2]

• Social phobias – 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.
• Specific phobias – fear of a single specific panic trigger such as spiders, dogs, elevators, water, flying, catching a specific illness, etc.
• Agoraphobia – a generalized fear of leaving home or a small familiar 'safe' area, and of the inevitable panic attacks 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.

Many of the specific phobias, 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.

Many specific phobias can be traced back to a specific triggering event, usually a 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.

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.

Treatment

Some therapists use virtual reality or imagery exercise to desensitize patients to the feared entity. These are parts of systematic desensitization 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.

Anti-anxiety or anti-depression medications can be of assistance in many cases. Benzodiazepines could be prescribed for short-term use.

These treatment options are not mutually exclusive. Often a therapist will suggest multiple treatments.

Non-psychological conditions

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 eyes or excessively dilated pupils does not necessarily indicate photophobia.

Non-clinical uses of the term

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

A number of terms with the suffix -phobia are primarily understood as negative attitudes 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.

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.

Below are some examples:

• Xenophobia, fear or dislike of strangers or the unknown, often used to describe nationalistic political beliefs and movements
• Islamophobia, fear or dislike of Muslims
• Homophobia, dislike of homosexual people.
• Transphobia, fear or dislike of transgender or transsexual people.
• Ephebophobia, irrational fear of adolescents gaining more rights or showing behavioral, emotional or social emancipation

Other uses of term

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 attitudes or prejudices towards the named subjects. See Non-clinical uses of the term below.

Specific Phobia

"Specific phobia" is a generic term for any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. As a result, the affected persons tend to actively avoid direct contact with the objects or situations, and in severe cases any mention or depiction of them.

The fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. A person who encounters that of which they are phobic will often show signs of fear or express discomfort. In some cases it can result in a panic attack. In most cases of adults, this kind of phobia is consciously recognized by the person; still, anxiety and avoidance are difficult to control and may significantly impair person's functioning and even physical health.

Diagnoses criteria for specific phobia

All information about Diagnoses Criteria for Specific Phobia comes from the website http://www.mentalhealth.com/dis1/p21-an04.html

• Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
• The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.
• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
• The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
• In individuals under age 18 years, the duration is at least 6 months.
• The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

If the fear is just a reasonable fear that passes, then the fear is not a phobia.

Causes of specific phobia

All information about the Causes of Specific Phobia (except NOTE) comes from the textbook (2006,) Essentials of Abnormal Psychology:Fourth Edition

• Direct experience

This is where the object that a person is afraid of is experienced directly. For example if a person is afraid of snakes and he/she got bitten by that snake, then he/she has just experienced a direct experience

• Experiencing a False Alarm

This is actually experiencing a false alarm just as having a panic attack in the presence of the frightening object

NOTE - False Alarm experiences can be the catalyst for object selection in seemingly illogical phobias. While fear of such objects appears illogical, the significance of the selected object is that it allows a person, prone to unpredictable anxiety attacks, the ability to make the attacks more controllable or predictable. One such example is a girl who was afraid of cotton balls. By assigning these as the cause of her attacks and conditioning herself to believe it, she was able to reduce the trigger for her anxiety to one set of avoidable objects.

• Observing someone

This is where a person observed another person getting attacked by a snake. Therefore, he/she is afraid of the snake this way. That person is afraid that what had happened to that person could also happen to them

• Being Told

This is where a person is told about the dangers of a snake. The warning is so great and frightening to the person, he/she develops a phobia because of it.

Categories of specific phobias

According to the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders and the textbook (2006,) Essentials of Abnormal Psychology: Fourth Edition phobias can be classified under the following general categories:

• Animal type

For example the fear of spiders (arachnophobia) and the fear of snakes (ophidiophobia).

• Natural environment type: if the fear is cued by objects in the natural environment, such as storms, heights (acrophobia), or water (aquaphobia). This subtype generally has a childhood on set. If a person has the fear of water they are more likely to have another fear like the fear of storms. These situations may be dangerous, so mild to moderate fear can be adaptive. If the fear is just a passing fear, for example, being worried or cautious in dangerous or risky areas is not a phobia. These fears have to be persistent and cause distress or impairment. For example, avoiding a boat ride or a trip for fear of a storm.
• Situational type

Like the fear of small confined spaces (claustrophobia) and being "afraid of the dark," (nyctophobia).

• Blood/injection/injury type

This situational phobia consists of a persistent, debilitating fear of blood (seeing it or expelling it), bodily injury of any type, and injection of one’s own body with a needle. Many people may have mild fears of these types of situations, but those with a blood/injection/injury type situational phobia are seriously impaired when even a thought of these situations occur. They may avoid certain situations, places, and careers in order to avoid their fear. A panic-type reaction can be triggered by the sight or even thought of any type of blood/injection/injury image. This reaction can be in the form of dizziness, fainting, etc. There is nothing physically wrong with a person with this type of phobia, but they still have these physical reactions. Generally, phobias cause distress, impairment, and are excessive of an expected response to a particular situation.

• Other

Like the fear of the number 13 (triskaidekaphobia), and the fear of clowns (coulrophobia).

• Separation Anxiety Disorder

This is where little children are afraid of being separated by loved ones, or are afraid that their loved ones will be separated from them. For example, a child might refuse to go to school because he or she might be afraid that they will lose one of their parents while they are away. They also might be afraid to sleep alone because they might be afraid that they might lose their loved ones as well while they are asleep. This is a lot to do with the self-preservation instinct, for in the wild, a lone child is vulnerable to natural hazards and predators, as well as being unable to sustain themselves properly, e.g. feeding.

Examples of Phobias

Acrophobia

Acrophobia (from Greek ἄκρος, meaning "summit") is an extreme or irrational fear of heights. It is a particular case of specific phobias, which share both causes (differing in the source of the phobia) and options for treatment.

Acrophobia can be dangerous, as sufferers can experience a panic attack in a high place and become too agitated to get themselves down safely. Some acrophobics also suffer from urges to throw themselves off high places, despite not being suicidal.

"Vertigo" is often used, incorrectly, to describe the fear of heights, but it is more accurately described as a spinning sensation.

Causes of acrophobia

The most widely accepted explanation is that acrophobia stems from fear — fear of falling and being injured or killed: this is a normal and rational fear that most people have (people without such fears would die out).

A phobia occurs when fear is taken to an extreme — possibly through conditioning or a traumatic experience. Then, the mind seeks to protect the body from further trauma in the future, and elicits an extreme fear of the situation — in this case, heights.

This extreme fear can be counter-productive in normal everday life though, with some sufferers being afraid to go up a flight of stairs or a ladder, or to stand on a chair, table, (etc.).

Some neurologists question the prevailing wisdom and argue that acrophobia is caused by dysfunction in maintaining balance and that the anxiety is both well founded and secondary. According to the dysfunction model, a normal person uses both vestibular and visual cues appropriately in maintaining balance. An acrophobic overrelies on visual signals whether because of inadequate vestibular function or incorrect strategy. Locomotion at a high elevation requires more than normal visual processing. The visual cortex becomes overloaded and the person becomes confused. Research is underway at several clinics. [3] [4] Some proponents of the alternate view of acrophobia warn that it may be ill-advised to encourage acrophobics to expose themselves to height without first resolving the vestibular issues.

Popular culture

• Vertigo — a film by Alfred Hitchcock in which detective John "Scottie"/"Johnny Oh" Ferguson (James Stewart) , a police officer, feels vertigo and becomes acrophobic after losing his partner in a high fall
• Monk - Adrian Monk has a phobia = fear of height.
• High Anxiety — a spoof by Mel Brooks in which the main character, a leading psychiatrist, is acrophobic, but throughout the film the disorder is medically referred to as "high anxiety"
• In The Muppet Christmas Carol, Rizzo the Rat claims that he is acrophobic.
• In Code Lyoko, Ulrich Stern has an extreme case of acrophobia which throughout the episode is incorrectly stated as vertigo.

Agoraphobia

Agoraphobia an anxiety disorder which primarily consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape.

Agoraphobics may experience severe panic attacks in situations where they feel trapped, insecure, out of control, or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined not only to their home, but to one or two rooms, and they may even become bed-bound.

Agoraphobics are often extremely sensitized to their own bodily sensations, subconsciously over-reacting to perfectly normal events. For example, the exertion involved in climbing a flight of stairs may trigger a full-blown panic attack, because it increases the heartbeat and breathing rate, which the agoraphobic interprets as the start of a panic attack instead of a normal fluctuation.

Misconceptions

The word agoraphobia is an English adoption of the Greek words agora (αγορά) and phobos (φόβος), literally translated as "a fear of the marketplace". This translation is the reason for the common misconception that agoraphobia is a fear of open spaces. This not exactly the case, since agoraphobics are not afraid of open spaces themselves, but of having panic attacks as a result of being in certain locations.

Another misconception is that agoraphobia is a fear of "crowded spaces". Once again, an agoraphobic does not fear people: he or she rather fears an embarrassing/dangerous situation with no escape. Some people with agoraphobia are comfortable seeing visitors, but only in a defined space they feel in control of. Such people may live for years without leaving their homes, while happily seeing visitors and working, as long as they can stay within their safety zones.

Prevalence

The one-year prevalence of agoraphobia is about 5 percent. Agoraphobia occurs about twice as commonly among women than men (Magee et al., 1996 ). The gender difference may be attributable to social/cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women (DSM-IV), although other explanations are possible.

Diagnosis

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and the subsequent worry, preoccupation, and avoidance. Thus, the formal diagnosis of panic disorder with agoraphobia was established. However, for those people in communities or clinical settings who do not meet full criteria for panic disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used (DSM-IV).

Treatments

Agoraphobia can be successfully treated in many cases through a very gradual process of graduated exposure therapy combined with cognitive therapy and sometimes anti-anxiety or antidepressant medications. Anti-anxiety medications include benzodiazepines such as alprazolam. Anti-depressant medications which are used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class such as sertraline, paroxetine and fluoxetine.

Treatment options for agoraphobia and panic disorder are similar.

Alternate academic theories

Attachment theory and agoraphobia

GA FAVA, C RAFANELLI, S GRANDI, S CONTI, C RUINI (2001), Long-term outcome of panic disorder with agoraphobia treated by exposure. Psychological Medicine. Vol. 31, pp 891-898 Cambridge: University Press. Conclusions The findings suggest that exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

Some scholars (e.g., Liotti 1996 , Bowlby 1998 ) have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.

Spatial theory and agoraphobia

In the social sciences there is a perceived clinical bias (e.g., Davidson 2003 ) in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon.

Aviophobia

For other uses, see Fear of Flying

Fear of flying is a fear of air travel. It is also sometimes referred to as aviatophobia or aviophobia. Commercial flight has become an important, even essential, part of modern life; yet flying continues to cause a significant proportion of the public to feel anxiety. Fear of flying seems to contradict the facts; for example, driving in an automobile is statistically many times more dangerous.

Causes

The fear of flying may be created by various factors:

• a fear of closed in spaces (claustrophobia), such as that of an aircraft cabin
• a fear of heights (acrophobia)
• a feeling of not being in control (since a passenger is not piloting the plane and can't get out at will)
• previous traumatizing experiences while in flight
• fear of hijacking or terrorism
• fear of turbulence
• fear of having a panic attack

Some people blame the media as a major factor behind fear of flying, claiming the media sensationalizes airline crashes (and the high casualty rate per incident), in comparison to the perceived scant attention given the massive number of isolated automobile crashes.

Impact

Some people who are afraid of flying manage their fears well enough that they are able to fly, but they may still spend considerable time and emotional energy thinking about the dangers that may befall them during flight.

A few people are nearly incapable, however, of getting on a plane, and must use cars, trains, buses and ships – all of which are slower and usually less safe than airplanes – 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 (even when not embarking on air travel themselves), or when watching television programs or films that depict air travel.

Treatment

Some airline and travel companies run courses to help people get over the fear of flying – for example, Virgin Atlantic's "Flying Without Fear".

Fear of flying may also be treated by the use of psychoactive medications. For individuals experiencing anxiety due to a phobia, the standard psychiatric prescription might be any of a number of different psychoactive medications such as benzodiazepines or other relaxant/depressant drugs. Psychiatrists are sometimes reluctant to prescribe any medication for the treatment of fear of flying due to the need for patients to medicate irregularly.

Some individuals with fear of flying may self-medicate with other psychoactive substances—particularly alcohol, which is served in many commercial airline cabins—in order to deal with their anxiety. Most mental health professionals would advise against consuming alcohol as a medication both due to the strong risk of dependency (alcoholism) and due to the particular physiological effects on the body of air travel. In a pressurized cabin, the lower-than-normal oxygen content of the air will cause an alcoholic beverage to have a significantly enhanced effect on the body—resulting in a perhaps surprising level and rapidity of intoxication from only one or two drinks.

On the other hand, some professionals believe that if an individual is capable of controlling his or her drinking—i.e. is not an alcoholic—and consumes only a small amount at a time, that an alcoholic beverage before or during a flight may be beneficial as a short-term treatment of the fear of flying. Most would still advise a more long-term strategy of systematic desensitization therapy.

Claustrophobia

Claustrophobia is an anxiety disorder that involves the fear of enclosed or confined spaces. Claustrophobes 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, theatres, and elevators. Like many other disorders, claustrophobia can sometimes develop due to a traumatic incident in childhood.

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.

Popularly, claustrophobia is considered to be the opposite of agoraphobia^{[citation needed]}, or a "fear of open spaces". This is an oversimplification, however: claustrophobes may also fear being in crowds, and agoraphobia can also be characterized as a "fear of public spaces", and so a crowded city square might trigger claustrophobics and agoraphobics alike.

Frequency

It was found that 5-10.6% of people screened before an MRI scan had claustrophobia. Furthermore, it was found that 7% of patients had unidentified claustrophobia, and had to terminate the scanning procedure prematurely. 30% reported milder distress due to the necessity to lie in a confined space for a long time. For specific phobias in general, there is a lifetime prevalence rate of 7.2%-11.3%.

Treatment

There are a few kinds of psychotherapy to cure the phobia:

• Flooding - This is a form of exposure treatment, where the patient is exposed to confined spaces. The realisation that they have encountered their most dreaded object or situation, and come to no actual harm, can be a powerful form of therapy.
• Counter-conditioning - This is a method of systematic desensitization, whereby the patient is taught to use specific relaxation and visualisation techniques when experiencing phobia-related anxiety. The phobic trigger is slowly introduced, step-by-step, while the person concentrates on attaining physical and mental relaxation. Eventually, they can confront the source of their fear without feeling anxious.
• Modeling - Similarly, this is where a patient is shown people flooding, and are encouraged to mimic the confidence.
• Cognitive behaviour therapy - the person is encouraged to confront and change the specific thoughts and attitudes that lead to feelings of fear.
• Medications - Drugs such as tranquilizers and anti-depressants. Drugs known as beta blockers may be used to treat the physical symptoms of anxiety, such as a pounding heart.

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 or in general of people different from one's self. For example, racism is sometimes described as a form of xenophobia, but in most cases racism has nothing to do with a real phobia. 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.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th edition ("DSM-IV") includes in its description of a phobia an "intense anxiety" which follows exposure to the "object of the phobia, either in real life or via imagination or video..." For xenophobia there are two main objects of the phobia. The first is a population group present within a society, which is not considered part of that society. Often they are recent immigrants, but xenophobia may be directed against a group which has been present for centuries. This form of xenophobia can elicit or facilitate hostile and violent reactions, such as mass expulsion of immigrants, or in the worst case, genocide.

The second form of xenophobia is primarily cultural, and the objects of the phobia are cultural elements which are considered alien. All cultures are subject to external influences, but cultural xenophobia is often narrowly directed, for instance at foreign loan words in a national language. It rarely leads to aggression against persons, but can result in political campaigns for cultural or linguistic purification. Isolationism, a general aversion of foreign affairs, is not accurately described as xenophobia. Additionally, in the world of science fiction, xenophobia usually refers to a fear or hatred of extraterrestrial cultures or beings.

External links

• Diagnostic criteria for social phobia in the DSM-IV
• Diagnostic criteria for specific phobia in the DSM-IV
• List of anxiety disorders in the DSM-IV, which includes several agoraphobic disorders.
• National Phobics Society
• The Phobia List Unofficial list with phobias and their technical names.

• VR and tall buildings
• Pilots and fear of heights
• Fears and Phobias and How to Deal with Them

• Encyclopedia of Mental Disorders - Specific phobias

• Great fear of flying community
• Free Online Fear of Flying Help Course
• Virgin Atlantic's "Flying Without Fear"
• Fear of Flying Tips
• Fear Of Flying by Keith Godfrey
• "Taking Flight", a Free Online Support Group for Fear of Flying
• Superstition and flight numbers

• Government of Victoria's article on claustrophobia

• h2g2 Xenophobia Edited Guide Entry

• Mental Health Matters: Agoraphobia
• Help for Agoraphobia

References

ISBN links support NWE through referral fees

• Lynne L. Hall, Fighting Phobias, the Things That Go Bump in the Mind, FDA Consumer Magazine, Volume 31 No. 2, March 1997 [5]

Sources

Yahoo Health

Footnotes

Materials for this topic are obtained from the public domain source:

• David Satcher etal. (1999). "Chapter 4.2", Mental Health: A Report of the Surgeon General. 

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