Specific phobias

views updated May 11 2018

Specific phobias

Definition

Specific phobia is a type of disorder in which the affected individual displays a marked and enduring fear of specific situations or objects. Individuals with specific phobias experience extreme fear as soon as they encounter a defined situation or object, a phobic stimulus. For example, an individual with a specific phobia of dogs will become anxious when coerced to confront a dog. The specific phobia triggers a lot of distress or significantly impairs an affected individual.

Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (the DSM ) to diagnose mental disorders. The 2000 edition of this manual (the Fourth Edition Text Revision, also called the DSM-IV-TR ) classifies specific phobia as a type of anxiety disorder. Formerly, specific phobia was known as simple phobia. In the last few years, mental health professionals have paid more attention to specific phobias.

Description

Specific phobia has a unique position among the anxiety disorders in that individuals with this disorder do not experience pervasive anxiety nor do they seek treatment as readily as individuals with other anxiety disorders. Unlike individuals with other anxiety disorders, the fear of individuals with specific phobias is limited to defined situations or objects. Individuals with specific phobias experience impairment or a significant amount of anguish. They may lead restricted lifestyles depending upon the phobia type. Adults and adolescents with specific phobias recognize that their fear is unreasonable. Children, on the other hand, may not recognize that their fear of the phobic stimulus is unreasonable or extreme.

The types of specific phobias include situational, object, and other. The situational type is diagnosed if an individual's fear is cued by a defined situation. Examples include situations such as flying, enclosed places, tunnels, driving, bridges, elevators, or public transportation. Object types include animal, natural environment, and blood-injection-injury types. Animal type is diagnosed if an individual's fear is cued by animals or insects. Natural environment type is diagnosed if an individual's fear is cued by storms, water, or heights. Blood-injection-injury type is diagnosed if an individual's fear is cued by seeing an injury or blood or by an injection or other invasive medical treatment. Other type is diagnosed if an individual's fear is cued by other stimuli such as fears of vomiting, choking, becoming ill, and falling down if far from a means of physical support, and a child's fears of loud noises or characters in costumes.

Researchers have found that the frequency of type for adults in clinical settings, from least to most frequent, is: animal, blood-injection-injury, natural environment, and situational. The most common phobias for community samples, however, include phobias of heights, mice, spiders, and insects.

Causes and symptoms

Causes

The development of a specific phobia may be determined by a variety of factors. Behavioral, cognitive, and social theories of learning and conditioning, psychodynamic models such as the psychoanalytic theory of Freud, physiological studies of the brain , family background and genetic predisposition, variations in sociocultural themes, and theories on trauma can influence the development of specific phobia disorder. Some theorists propose that biological researchers have ignored specific phobias because pharmacological treatment is not the treatment of choice for this disorder.

LEARNING AND CONDITIONING CAUSES. As of 2002, research on phobias focuses on information-processing, learning, and conditioning themes. Learning to experience fear is the core of a conditioning perspective. Informational and instructional factors can result in the formation of fears. For example, an individual who frequently hears of plane crashes in the news may develop a specific phobia of flying. Research shows that individuals with specific phobias pay more attention to information about danger than do individuals who do not have specific phobias. Vicarious acquisition occurs when an individual witnesses a traumatic event or sees another individual behave with fear when confronting a phobic stimulus. Direct conditioning occurs when an individual is frightened by a phobic stimulus.

A major determinant of specific phobias is conditioning. Association and avoidance are types of conditioning. In association conditioning, a stimulus that was initially neutral begins to trigger an anxiety response. For example, if an individual was driving one day and experienced a strong anxiety response, an association may form between driving and anxiety. Individuals do not learn to become phobic until they begin to avoid. In avoidance conditioning, individuals learn to avoid a stimulus that triggers anxiety. Every time individuals avoid the phobic stimulusdriving, for examplethey are rewarded by the relief from anxiety.

TRAUMATIC CAUSES. A determinant of specific phobias includes traumas. For example, individuals who have been attacked by a dog may develop a specific phobia disorder and become conditioned to fear dogs. Individuals who observe others experiencing a trauma (the others are "modeling" behavior for the individual who will be affected) may become predisposed to developing specific phobia disorder. For example, individuals who witness people falling from a building may develop a specific phobia disorder. Phobias with a traumatic origin may develop acutely, or, in other words, have a more sudden onset than other phobias that develop more gradually.

PSYCHODYNAMIC CAUSES. Psychodynamic theorists explain that phobias emerge because individuals have impulses that are unacceptable, and they repress these impulses. More specifically, Freud proposed that phobias emerge because of an unresolved oedipal conflict. According to Freud's theory, an oedipal conflict is a developmental conflict that emerges during the third (or oedipal) stage of Freud's psychosexual development stages. During this stage, a conflict emerges with regard to the triad of father, mother, and child. The conflict concerns the sexual impulses that the child has toward the parent of the opposite gender and the hostile impulses that the child has towards the parent of the same gender. During this stage, the developmental conflict concerns a resolution of oedipal issues. Psychoanalysts propose that when repression does not work, individuals with phobias displace their anxiety connected to the unresolved oedipal conflict upon a situation or object that is less relevant. The feared situation or object symbolizes the source of the conflict. For example, a specific phobia may be connected to an individual's conflict about aggressive or sexual thoughts and feelings. In one sense, a phobia protects individuals from realizing their emotional issues.

The case of Hans, a boy with a horse phobia, is Freud's paradigm example of a phobia. Freud attributed Hans' fear of horses to an oedipal conflict that was not resolved, and he explained that Hans repressed his sexual feelings for his mother and his wish that his father would die. Freud proposed that Hans feared that his father would discover his wish, repressed his wish to attack his father, and displaced his fear of his father's aggression onto horses. The young boy resolved the conflict of loving and hating his father by hating horses rather than admitting that he had aggressive feelings towards his father. Hans was better able to avoid the feared horses than his father. Thus, the phobia in the case of Hans represents a compromise of intrapsychic movement.

PHYSIOLOGICAL CAUSES. Some research has suggested that the high activation of brain pathways that correspond to the cognitive and emotional constituents of anxiety biologically predispose individuals to specific phobias.

GENETIC AND FAMILY CAUSES. Although specific phobia is frequently attributed to environmental issues such as modeling , learning by association, and negative reinforcement , genetic predisposition can influence this disorder. An individual who has a family member with a specific phobia is at an increased risk for developing this disorder. Some research indicates that the pattern of types are similar within families. For example, a first-degree biological relative of individuals with a situational type is likely to have phobias of situations. Studies indicate that the blood and injury phobias have strong familial patterns.

SOCIOCULTURAL CAUSES. There is a paucity of information about cultural differences in specific phobias. Phobia content may vary by culture. Fear of a phobic stimulus such as magic or spirits, present in several cultures, is diagnosed as a specific phobia only if the fear is excessive for a particular culture and if the fear triggers major distress or interferes with functioning. Some research indicates that African Americans are more likely than whites to report specific phobias. Some studies show that specific phobias are less common among whites born in the U.S. or immigrant Mexican-Americans than among Mexican-Americans born in the U.S. Research suggests mixed data with regard to socioeconomic level, with some data associating specific phobia disorder with a lower socioeconomic level.

PERSONAL VARIABLES. Studies suggest a relationship between age and specific phobia. Research indicates some connections between the age of individuals with specific phobias and insight into the extreme quality of their fears. Insight increases with age. Children, unlike adults and adolescents, often do not report feelings of distress about having phobias. Insight into the unreasonable nature of the fear is not required for a diagnosis of specific phobia in children. The animal and natural environment types of specific phobia are common and generally transitory in children. Some studies indicate a connection between gender and specific phobia. Research shows that specific phobias from the animal type are more common among women. Some studies suggest that women are more likely to report specific phobias and to seek treatment than men.

Symptoms

DSM-IV-TR delineates seven diagnostic criteria for specific phobia:

  • Significant and enduring fear of phobic stimulus: Patients with specific phobia display marked and enduring fear when they encounter a defined situation or object, the phobic stimulus.
  • Anxiety response to phobic stimulus: Patients with specific phobia display anxiety as soon as they confront the phobic stimulus. When they confront the phobic stimulus, a defined situation or object, patients with specific phobia may experience a panic attack related to the specific situation. Children may cry, cling, freeze, or display tantrums when they express their anxiety in the face of the phobic stimulus.
  • Recognition: Although adolescents and adults realize that their fear is unreasonable and disproportionate to the situation, children may not recognize that their fear is excessive.
  • Avoidance: Individuals with specific phobia avoid the phobic stimulus or endure it with deep distress and anxiety.
  • Impairment and distress: Individuals with specific phobia display avoidance, distress, and anxious anticipation when they encounter the phobic stimulus. Their avoidance reactions interfere with their daily functioning, or they express significant distress about having a phobia.
  • Duration: To diagnose specific phobia in a patient who is under 18 years of age, the duration of the disorder needs to be at least six months.
  • Not accounted for by another disorder: A diagnosis of specific phobia is assigned if the phobic avoidance, panic attacks, or anxiety related to the defined situation or object are not better accounted for by other disorders.

Demographics

General United States population

Specific phobias are common. The prevalence rates of specific phobia in community samples range from 4% to 8%. Over the course of a lifetime, the prevalence estimates in community samples range from 7.2% to 11.3%.

High-risk populations

Individuals whose family members have specific phobia are at a higher risk for developing this disorder.

Cross-cultural issues

Prior to assigning a diagnosis of specific phobia, clinicians need to consider whether a patient's fear is extreme in the context of a particular culture and whether the phobia causes difficulties in daily functioning or triggers a lot of distress. Further research is needed on the effects of culture upon the symptoms of specific phobia.

Gender issues

There are twice as many women with specific phobia than there are men with this disorder. The gender ratio variable varies depending upon the type of specific phobia. Approximately 75%90% of people with the animal, situational, and natural environment types are female. Approximately 55%70% of people with the blood-injection-injury subtype are female. For height phobias, there are fewer women than men than for other specific phobia types; however, illness phobias are more common in men.

Diagnosis

The diagnosis of specific phobia is complicated by factors such as degree of impairment and differential diagnosis. Although fears of specified situations or objects are common, a diagnosis of specific phobia relies on the degree of sufficient impairment.

With regard to differentiating specific phobia types, factors such as the focus of fear and the predictability and timing of the reaction to the phobic stimulus across the specific phobia types can assist clinicians to differentiate. With regard to differentiating specific phobia from other disorders, there are several disorders with similar symptoms. They include panic disorder with agoraphobia , social phobia , post-traumatic stress disorder , obsessive-compulsive disorder , hypochondriasis , schizophrenia , delusional, and other psychotic disorders. Generally, a diagnosis of specific phobia rather than panic disorder is made when there are no spontaneous panic attacks and no fear of panic attacks. It is often difficult to differentiate specific phobia, situational type, from panic disorder with agoraphobia. Specific phobia, situational type, is commonly diagnosed when an individual displays situational avoidance without unexpected and recurrent panic attacks. On the other hand, panic disorder with agoraphobia is diagnosed if an individual experiences an initial onset of panic attacks that are not anticipated and subsequently experiences avoidance of several situations considered triggers of panic attacks. Although individuals with specific phobia, unlike individuals with panic disorder with agoraphobia, do not display enduring anxiety, anxious anticipation may occur when confrontation with a phobic stimulus is more likely to occur. DSM-IV-TR outlines differentiating factors as the type and number of panic attacks, the number of avoided contexts, and the focus of the fear. At times, both diagnoses, specific phobia and panic disorder with agoraphobia, need to be assigned.

Psychological measures

Measures used to diagnose specific phobia include behavioral observation, clinical interviews, physiological evaluation, and self-report measures. The Behavioral Avoidance Task (BAT) is a common behavioral observation method used to assess specific phobia. Often, the diagnosis of specific phobia is made on the basis of an individual's responses to semistructured interviews such as the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV). To assist in differential diagnosis between specific phobias and other disorders with similar characteristics, clinicians use the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). Physiological evaluations usually include heart rate monitors. Self-report questionnaires include measures such as the SUDS (subjective units of discomfort/distress scale), the most frequently used self-report measure, the Fear Survey Schedule (FSS-III), and the Mutilation Questionnaire, specifically for measuring fear of the blood type of specific phobia.

Time of onset/symptom duration

Generally, the initial symptoms of specific phobia occur when an individual is a child or a young adolescent. The type of phobia determines the age of onset. The blood, animal, and natural environment types begin when an individual is a child; however, many new cases of the natural environment type occur when an individual is a young adult. The onset for the height type begins in adolescence. The onset age for the situational type occurs in childhood, but peaks again in the mid-twenties. There is no specific onset age for phobias with a traumatic origin.

Individual variations in specific phobia

Classification systems distinguish between individuals with different types of specific phobias. The types of specific phobia, situation, object, and other, relate to particular features such as the age, gender, and culture of an individual. Some researchers propose that to distinguish individual differences in treatment planning, it is more helpful to simply name the specific phobia rather than to use the type classification system. For example, researchers have found that for the animal type, some animals such as a tiger or a bear did not trigger disgust for tiger-phobic or bear-phobic individuals, but other animals such as a spider triggered disgust for some spider phobic individuals, but did not trigger disgust for other spider phobic individuals.

Dual diagnoses

Specific phobia often occurs with other disorders of mood and anxiety, and with substance-related disorders. When specific phobias occur with other disorders in clinical contexts, the primary diagnosis is associated with greater distress than is the specific phobia. The blood-injury-injection type of specific phobia may occur with physical symptoms such as vasovagal fainting. The vasovagal fainting response is characterized by a short heart rate acceleration and blood pressure elevation. Then, the heart rate decelerates and the blood pressure drops. Research shows that individuals who have one specific phobia type are more likely to have other phobias of the same type.

Treatments

Specific phobias are highly treatable. They are most effectively treated by psychological rather than biological treatments. The primary goal of most treatments of specific phobias is to reduce fear, phobic avoidance, impairment, and distress. Approximately 12%30% seek treatment for specific phobias.

Cognitive-behavioral therapy

Cognitive-behavioral therapy has been effective in treating specific phobias. There has not been much research on the effects of cognitive therapy alone on specific phobias. Cognitive therapists challenge fearful thoughts and replace them with more positive thoughts. Although some studies show benefits in that cognitive therapy may assist patients to decrease anxiety related to their exposure exercises, research indicates that cognitive therapy alone is probably not an effective treatment for specific phobia. Researchers suggest adding panic management strategies such as cognitive restructuring to assist with behavioral treatments.

Several studies indicate that real-life (in vivo) desensitization or exposure is the most effective and long-lasting treatment for a broad range of specific phobias. Systematic desensitization includes a process by which individuals unlearn the association between the phobic stimulus and anxiety. Incremental exposure involves the patient's gradual facing of the phobic stimulus through a series of graded steps. Wolpe's imagery desensitization is suggested so that patients with specific phobias can face the fear in imagery prior to attempting in vivo exposure. Unlike many of the other treatments, the treatment gains of in vivo exposure are maintained upon follow-up. Some desensitization treatments employ flooding as a useful strategy. When flooding is used, patients maintain a high anxiety level without retreating. Similar to desensitization, flooding can be used both in imagination and in vivo. Flooding is not suggested for most individuals because it can trigger a higher level of sensitization and fear reinforcement. For in vivo treatment, a patient needs to be highly motivated because the treatment may lead to temporary discomfort. The primary reasons for poor compliance with cognitive-behavioral treatment include lack of time, anxiety, and low motivation.

Psychodynamic therapy

Psychodynamic psychotherapy , or insight-oriented therapy assists patients to become more aware of the symbolic nature of their anxiety and to explore traumatic past events. Insight-oriented therapy is a psychodynamic therapy that aims to expose and reduce patients' unconscious conflicts, increase patients' understanding of their underlying thoughts, and assist patients to gain conscious control over their psychological conflicts. In psychodynamic therapy, for example, patients may discover that their anxiety may be connected to aggressive or sexual feelings and thoughts.

Group therapy

There is little research on group therapy for specific phobia disorder. Some studies suggest that group treatment has been effective for dental and spider phobias.

Medications

There has been a paucity of research on the relationship between medication and specific phobia. Generally, pharmacotherapy has not been considered to be a treatment of choice for individuals with specific phobias. Benzodiazepines, however, (medications that slow the central nervous system to ease nervousness and tension) may decrease anticipatory anxiety prior to an individual's entrance into a phobic situation. A low dose of a benzodiazepine such as clonazepam (Klonopin) or alprazolam (Xanax) is indicated to decrease some fear arousal prior to in vivo exposure. The reduction of symptoms, however, may interfere with the treatment. Prior to beginning in vivo exposure, an antidepressant such as sertraline (Zoloft) or paroxetine (Paxil) is suggested to increase motivation for undertaking an uncomfortable treatment. Beta blockers can assist individuals to confront the specific phobia.

Alternative therapies

Research shows some benefits for specific phobias with applied relaxation. Relaxation training includes abdominal breathing and muscle relaxation on a regular basis. Studies have indicated that applied muscle tension has been highly effective for individuals with blood type phobias who faint in that the treatment triggers an early response. When using applied tension, therapists request that patients tense their muscles several times. The repeated muscle tensing results in a temporary increase in blood pressure and prevents fainting when patients see blood. Similar to in vivo exposure, the gains from applied tension are maintained upon follow-up. Some alternative therapies include immersive virtual reality, hypnotherapy , eye-movement desensitization and reprocessing (EMDR), and energy balance approaches such as massage and acupuncture .

Prognosis

If specific phobias exist in adolescence, they have a greater chance of persisting in early adulthood. Specific phobias that continue into adulthood generally become chronic if they are not treated. Furthermore, there is a greater chance for an individual diagnosed with specific phobia to develop new phobias as a young adult. Phobias contracted during childhood or adolescence that continue when individuals become young adults remit approximately 20% of the time. Individuals with specific phobias do not often seek treatment. For those who seek treatment, research suggests that compared to individuals with specific phobias whose fear diminishes slowly during exposure, individuals with specific phobias whose fear diminishes more rapidly have a better prognosis for recovery.

A consideration of prognosis takes into account the distinction between fear onset and phobia onset. Studies indicate that individuals with specific phobias of animal, blood, heights, and driving had a fear onset nine years earlier than their phobia onset. Some studies have shown that generalized anxiety level, severity of symptoms, and prior experience with the phobic stimulus are factors that have been associated with treatment outcome.

Although most mental health professionals consider specific phobia that begins in childhood to be a benign disorder, it can last for years if left untreated. Some studies indicate, however, that specific phobia does not become worse and usually diminishes as an individual ages. Without treatment, the prognosis is poor for an individual who has several phobias.

Prevention

Early detection is a key to assisting individuals with mild cases of specific phobia to seek treatment to prevent the development of full-blown cases of the disorder. Individuals who are at risk for developing specific phobia as well as individuals who already have been diagnosed with specific phobia need to avoid caffeine because caffeine can increase arousal. Further research is needed to discover variables that predict the reason that only certain individuals will develop specific phobias after conditioning or acquiring information that leads to fear.

See also Anxiety-reduction techniques; Generalized anxiety disorder; Exposure treatment

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

Antony, Martin, M., Ph.D., and David H. Barlow, Ph.D. "Social Phobia, Specific Phobia." In Psychiatry. Volume 2. Edited by Allan Tasman, M.D., Jerald Kay, M.D., and Jeffrey A. Lieberman, M.D. Philadelphia: W. B. Saunders Company, 1997.

Antony, Martin, M., Ph.D., and Richard P. Swinson. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment. Washington, DC: American Psychological Association, 2000.

Bourne, Edmund J., Ph.D. The Anxiety and Phobia Workbook. 3rd Edition. Oakland, CA: New Harbinger Publications,2001.

Bourne, Edmund J., Ph.D. Beyond Anxiety and Phobia: A Step-by-Step Guide to Lifetime Recovery. Oakland, CA: New Harbinger Publications, 2001.

Donahue, Brad, and James Johnston. "Specific Phobia." In Diagnosis, Conceptualization, and Treatment Planning for Adults: A Step-by-Step Guide, edited by Michel Hersen and Linda K. Porzelius. Mahwah, New Jersey: Lawrence Erlbaum Associates, Publishers, 2002.

Elkin, David, M.D., and Cameron S. Carter, M.D. "Anxiety Disorders." In Introduction to Clinical Psychiatry, edited by G. David Elkin, M.D. 1st edition. Stamford, Connecticut: Appleton and Lange, 1999.

PERIODICALS

Mager, Ralph, Alex H. Bullinger, Franz Mueller-Spahn, Marcus F. Kuntze, and Robert Stoermer. "Real-Time Monitoring of Brain Activity in Patients with Specific Phobia during Exposure Therapy, Employing a Stereoscopic Virtual Environment." CyberPsychology and Behavior 4, no. 4 (2001): 465469.

ORGANIZATIONS

American Psychological Association. 750 First Street NE, Washington, D.C. 20002-4242. (202) 336-5500. <http://www.apa.org>.

Anxiety Disorders Association of America (ADAA). 11900 Parklawn Drive, Suite 100, Rockville, MD. 20852-2624.(301) 231-9350. <http://www.adaa.org>.

Phobics Anonymous. P.O. Box 1180, Palm Springs, CA. 92213. (760) 322-COPE.

Judy Koenigsberg, Ph.D.

Phobias

views updated May 14 2018

313. Phobias

See also 28. ATTITUDES ; 41. BEHAVIOR ; 156. FEAR ; 254. MANIAS ; 311. -PHILE, -PHILIA, -PHILY ; 334. PSYCHOLOGY .

N.B.:
noun forms end in -phobe and adjective forms end in -phobic, unless otherwise noted.
acarophobia
a fear of skin infestation by mites or ticks.
achluophobia
scotophobia.
acidophobia
an inability to accommodate to acid soils, as certain plants.
acousticophobia
an abnormal fear of noise.
acrophobia
an abnormal fear of heights. Also called altophobia, batophobia, hypsophobia .
aelurophobia
ailurophobia.
aerophobia
an abnormal fear or dislike of drafts. Cf. ancraophobia, anemophobia .
agoraphobia
an abnormal fear of being in crowded, public places, like markets. Cf. demophobia .
agyrophobia
an abnormal fear of crossing streets. Also dromophobia .
aichmophobia
an abnormal fear of pointed objects.
ailurophobia, aelurophobia, elurophobia
an abnormal fear of cats. Also called gatophobia, felinophobia .
albuminurophobia
a fear of albumin in ones urine as a sign of kidney disease.
algophobia
an extreme fear of pain. Cf. odynophobia .
altophobia
acrophobia.
amathophobia
an abnormal fear of dust.
amaxophobia
an abnormal fear of being or riding in vehicles.
ancraophobia
an abnormal fear of wind. Cf. aerophobia, anemophobia .
androphobia
1. an abnormal fear of men.
2. a hatred of males. Cf. gynephobia .
anemophobia
an abnormal fear of drafts or winds. Cf. aerophobia, ancraophobia .
anginophobia
an abnormal fear of quinsy or other forms of sore throat.
Anglophobia
a hatred or fear of England and things English.
anthophobia
an abnormal fear of flowers.
anthropophobia
an abnormal fear of people, especially in groups.
antlophobia
an abnormal fear of floods.
apeirophobia
an abnormal fear of infinity.
aphephobia
an abnormal fear of touching or being touched. Also called haphephobia, haptephobia, thixophobia .
apiphobia, apiophobia
an intense fear of bees. Also called melissophobia .
arachnephobia
an abnormal fear of spiders.
asthenophobia
an abnormal fear of weakness.
astraphobia, astrapophobia
an abnormal fear of lightning. Cf. brontophobia, keraunophobia.
astrophobia
siderophobia.
ataxiophobia, ataxophobia
an abnormal fear of disorder.
atelophobia
an abnormal fear of imperfection.
atephobia
an abnormal fear of ruin.
aulophobia
an abnormal fear of flutes.
aurophobia
an abnormal dislike of gold.
automysophobia
an abnormal fear or dislike of being dirty. Cf. misophobia .
autophobia, autophoby
an abnormal fear of being by oneself. Also called eremiophobia, eremophobia, monophobia .
bacillophobia
an abnormal fear of germs. Also called bacteriophobia .
ballistophobia
an abnormal fear of missiles.
barophobia
an abnormal fear of gravity.
basophobia, basiphobia
in plants, an inability to accommodate to alkaline soils.
bathmophobia
an abnormal dislike or fear of walking.
bathophobia
1. an abnormal fear of depth.
2. an intense dislike of bathing.
batophobia
1. acrophobia.
2. an abnormal fear of passing high buildings.
batrachophobia
an abnormal fear of frogs and toads.
belonephobia
an abnormal fear of pins and needles.
bibliophobia
an abnormal dislike for books.
blennophobia
an abnormal fear or dislike of slime. Also called myxophobia .
bogyphobia
a dread of demons and goblins.
bromidrosiphobia
an abnormal fear of having an unpleasant body odor.
brontophobia
an abnormal fear of thunder and thunderstorms. Also called tonitrophobia . Cf. astraphobia, keraunophobia .
cainophobia
an abnormal fear or dislike of novelty. Also called cainotophobia, neophobia .
carcinomophobia, carcinomatophobia, carcinophobia
an abnormal fear of cancer. Also called cancerophobia .
cardiophobia
an abnormal fear of heart disease.
cathisophobia
an abnormal fear or dislike of sitting down.
catoptrophobia
an abnormal fear of mirrors.
Celtophobia
an intense dislike of Celts.
cenophobia, kenophobia
an abnormal fear of a void or of open spaces.
ceraunophobia
keraunophobia.
chaetophobia
an abnormal fear of hair.
cheimaphobia, cheimatophobia
an abnormal fear or dislike of cold. Cf. cryophobia, psychrophobia .
cherophobia
an abnormal fear of gaiety.
chinophobia
an abnormal fear or dislike of snow.
cholerophobia
an intense fear of cholera.
chrematophobia
an intense fear or dislike of wealth.
chrometophobia
an abnormal fear or dislike of money.
chromophobia
an abnormal fear of colors.
chronophobia
an abnormal discomfort concerning time.
cibophobia
an abnormal fear of food. Also called sitophobia, sitiophobia . Cf. phagophobia .
claustrophobia
an abnormal fear of enclosed spaces. Also called cleistophobia .
cleptophobia
kleptophobia.
clinophobia
an abnormal fear or dislike of going to bed.
coitophobia
an abnormal fear of sexual intercourse. Also called genophobia . Cf. erotophobia .
cometophobia
an abnormal fear of cornets.
computerphobia
intense fear or dislike for computers and things associated with them.
coprophobia
an abnormal fear of excrement.
cremnophobia
an abnormal fear of precipices.
cryophobia
an abnormal fear of ice or f rost. Cf. cheimaphobia .
crystallophobia
an abnormal fear of glass. Also called hyalophobia .
cymophobia
an abnormal fear of waves.
cynophobia
1. an intense dread of dogs.
2. kynophobia.
cypridophobia
an abnormal fear of venereal disease. Also called venereophobia .
deipnophobia
an abnormal fear or dislike of dining and dinner conversation.
demonophobia
an abnormal fear of spirits.
demophobia
an intense dislike of crowds. Cf. agoraphobia .
dermatophobia
an abnormal fear of skin disease. Also called dermatosiophobia, dermatopathophobia .
dextrophobia
an abnormal fear of objects on the right side of the body. Cf. levophobia .
diabetophobia
an intense fear of diabetes.
dikephobia
an abnormal fear or dislike of justice.
dinophobia
an abnormal fear of whirlpools.
diplopiaphobia
an abnormal fear of double vision.
domatophobia
an abnormal fear of being in a house.
doraphobia
an abnormal fear or dislike of fur.
dromophobia
1. agyrophobia.
2. kinetophobia.
dysmorphophobia
an abnormal dread of deformity, usually in others. Also called dysmorphomania .
ecclesiophobia
an abnormal fear or dislike of church.
ecophobia, oecophobia, oikophobia
an abnormal fear of or aversion to home surroundings.
eisoptrophobia
an abnormal fear of mirrors.
eleutherophobia
an abnormal fear of freedom.
elurophobia
ailurophobia.
emetophobia
an abnormal fear of vomiting.
enetophobia
an abnormal fear of needles.
entomophobia
an abnormal fear of insects.
eosophobia
an abnormal fear of the dawn.
eremiophobia, eremophobia
autophobia.
ergasiophobia
an abnormal fear or dislike of work.
ergophobia
a hatred of work.
erotophobia
an abnormal fear of sexual feelings and their physical expression. Also called miserotica . Cf. coitophobia .
erythrophobia
1. an abnormal fear of the color red.
2. an abnormal fear of blushing.
eurotophobia
an abnormal fear of female genitals.
febriphobia
an abnormal fear of fever.
felinophobia
ailurophobia.
Francophobia, Callophobia
a hatred of France or things French.
galeophobia
an abnormal fear of sharks.
Gallophobia
Francophobia.
gamophobia
an abnormal fear or dislike of marriage.
gatophobia
ailurophobia.
genophobia
coitophobia.
gephyrophobia
an abnormal fear of crossing a bridge.
gerascophobia
an abnormal fear of growing old.
Germanophobia
a hatred of Germany, or things German. Also called Teutophobia, Teutonophobia .
geumophobia
an abnormal fear of tastes or flavors. Cf. olfactophobia .
glossophobia
an abnormal fear of speaking in public or of trying to speak.
graphophobia
a dislike of writing.
gringophobia
in Spain or Latin America, an intense dislike of white strangers.
gymnophobia
an abnormal fear of nudity. Also called nudophobia .
gynephobia, gynophobia
an abnormal fear or hatred of women. Cf. androphobia, parthenophobia .
hadephobia
an abnormal fear of heil. Also called stygiophobia .
haemaphobia
hemophobia.
hagiophobia
an intense dislike for saints and the holy.
hamartophobia
an abnormal fear of error or sin.
haphephobia, haphophobia, haptephobia, haptophobia
aphephobia. Also called thixophobia .
harpaxophobia
an abnormal fear of robbers. Cf. kleptophobia .
hedonophobia
an abnormal fear of pleasure.
heliophobia
1. an abnormal sensitivity to the effects of sunlight.
2. an abnormal fear of sunlight.
helminthophobia
an abnormal fear of being infested with worms. Cf. scoleciphobia .
hemaphobia, haemaphobia, hemophobia
an abnormal fear of the sight of blood. Also called hematophobia .
herpetophobia
an abnormal fear of reptiles. Cf. ophidiophobia .
hierophobia
an abnormal fear or dislike of sacred objects.
hippophobia
an abnormal fear of horses.
hodophobia
an abnormal fear or dislike of travel.
homichlophobia
an abnormal fear of fog.
homilophobia
a hatred for sermons.
homophobia
fear of or apprehension about homosexuality. Cf. uranophobia .
hyalophobia
crystallophobia.
hydrophobia
1. an abnormal fear of water.
2. the occurrence in humans of rabies. Also called lyssa .
hydrophobophobia
an abnormal fear of rabies. Also called lyssophobia . Cf. kynophobia .
hygrophobia
an abnormal fear of liquids in any form, especially wine and water.
hylephobia
an intense dislike for wood or woods.
hypengyophobia
an abnormal fear of responsibility. Cf. paralipophobia .
hypnophobia
an abnormal fear of sleep.
hypsophobia, hypsiphobia
acrophobia.
iatrophobia
an abnormal fear of going to the doctor.
ichthyophobia
an abnormal fear of fish.
iophobia
an abnormal fear of poisons. Cf. toxiphobia .
isopterophobia
an abnormal fear of termites.
Judophobism, Judophobia
a hatred of Jews and of Jewish culture. Also called Judaeophobia .
kakorrhaphiophobia
an abnormal fear of failure or defeat.
katagelophobia
an abnormal fear or dislike of ridicule.
keraunophobia, ceraunophobia
an abnormal fear of thunder and lightning. Cf. astraphobia, brontophobia .
kinetophobia
an abnormal fear or dislike of motion. Also called dromophobia .
kleptophobia, cleptophobia
an abnormal fear of thieves or of loss through thievery. Cf. harpaxophobia .
kopophobia
an abnormal fear of mental or physical examination.
kynophobia, cynophobia
an abnormal fear of pseudorabies. Cf. hydrophobophobia .
laliophobia, lalophobia
an abnormal fear of talking.
lepraphobia
an abnormal fear of leprosy.
levophobia
an abnormal fear of objects on the left side of the body. Cf. dextrophobia .
Iimnophobia
an abnormal fear of lakes.
linonophobia
an abnormal fear of string.
logophobia
an abnormal fear or dislike of words.
lyssophobia
1. an abnormal fear of becoming insane.
2. hydrophobophobia.
maieusiophobia
tocophobia.
maniaphobia
an abnormal fear of madness.
mastigophobia
rhabdophobia.
mechanophobia
an abnormal aversion to or fear of machinery.
melissophobia
apiphobia.
meningitophobia
an abnormal fear of meningitis.
merinthophobia
an abnormal fear of being bound.
metallophobia
an abnormal fear of metals.
meteorophobia
an abnormal fear of meteors or meteorites.
misophobia, musophobia, mysophobia
an abnormal fear of dirt, especially of being contaminated by dirt. Cf. automysophobia, rhypophobia .
molysomophobia
an abnormal fear of infection.
monopathophobia
an abnormal fear of sickness in a specified part of the body
monophobia
autophobia.
motorphobia
an abnormal fear or dislike of motor vehicles.
musicophobia
an intense dislike of music.
musophobia
1. an abnormal fear of mice.
2. misophobia.
mysophobia
misophobia.
mythophobia
an abnormal fear of making false statements.
myxophobia
blennophobia.
necrophobia
1. Also called thanatophobia . an abnormal fear of death.
2. an abnormal fear of corpses.
negrophobia
a strong dislike or fear of Negroes.
neophobia
cainophobia.
nephophobia
an abnormal fear of clouds.
noctiphobia
an abnormal fear of the night. Cf. nyctophobia .
nosophobia
an abnormal fear of contracting disease.
nudophobia, nudiphobia
gymnophobia.
nyctophobia
an abnormal fear of darkness or night. Cf. noctiphobia .
ochlophobia
an abnormal fear of crowds.
ochophobia
an abnormal fear of vehicles.
odontophobia
an abnormal fear of teeth, especially those of animals.
odynophobia
an abnormal fear of pain. Cf. algophobia .
oenophobia, oinophobia
a dislike of or hatred for wine.
olfactophobia
an abnormal fear or dislike of smells. Also called osmophobia, osphresiophobia . Cf. geumophobia .
ombrophobia
an abnormal fear of rain.
ommatophobia
an abnormal fear of eyes.
onomatophobia
an abnormal fear of a certain name.
ophidiophobia
an abnormal fear of snakes. Also called ophiophobia . Cf. herpetophobia .
ornithophobia
an abnormal fear of birds.
osmophobia
olfactophobia.
osphresiophobia
olfactophobia.
ouranophobia
uranophobia.
paedophobia
pedophobia.
panophobia
1. a nonspecific fear; a state of general anxiety.
2. an abnormal fear of everything. Also panphobia, pantaphobia, pantophobia .
papaphobia
an intense fear or dislike of the pope or the papacy.
paralipophobia
an abnormal fear of neglect of some duty. Cf. hypengyophobia .
paraphobia
an abnormal fear of sexual perversion.
parasitophobia
an abnormal fear of parasites.
parthenophobia
an extreme aversion to young girls. Cf. gynephobia .
pathophobia
an abnormal fear of disease.
peccatiphobia, peccatophobia
an abnormal fear of sinning.
pediculophobia
an abnormal fear of lice. Also called phthiriophobia .
pedophobia, paedophobia
an abnormal fear or dislike of dolls.
pellagraphobia
an abnormal fear of catching pellagra.
peniaphobia
an abnormal fear of poverty.
phagophobia
an abnormal fear of eating. Cf. cibophobia .
pharmacophobia
an abnormal fear of drugs.
phasmophobia
an abnormal fear of ghosts. Cf. pneumatophobia, spectrophobia .
phengophobia
an abnormal fear of daylight.
philosophobia
an abnormal fear or dislike of philosophy or philosophers.
phobophobia
an abnormal fear of fear itself.
phonophobia
an abnormal fear or dislike of noise.
photalgiophobia
an abnormal fear of photalgia, pain in the eyes caused by light.
photophobia
1. an abnormal fear of light.
2. a painful sensitivity to light, especially visually. Also called photodysphoria .
3. a tendency to thrive in reduced light, as exhibited by certain plants.
phronemophobia
an abnormal fear of thinking.
phthiriophobia
pediculophobia.
phthisiophobia
an abnormal fear of tuberculosis. Also called tuberculophobia .
pneumatophobia
an abnormal fear of incorporeal beings. Cf. phasmophobia, spectrophobia .
pnigophobia
an abnormal fear of choking.
pogonophobia
an abnormal fear or dislike of beards.
poinephobia
an abnormal fear of punishment.
politicophobia
a dislike or fear of politicians.
polyphobia
an abnormal fear of many things. Cf. panophobia, def. 2.
ponophobia
an abnormal fear of fatigue, especially through overworking.
potamophobia
a morbid fear of rivers.
proctophobia
Medicine. a mental apprehension in patients with a rectal disease.
proteinphobia
a strong aversion to protein foods.
psychophobia
an abnormal fear of the mind.
psychrophobia
an abnormal fear of the cold. Cf. cheimaphobia .
pteronophobia
an abnormal fear of feathers.
pyrexiophobia
an abnormal fear of fever. Cf. thermophobia .
pyrophobia
an abnormal fear of fire.
rhabdophobia
1. an abnormal fear of being beaten.
2. an abnormal fear of magic.
rhypophobia
an abnormal fear of filth. Cf. misophobia .
Russophobism, Russophobia
an excessive fear or dislike of Russians and things Russian.
Satanophobia
an excessive fear of Satan.
scabiophobia
an abnormal fear of scabies.
scatophobia
1. coprophobia.
2. an abnormal dread of using obscene language.
sciophobia
an abnormal fear of shadows.
scoleciphobia
an abnormal fear of worms. Also called vermiphobia . Cf. helminthophobia .
scopophobia
an abnormal fear of being looked at. Also scoptophobia .
scotophobia
an abnormal fear of the dark. Also called achluophobia .
selaphobia
an abnormal fear or dislike of flashes of light.
siderodromophobia
an abnormal fear or dislike of railroads or of traveling on trains.
siderophobia
an abnormal fear of the stars. Also called astrophobia .
sitophobia, sitiophobia .
cibophobia.
Slavophobia
fear or hatred of things Slavic, especially of their real or imagined political influence.
spectrophobia
an abnormal fear of specters or phantoms. Cf. phasmophobia, pneumatophobia .
stasibasiphobia
1. an abnormal conviction that one cannot stand or walk.
2. an abnormal fear of attempting to do either.
stygiophobia
hadephobia.
symmetrophobia
an abnormal fear or dislike of symmetry.
syphiliphobia, syphilophobia
an abnormal fear of becoming infected with syphilis. Cf. cypridophobia .
tabophobia
an abnormal fear of a wasting sickness.
tachophobia
an abnormal fear of speed.
taphephobia, taphiphobia, taphophobia
an abnormal fear of being buried alive.
tapinophobia
an abnormal fear of small things.
taurophobia
an abnormal fear of bulls.
teleophobia
a dislike and rejection of teleology.
telephonophobia
an abnormal fear of using the telephone.
teratophobia
an abnormal fear of monsters or of giving birth to a monster.
Teutophobia, Teutonophobia
Germanophobia.
thaasophobia
an abnormal fear or dislike of being idle.
thalassophobia
an abnormal fear of the sea.
thanatophobia
necrophobia, def. 1.
theatrophobia
an abnormal fear of theaters.
theophobia
an abnormal fear of God.
thermophobia
an abnormal fear or dislike of heat. Cf. pyrexiophobia .
thixophobia
aphephobia.
tocophobia, tokophobia
an abnormal fear of childbirth. Also called maieusiophobia .
tomophobia
an abnormal fear of surgical operations.
tonitrophobia, tonitruphobia
brontophobia.
topophobia
Rare. an abnormal fear of certain places.
toxiphobia, toxicophobia
an abnormal fear of being poisoned. Cf. iophobia .
traumatophobia
an excessive or disabling fear of war or physical injury.
tremophobia
an abnormal fear of trembling.
trichinophobia
an abnormal fear of trichinosis. Also called trichophobia, trichopathophobia .
tridecaphobia
triskaidekaphobia.
triskaidekaphobia
an abnormal fear of the number 13. Also called tridecaphobia .
trypanophobia
vaccinophobia.
tuberculophobia
phthisiophobia.
tyrannophobia
an intense fear or hatred of tyrants.
uranophobia
1. an abnormal fear of homosexuals and homosexuality. Also homophobia.
2. an abnormal fear of the heavens. Also called ouranophobia .
urophobia
an abnormal fear of passing urine.
vaccinophobia
an abnormal fear of vaccines and vaccination. Also called trypanophobia .
venereophobia
cypridophobia.
vermiphobia
scoleciphobia.
xenophobia
an abnormal fear or hatred of foreigners and strange things.
xerophobia
an abnormal fear of dryness and dry places, like deserts.
zelophobia
an abnormal fear of jealousy.
zoophobia
an abnormal fear or dislike of animals.

Phobias

views updated Jun 08 2018

Phobias

Freud and psychoanalysis

Some individual phobias

BIBLIOGRAPHY

A phobia is an irrational, persistent fear of a particular object or place, class of objects or places, etc. Used as a noun or combining form, phobia denotes fear or dread, and in medicine and psychiatry it is joined either with names of objects, situations, etc., or with Greek-derived forms of such names; thus, street phobia, or agoraphobia (from the Greek agora, or “market place”). As a symptom complex the phobia also includes any avoidances and inhibitions employed to forestall impending attacks of anxiety. Thus, an agoraphobic person may be unable to leave his home without incurring anxiety and may therefore remain in it constantly. A person with rat phobia may stop his ears when rats are mentioned in conversation. The phobic person may elaborate and form compromises to keep the dreaded object, or the idea of it or allusion to it, at a distance (e.g., by restricting his activities, putting general or special taboos on certain localities, etc.).

Whether a state of mind is to be considered rational or irrational eventually depends on commonsense judgment. This judgment is usually that of the phobic person himself, who knows that the feared object is harmless or in any case should not provoke such intense, unmasterable anxiety. Often ashamed or aware of the absurdity, the phobic patient may nevertheless try to rationalize that there is a possibility of “danger.” Accessory circumstances often determine whether a given fear is rational or not, but judging the degree of rationality is still ultimately a matter of common sense.

In early childhood the matter of rationality is irrelevant. The fears of small children are rarely rational according to adult standards. Children’s insecurity and fear of strangers are neither rational nor irrational. Animal phobias of small children resemble in many ways the fears of certain savages, with whom they share a “totemistic” attitude, the differentiation between man and other animals not being well established. Gradual development of the sense of reality through experience and education leads to such differentiation.

History and semantics. Modern interest and ideas about the phobias began with an article by Westphal, “Die Agoraphobie” (1871). The term agoraphobia was invented in this case to denote a morbid fear of open places and is usually extended to mean a fear of streets or the outdoors generally. The German words used were Platzangst and Platzfurcht, which retain the idea of an open square. To one of Westphal’s three patients, a certain square in Berlin looked as if it were miles wide. The patient complained that any attempt to cross the square or to walk on certain streets brought on a severe attack of anxiety accompanied by trembling, head sensations, palpitation, etc. The presence of a companion prevented or assuaged the anxiety and enabled the patient to skirt the square with somewhat lessened fear. He did not fear traffic; indeed, he felt no anxiety if he could stay near a carriage while crossing. To see houses with windows was also reassuring, but to walk along windowless walls, like those of certain barracks, would bring on an anxiety attack, and he could not go into the Tiergarten, where there were no houses. Absence of human beings or signs of life, an empty street or park, was more dangerous than traffic.

Phobeio, the Greek word from which phobia is derived, means “I fear,” but in earliest times it meant both “I am afraid” and “I am put to flight”; for Homeric Greeks, emotion and tendency to action were “close together” (Onians 1951, p. 19). Greek words can be readily used in compounds, and phobo- and -phobia were used as combining forms. Hence, -phobia easily became one of a large class of suffixes (including -mania, -philia, -pathy, etc.) that were adopted by medical and psychological writers. Thus we have hydrophobia, fear of water, at one time also called phobodipsia, fear of drinking; photophobia, fear and avoidance of light, a medical but not necessarily a psychiatric term; xenophobia, fear and avoidance of strangers or foreigners. An obsolete term of this sort is panophobia, the night terror of infants. (See Sauvages 1763.)

Name inventing has periodically flourished and waned in science and medicine. In the late eighteenth and early nineteenth centuries, partly in emulation of Linnaeus, imaginative nomenclature was in vogue. Psychiatrists participated heartily in wordbuilding, particularly after Esquirol’s adventures with the suffix -mania (1838). They made such wide use of the suffix -phobia that Benjamin Rush (1825) jocularly suggested the name rum phobia for what he opined must be “a very rare distemper.” He also facetiously suggested doctor phobia and church phobia (cited in Menninger et al. 1963). Such near-slang usage emphasizes the avoidance aspect and ignores any anxiety. It has been resuscitated in current psychiatric writings in such terms as school phobia, job phobia, and the like, where the anxiety may not be of the conscious phobic type at all.

The modern popularity of the word and suffix began with Westphal’s coining of agoraphobia. The new term was widely accepted, and many analogous terms were invented (see Janet & Raymond 1903). For several decades after Westphal many types of phobias were described and named. Some names are still in use, some are obsolete, and others are met with only occasionally. Claustrophobia still refers to the morbid fear of entering or staying in closed spaces, and ereuthophobia is a word generally understood to mean a fear of blushing. Aelurophobia and gephyrophobia are rather rare and are ordinarily superseded by cat phobia and bridge phobia, respectively. Zoophobia, or animal phobia, is inclusive, applying to dogs, cats, birds, etc. Besides the newly described phobias, others were retrieved from earlier literature and given new names. By 1914, G. Stanley Hall could list 136 words ending in -phobia; many of these were never subjects of clinical description but were apparently purely philological virtuoso inventions. The history of this period and pertinent references are to be found in Krafft-Ebing (1895), Janet (see in Janet & Raymond 1903), and Loewenfeld (1904).

The study of the phobias and other neuroses went well beyond philology. Obsessions and compulsions were described by Westphal (1877), and many studies dealt with nervousness, neurasthenia, and anxiety states other than phobias, such as hysteria and hypochondria. This work culminated in a general conception of the neuroses, or psychoneuroses, a group of conditions with all sorts of nonpsychotic psychological symptoms not attributable to recognizable pathological changes in the body. [SeeObsessive–compulsive disorders.]

Classification. The general tendency was to group phobias along with obsessions and compulsions under one heading, on the grounds that they were “compulsive emotions” (Zwangsaffekte). Even today German textbooks usually put quotation marks around the word phobia or refer to die sogenannten Phobien—the so-called phobias (Bumke 1924; Bleuler 1916). French writers, following Janet (see in Janet & Raymond 1903), group phobias with other anxiety states, compulsions, and obsessions under the general rubric psychasthenia. Such classification has some point, at least superficially, for many adults troubled by obsessions and compulsions also may have one or more phobias. However, there are certain cases, adult and infantile, in which there are phobias but no obsessional symptoms. Moreover, Stekel (1908), psychoanalyzing phobic patients of the “pure” type, found that they resembled the conversion hysterics he had treated, differing only in that where the phobic patient suffered an anxiety attack, the classical hysterical patient would manifest a conversion symptom. For this nearly pure type of case Freud suggested to Stekel the designation anxiety hysteria and justified this term in a paper on a childhood phobia (1909). As psychoanalytic conceptions of anxiety developed, and particularly as analysis of phobias in small children progressed, it became evident that phobias might or might not be found in obsessional persons and that they were to be found in patients of all types. Freud’s final theory of anxiety (1926), which interpreted phobias in a novel and original way, lessened the interest in classification.

Although in a general way earlier authors recognized psychological influences as precipitating and predispositional factors, they did not distinguish the phobia from other neurotic disorders in regard to etiology. From the mid-nineteenth century through the beginning of the twentieth, all neuroses were supposed to arise from constitutional weakness or deficiency (“degeneration” in some authors’ terminology) and essentially from a subtle hereditary or inherent defect of the nervous system. Except for Freud and those who accepted his views phobias were, in short, stigmata of the degénérés supérieurs or of psychasthenia.

Freud and psychoanalysis

Freud’s early papers on anxiety and the neuroses contained incidental discussion of certain phobias (1894; 1895a; 1895b), but he first clearly expressed his thoughts on this matter in the case history of “little Hans” (1909; see also Strachey 1962). There he recognized a class of phobias of psychic origin, resembling in many ways the agoraphobia previously described; he gave them the name anxiety hysteria. Phobias were conceived not as illnesses, nor yet precisely as signs of an illness, but as a set of findings: anxiety plus certain special avoidances and inhibitions. In such cases, as time goes on, overt anxiety decreases pari passu as restrictive measures increase. An anxiety state becomes more and more of a phobia.

Infantile zoophobias

Freud characteristically looked to the phobias of children for a situation that would furnish a clue, uncomplicated by later elaborations, to their essential meaning, much as he had found simple, direct wish fulfillments in children’s dreams that threw light on the complicated and distorted wish-fulfilling dreams of adults. The childhood zoophobias did indeed provide a relatively simple picture of the elements in the formation of phobias and ultimately of psychogenic symptoms in general. The two cases best studied and most cited are the horse phobia of “little Hans” (Freud 1909) and the wolf phobia of the young Russian referred to as “the wolf-man” (1918). In later discussions of anxiety, anxiety hysteria, and symptom formation Freud constantly used the material of these cases to illustrate and develop his theories (see 1915a; 1915b; 1926).

In The Problem of Anxiety (1926) Freud explained Hans’s phobia as originating in oedipal wishes. Hans was in love with his mother and was jealous of his father, toward whom he harbored hostile wishes; these wishes came into conflict with his love for his father. The aggression led to a fear of castration, the possibility of which he believed to be a reality. Repressing his love for his mother and his hostility toward his father from consciousness, he displaced his aggression and consequent fear from his father to horses, which he feared would bite off his penis. Thus, to form his phobic symptom, after his repression of the original impulses, Hans used three defense mechanisms: displacement, reversal, for actually his feelings were dangerous to his father rather than the other way round, and regression from the genital idea of castration to the oral idea of being bitten.

The wolf-man’s phobia arose from a different component of the Oedipus complex, from an inverted oedipal wish. Having observed parental coitus, he identified himself with his apparently castrated mother and feared castration if he permitted himself feminine longings for his father. His fear of castration was displaced to the picture of a wolf in a storybook. The fear that came to consciousness when he ran the risk of seeing the picture was of being devoured—an oral equivalent of the desired passive genital satisfaction. Memories recovered during his analysis established the connection between the wolf and the idea of castration. Avoidance here took the convenient form of not looking at the wolfs picture.

From these and other cases of childhood zoophobia Freud asserted that the motive for repression was castration anxiety and that the repressed wishes were the erotic or aggressive components of the Oedipus complex, whether normal or inverted. Repression was then followed by an appropriate displacement, determined by individual experience. Other infantile phobias are based on other types of anxiety, particularly on a fear of losing love, which serve as motives for repression.

Because of a child’s limited experience, the choice of animals is not large. The Angsttier (“dreaded animal”) is apt to be a horse, cow, dog, cat, bird, chicken, beetle, or wasp.

Totemism and zoophobia

The study of the zoophobias showed that a child could displace his feelings about his father to an animal and that this displacement reflected ambivalence. Hans not only feared horses but admired them, and at one point in his therapy he began to jump around like a horse and even bit his father (Freud 1909). His ambivalent attitude and his identification with the animal gave Freud one argument for interpreting the totem animals of primitive peoples as substitutes for the father, and he spoke of the “return of totemism in childhood” (1913, chapter 4).

Mechanisms in the phobia

The defense mechanism of displacement, by which the repressed wishes return to consciousness in disguise, is basic for all phobias, including those of adults. Avoidance behavior or restriction of function follows upon this. In adult phobias, too, the wishes are aggressive or erotic—largely the latter; they are the revived wishes of childhood, usually in new garb. Freud compared the content of the phobia to the manifest façade of the dream (1916–1917), implying that many defense mechanisms may alter the original content and give a conscious picture different from the unconscious latent fantasy. Thus regression modified the wolf-man’s fantasy of being castrated into a conscious fear of being devoured. This further altered the picture, in which the father had already been changed to a wolf by displacement. The displacement mechanism is fundamental, since it is the first and invariable means used by the ego in distorting material that comes back from repression. Other defense mechanisms, such as regression, reversal, and identification, are accessory or secondary in altering the content of the manifest phobic picture. Additional defense mechanisms are described by Sigmund Freud (1926) and some relevant to children by Anna Freud (1936). In the more complicated adult phobias several instinctual wishes may gain expression at the same time through the same content, as a dream may fulfill several wishes at the same time through what is called overdetermination (see Deutsch 1929; Weiss 1935; Fenichel 1944; Lewin 1952).

From the study of the simple phobias Freud constructed a paradigm for the formation of neurotic symptoms in general: threatened eruption of an instinct from repression (or from the id); anxiety or threatened anxiety as the signal of such impending danger; subsequent alterations in the ego by means of defense mechanisms that produce symptoms, each type of which (conversion, phobia, obsession, etc.) appears because of the predominance of one (or a few) defense mechanisms. Thus, the meaning of the word symptom is completely altered. No longer an indication of some underlying illness, it is considered a “structure” composed of alterations in ego functioning due to the mutual interaction of id, ego, and superego.

Some individual phobias

Like the dream, the phobia may show much variation in regard to its manifest façade. However, as certain frequent types of dreams have a nearly standard interpretation, so certain phobias, studied through psychoanalysis, show a relative constancy in unconscious meaning. For example, many wellstudied cases of agoraphobia show that the feared streets are unconsciously conceived as places suitable for sexual adventures (see Deutsch 1929; Katan 1937; Miller 1953; Weiss 1935). The companion chosen as protector by some agoraphobes represents a person to whom they are unconsciously hostile and whom they therefore put in the same jeopardy as themselves. Fear of crossing bridges is a feminine fear of childbirth. A fear of falling, on the street or elsewhere, is also feminine, one of its meanings referring to the figurative sexual fall. Claustrophobic anxiety is connected with unconscious ideas of being buried alive and with prenatal life (Lewin 1935). Generally speaking, these unconscious fantasies are either of temptation or punishment. Fear of being alone often indicates a temptation to masturbate under such circumstances. Fears of insanity may include this temptation, as well as a fear of symbolic castration (head equals penis). Fears of dirt refer to sexuality thus conceived. Animal fears have been discussed above. An interesting phobia is the fear of spiders, representing the devouring and dangerous female genitalia. Butterflies may represent beautiful and tempting women; beetles and crawling insects may represent genitalia of small children. This list could be extended greatly; but many other interpretations depend on the individual prephobic history, which determines the relative importance of the fantasy and the suitability of the object chosen for its representation.

Bertram D. Lewin

[For a conception of phobias that contrasts with the one in this article, seeMental disorders, treatment of, article onbehavior therapy; see alsoAnxietyandEmotion. Other relevant material may be found inDefense mechanisms; Hysteria; Mental disorders, article onChildhood mental disorders; and in the biography ofFreud.]

BIBLIOGRAPHY

Abraham, Karl (1922) 1953 The Spider as a Dream Symbol Pages 326–332 in Karl Abraham, Selected Papers. Volume 1: Selected Papers on Psychoanalysis. New York: Basic Books. → First published as “Die Spinne als Traumsymbol.”

Benedek, Therese 1925 Notes From the Analysis of a Case of Ereuthophobia. International Journal of Psycho-analysis 6:430–439.

Bleuler, Eugen (1916) 1951 Textbook of Psychiatry. Authorized English edition by A. A. Brill, with a biographical sketch by Jacob Shatsky. New York: Dover. → First published as Lehrbuch der Psychiatric

Bornstein, Berta (1931) 1935 Phobia in a Two-and-a-half-year-old Child. Psychoanalytic Quarterly 4:93 119. → First published in German.

Bornstein, Berta 1949 The Analysis of a Phobic Child: Some Problems of Theory and Technique in Child Analysis. Psychoanalytic Study of the Child 3/4:181–226.

Bumke, Oswald (1924) 1948 Lehrbuch der Geisteskrankheiten. 7th ed. Berlin: Springer.

Deutsch, Helene 1929 The Genesis of Agoraphobia. International Journal of Psycho-analysis 10:51–69.

Deutsch, Helene (1930) 1932 Psychoanalysis of the Neuroses. London: Hogarth. → First published in German. See especially Chapter 6, “Anxiety States”; Chapter 7, “A Case of Hen Phobia”; and Chapter 8, “Agoraphobia.”

Esquirol, Jean E. D. (1838) 1845 Mental Maladies: A Treatise on Insanity. Philadelphia: Lea & Blanchard. → First published in French.

Fenichel, Otto (1932) 1934 Outline of Clinical Psychoanalysis. New York: Norton. → First published as Spezielle psychoanalytische Neurosenlehre. See especially Chapter 2.

Fenichel, Otto 1944 Remarks on the Common Phobias. Psychoanalytic Quarterly 13:313–326.

Fenichel, Otto 1945 The Psychoanalytic Theory of Neurosis. New York: Norton. → See especially “Anxiety as Neurotic Symptom: Anxiety Hysteria,” pages 193–215.

Ferenczi, SÁndor (1913) 1952 A Little Chanticleer. London: Hogarth. → First published as “Ein kleiner Hahnemann.”

Freud, Anna (1936) 1957 The Ego and the Mechanisms of Defense. New York: International Universities Press. → First published as Das Ich und die Abwehrmechanismen.

Freud, Sigmund (1894) 1962 The Neuro-psychoses of Defense. Volume 3, pages 43–61 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan. → First published as “Die AbwehrNeuropsychosen.”

Freud, Sigmund (1895a) 1962 On the Grounds for Detaching a Particular Syndrome From Neurasthenia Under the Description “Anxiety Neurosis.” Volume 3, pages 87–139 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan. → First published as “Über die Berechtigung von der Neurasthenie einen bestimmten Symptomen-Komplex als ‘Angstneurose’ abzutrennen.”

Freud, Sigmund (1895b) 1962 Obsessions and Phobias: Their Physical Mechanism and Their Aetiology. Volume 3, pages 71–81 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan. → First published in French.

Freud, Sigmund (1909) 1955 Analysis of a Phobia in a Five-year-old Boy. Volume 10, pages 3–149 in Sigmund Freud, The Standard Edition of the CompletePsychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.

Freud, Sigmund (1913) 1955 Totem and Taboo. Volume 13, pages ix-162 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.

Freud, Sigmund (1915a) 1957 Repression. Volume 14, pages 143–158 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.

Freud, Sigmund (1915b) 1957 The Unconscious. Volume 14, pages 161–204 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.

Freud, Sigmund (1916–1917) 1952 A General Introduction to Psychoanalysis. Authorized English translation of the rev. ed. by Joan Riviere. Garden City, N.Y.: Doubleday. → First published as Vorlesungen zur Einfiihrung in die Psychoanalyse.

Freud, Sigmund (1918) 1955 From the History of an Infantile Neurosis. Volume 17, pages 3–122 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.

Freud, Sigmund (1926) 1936 The Problem of Anxiety. New York: Norton. → First published as Hemmung, Symptom und Angst. A British edition was published by Hogarth in 1936 under the title Inhibitions, Symptoms and Anxiety.

Friedman, Paul 1952 The Bridge: A Study in Symbolism. Psychoanalytic Quarterly 21:49–80.

Hall, G. Stanley 1914 A Synthetic Genetic Study of Fear American Journal of Psychology 25:149–200, 321–392.

Janet, Pierre; and Raymond, Fulgence (1903) 1919 Les obsessions et la psychasthénie. 3d ed. 2 vols. Paris: Alcan. → Pierre Janet was the sole author of Volume 1.

Katan, Anny A. (1937) 1951 The Role of “Displacement” in Agoraphobia. International Journal of Psychoanalysis 32:41–50.

Kraepelin, Emil (1883) 1909–1915 Psychiatrie. 8th ed., rev. 4 vols. Leipzig: Barth. → See especially Volume 4, Part 3.

Krafft-Ebing, Richard Von 1895 Nervosität und neurasthenische Zustande. Volume 12, part 2 in H. Nothnagel (editor), Specielle Pathologie und Therapie. Vienna: Hölder.

Lewin, Bertram D. 1935 Claustrophobia. Psychoanalytic Quarterly 4:227–233.

Lewin, Bertram D. 1952 Phobic Symptoms and Dream Interpretation Psychoanalytic Quarterly 21:295–322.

Loewenfeld, Leopold 1904 Die psychischen Zwangserscheinungen. Wiesbaden (Germany): Bergmann. → See especially pages 330–355.

Menninger, Karl; Mayman, Martin; and Pruyser, Paul 1963 The Vital Balance: The Life Processes in Mental Health and Illness. New York: Viking. → See especially page 444.

Miller, Milton L. 1953 On Street Fear. International Journal of Psycho-analysis 34:232–240.

Onians, Richard B. 1951 The Origins of European Thought. Cambridge Univ. Press.

Rush, Benjamin 1825 Medical Inquiries and Observations Upon the Diseases of the Mind. Philadelphia: Grigg.

Sauvages De La Croix, Francois Boissier De (1763) 1768 Nosologia methodica sistens morborum classes juxtd sydenhami mentem & botanicorum ordinem. 2 vols. Amsterdam: Tournes.

Stekel, Wilhelm (1908) 1923 Conditions of Nervous Anxiety and Their Treatment. London: Routledge. → First published in German. See especially Part 2, pages 163–376.

Sterba, Editha (1933) 1935 Excerpt From the Analysis of a Dog Phobia. Psychoanalytic Quarterly 4:135160. → First published in German.

Strachey, James 1962 Appendix [to Freud’s “Obsessions and Phobias”]. Volume 3, pages 83–84 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.

Weiss, Edoardo 1935 Agoraphobia and Its Relation to Hysterical Attacks. International Journal of Psychoanalysis 16:59–83.

Weiss, Edoardo 1936 Agorafobia: Isterismo d’angoscia. Rome: Cremonese.

Westphal, Carl F. O. 1871 Die Agoraphobie: Eine neuropathische Erscheinung. Archiv fur Psychiatrie 3:138–161.

Westphal, Carl F. O. 1877 Über Zwangsvorstellungen. Berliner klinische Wochenschrift 46:669; 47:687.

Wulff, M. W. 1928 A Phobia in a Child of Eighteen Months International Journal of Psycho-analysis 2: 354–359.

Phobias

views updated May 18 2018

Phobias

Definition

A phobia is an intense but unrealistic fear that can interfere with the ability to socialize, work, or go about everyday life, brought on by an object, event or situation.

Description

Just about everyone is afraid of somethingan upcoming job interview or being alone outside after dark. But about 18% of all Americans are tormented by irrational fears that interfere with their daily lives. They aren't crazythey know full well their fears are unreasonablebut they can't control the fear. These people suffer from phobias.

Phobias belong to a large group of mental problems known as anxiety disorders that include obsessive-compulsive disorder (OCD), panic disorder , and post-traumatic stress disorder . Phobias themselves can be divided into three specific types:

  • specific phobias
  • social phobia
  • agoraphobia

Specific phobias

As its name suggests, a specific phobia is the fear of a particular situation or object, including anything from airplane travel to dentists. Found in one out of every 10 Americans, specific phobias seem to run in families and are roughly twice as likely to appear in women. If the person doesn't often encounter the feared object, the phobia doesn't cause much harm. However, if the feared object or situation is common, it can seriously disrupt everyday life. Common examples of specific phobias, which can begin at any age, include fear of snakes, flying, dogs, escalators, elevators, high places, disease, or open spaces.

Social phobia

People with social phobia have deep fears of being watched or judged by others and being embarrassed in public. This may extend to a general fear of social situationsor be more specific, such as a fear of giving speeches or of performing (stage fright). More rarely, people with social phobia may have trouble using a public restroom, eating in a restaurant, or signing their name in front of others.

Social phobia is not the same as shyness. Shy people may feel uncomfortable with others, but they don't experience severe anxiety, they don't worry excessively about social situations beforehand, and they don't avoid events that make them feel self-conscious. On the other hand, people with social phobia may not be shythey may feel perfectly comfortable with people except in specific situations. Social phobias may be only mildly irritating, or they may significantly interfere with daily life. It is not unusual for people with social phobia to turn down job offers or avoid relationships because of their fears.

Agoraphobia

Agoraphobia is the intense fear of feeling trapped and having a panic attack in a public place. It usually begins between ages 15 and 35, and affects three times as many women as menabout 3% of the population.

An episode of spontaneous panic is usually the initial trigger for the development of agoraphobia. After an initial panic attack, the person becomes afraid of experiencing a second one. Sufferers literally fear the fear, and worry incessantly about when and where the next attack may occur. As they begin to avoid the places or situations in which the panic attack occurred, their fear generalizes. Eventually the person completely avoids public places. In severe cases, people with agoraphobia can no longer leave their homes for fear of experiencing a panic attack.

Causes & symptoms

Experts don't really know why phobias develop, although research suggests they may arise from a complex interaction between heredity and environment. Some hypersensitive people have unique chemical reactions in the brain that cause them to respond much more strongly to stress . These people also may be especially sensitive to caffeine , which triggers certain brain chemical responses.

Advances in neuroimaging have also led researchers to identify certain parts of the brain and specific neural pathways that are associated with phobias. One part of the brain that is currently being studied is the amygdala, an almond-shaped body of nerve cells involved in normal fear conditioning. Another area of the brain that appears to be linked to phobias is the posterior cerebellum.

While experts believe the tendency to develop phobias runs in families and may be hereditary, a specific stressful event usually triggers the development of a specific phobia or agoraphobia. For example, someone predisposed to develop phobias who experiences severe turbulence during a flight might go on to develop a phobia about flying.

Social phobia typically appears in childhood or adolescence, sometimes following an upsetting or humiliating experience. Certain vulnerable children who have had unpleasant social experiences (such as being rejected) or who have poor social skills may develop social phobias. The condition also may be related to low self-esteem, unassertive personality, and feelings of inferiority.

A person with agoraphobia may have a panic attack at any time for no apparent reason. While the attack may last only a minute or so, the person remembers the feelings of panic so strongly that the possibility of another attack becomes terrifying. For this reason, people with agoraphobia avoid places where they might not be able to escape if a panic attack occurs.

While the specific trigger may differ, the symptoms of different phobias are remarkably similar (e.g., feelings of terror and impending doom, rapid heartbeat and breathing, sweaty palms, and other features of a panic attack). Patients may experience severe anxiety symptoms in anticipating a phobic trigger. For example, someone who is afraid to fly may begin having episodes of pounding heart and sweating palms at the mere thought of getting on a plane in two weeks.

Diagnosis

A mental health professional can diagnose phobias after a detailed interview and discussion of both mental and physical symptoms. Social phobia is often associated with other anxiety disorders, depression , or substance abuse.

Treatment

People who have a specific phobia that is easy to avoid (such as snakes) and that doesn't interfere with their lives may not need to seek treatment. In all types of phobias, symptoms may be eased by lifestyle changes, such as:

  • eliminating caffeine
  • cutting down on alcohol
  • eating a good diet
  • getting plenty of exercise
  • reducing stress

Meditation and mindfulness training can be beneficial to patients with phobias and panic disorder. Hydrotherapy, massage therapy , and aromatherapy are useful to some anxious patients because they can promote general relaxation of the nervous system. Relaxation training, which is sometimes called anxiety management training, includes breathing exercises and similar techniques intended to help the patient prevent hyperventilation and relieve the muscle tension associated with the fight-or-flight reaction of anxiety. Yoga , aikido, t'ai chi , and dance therapy help patients work with the physical, as well as the emotional, tensions that either promote or are created by anxiety.

Herbs known as adaptogens may be prescribed to treat the anxiety related to phobias. These herbs are thought to promote adaptability to stress, and include Siberian ginseng (Eleutherococcus senticosus ), and ginseng (Panax ginseng ). Adrenal modulators such as licorice (Glycyrrhiza glabra ) and borage (Borago officinalis ), nervine herbs such as chamomile (Chamaemelum nobile ) and skullcap (Scutellaria lateriafolia ), and antioxidal herbs like milk thistle (Silybum marianum ) are also beneficial. Tonics of skullcap and oats (Avena sativa ) may also be recommended to ease anxiety.

Allopathic treatment

When phobias interfere with a person's daily life, a combination of psychotherapy and medication can be quite effective. Medication can block the feelings of panic, and when combined with cognitive-behavioral therapy, can be quite effective in reducing specific phobias and agoraphobia.

Cognitive-behavioral therapy adds a cognitive approach to more traditional behavioral therapy . It teaches patients how to change their thoughts, behavior, and attitudes, while providing techniques to lessen anxiety, such as deep breathing, muscle relaxation, and refocusing.

One cognitive-behavioral therapy is desensitization (also known as exposure therapy), in which people are gradually exposed to the frightening object or event until they become used to it and their physical symptoms decrease. For example, someone who is afraid of snakes might first be shown a photo of a snake. Once the person can look at a photo without anxiety, he might then be shown a video of a snake. Each step is repeated until the symptoms of fear (such as pounding heart and sweating palms) disappear. Eventually, the person might reach the point where he can actually touch a live snake. Three-fourths of patients are significantly improved with this type of treatment.

Another more dramatic cognitive-behavioral approach is called flooding, which exposes the person immediately to the feared object or situation. The person remains in the situation until the anxiety lessens.

Several drugs are used to treat specific phobias by controlling symptoms and helping to prevent panic attacks. These include anti-anxiety drugs (benzodiazepines) such as alprazolam (Xanax) or diazepam (Valium). Blood pressure medications called beta blockers, such as propranolol (Inderal) and atenolol (Tenormin), appear to work well in the treatment of circumscribed social phobia, when anxiety gets in the way of performance, such as public speaking. These drugs reduce overstimulation, thereby controlling the physical symptoms of anxiety.

In addition, some antidepressants may be effective when used together with cognitive-behavioral therapy. These include the monoamine oxidase inhibitors (MAO inhibitors) phenelzine (Nardil) and tranylcypromine (Parnate), as well as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox).

A medication that shows promise as a treatment for social phobia is valproic acid (Depakene or Depakote), which is usually prescribed to treat seizures or to prevent migraine headaches. Researchers conducting a twelve-week trial with 17 patients found that about half the patients experienced a significant improvement in their social anxiety symptoms while taking the medication. Further studies are underway.

Treating agoraphobia is more difficult than other phobias because there are often so many fears involved, such as open spaces, traffic, elevators, and escalators. Treatment includes cognitive-behavioral therapy with antidepressants or anti-anxiety drugs. Paxil and Zoloft are used to treat panic disorders with or without agoraphobia.

Expected results

Phobias are among the most treatable mental health problems; depending on the severity of the condition and the type of phobia, most properly treated patients can go on to lead normal lives. Research suggests that once a person overcomes the phobia, the problem may not return for many yearsif at all.

Untreated phobias are another matter. Only about 20% of specific phobias will go away without treatment, and agoraphobia will get worse with time if untreated. Social phobias tend to be chronic, and without treatment, will not likely go away. Moreover, untreated phobias can lead to other problems, including depression, alcoholism , and feelings of shame and low self-esteem.

A group of researchers in Boston reported in 2003 that phobic anxiety appears to be a risk factor for Parkinson's disease (PD) in males, although it is not yet known whether phobias cause PD or simply share an underlying biological cause.

While most specific phobias appear in childhood and subsequently fade away, those that remain in adulthood often need to be treated. Unfortunately, most people never get the help they need; only about 25% of people with phobias ever seek help to deal with their condition.

Prevention

There is no known way to prevent the development of phobias. Medication and cognitive-behavioral therapy may help prevent the recurrence of symptoms once they have been diagnosed. Early detection and treatments may decrease severity.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.

Bloomfield, Harold H. Healing Anxiety with Herbs. New York: Harper Collins, 1998.

Peurifoy, Reneau Z. Anxiety, Phobias and Panic: A Step by Step Program for Regaining Control of Your Life. New York: Warner Books, 1996.

"Phobic Disorders. " Section 15, Chapter 187 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Schneier, Franklin, and Lawrence Welkowitz. The Hidden Face of Shyness: Understanding and Overcoming Social Anxiety. New York: Avon Books, 1996.

Stern, Richard. Mastering Phobias: Cases, Causes and Cures. New York: Penguin USA, 1996.

PERIODICALS

Kinrys, G., M. H. Pollack, N. M. Simon, et al. "Valproic Acid for the Treatment of Social Anxiety Disorder." International Clinical Psychopharmacology 18 (May 2003): 169172.

Modica, Peter. "Social phobia may run in the family." American Journal of Psychiatry 155 (1998): 90-97.

Ploghaus, A., L. Becerra, C. Borras, and D. Borsook. "Neural Circuitry Underlying Pain Modulation: Expectation, Hypnosis, Placebo." Trends in Cognitive Science 7 (May 2003): 197200.

Rauch, S. L., L. M. Shin, and C. I. Wright. "Neuroimaging Studies of Amygdala Function in Anxiety Disorders." Annals of the New York Academy of Sciences 985 (April 2003): 389410.

Weisskopf, M. G., H. Chen, M. A. Schwarzschild, et al. "Prospective Study of Phobic Anxiety and Risk of Parkinson's Disease." Movement Disorders 18 (June 2003): 646651.

ORGANIZATIONS

Agoraphobics Building Independent Lives. 1418 Lorraine Ave., Richmond, VA 23227.

Agoraphobics In Motion. 605 W. 11 Mile Rd., Royal Oak, MI 48067.

American Psychiatric Association (APA). 1400 K Street, NW, Washington, DC 20005. (888) 357-7924. <http://www.psych.org>.

Anxiety Disorders Association of America. 11900 Parklawn Dr., Ste. 100, Rockville, MD 20852. (301) 231-9350.

National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272-7166. http://www.lexington-online.com/naf.html.

National Institute of Mental Health (NIMH) Office of Communications. 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (866) 615-NIMH or (301) 443-4513. <http://www.nimh.nih.gov>.

OTHER

Anxiety Network Homepage. http://www.anxietynetwork.com.

National Institute of Mental Health (NIMH). Anxiety Disorders. NIH Publication No. 02-3879. Bethesda, MD: NIMH, 2002.

Paula Ford-Martin

Rebecca J. Frey, PhD

Phobias

views updated May 14 2018

Phobias

Definition

A phobia is an intense but unrealistic fear that can interfere with the ability to socialize, work, or go about everyday life, brought on by an object, event or situation.

Description

Just about everyone is afraid of somethingan upcoming job interview or being alone outside after dark. But about 18% of all Americans are tormented by irrational fears that interfere with their daily lives. They are not "crazy"they know full well their fears are unreasonable-but they can not control the fear. These people have phobias.

Phobias belong to a large group of mental problems known as anxiety disorders that include obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder. Phobias themselves can be divided into three specific types:

  • specific phobias (formerly called "simple phobias")
  • social phobia
  • agoraphobia

Specific phobias

As its name suggests, a specific phobia is the fear of a particular situation or object, including anything from airplane travel to dentists. Found in one out of every 10 Americans, specific phobias seem to run in families and are roughly twice as likely to appear in women. If the person rarely encounters the feared object, the phobia does not cause much harm. However, if the feared object or situation is common, it can seriously disrupt everyday life. Common examples of specific phobias, which can begin at any age, include fear of snakes, flying, dogs, escalators, elevators, high places, or open spaces.

Social phobia

People with social phobia have deep fears of being watched or judged by others and being embarrassed in public. This may extend to a general fear of social situationsor be more specific or circumscribed, such as a fear of giving speeches or of performing (stage fright). More rarely, people with social phobia may have trouble using a public restroom, eating in a restaurant, or signing their name in front of others.

Social phobia is not the same as shyness. Shy people may feel uncomfortable with others, but they don't experience severe anxiety, they don't worry excessively about social situations beforehand, and they don't avoid events that make them feel self-conscious. On the other hand, people with social phobia may not be shy-they may feel perfectly comfortable with people except in specific situations. Social phobias may be only mildly irritating, or they may significantly interfere with daily life. It is not unusual for people with social phobia to turn down job offers or avoid relationships because of their fears.

Agoraphobia

Agoraphobia is the intense fear of feeling trapped and having a panic attack in a public place. It usually begins between ages 15 and 35, and affects three times as many women as menabout 3% of the population.

An episode of spontaneous panic is usually the initial trigger for the development of agoraphobia. After an initial panic attack, the person becomes afraid of experiencing a second one. Patients literally "fear the fear," and worry incessantly about when and where the next attack may occur. As they begin to avoid the places or situations in which the panic attack occurred, their fear generalizes. Eventually the person completely avoids public places. In severe cases, people with agoraphobia can no longer leave their homes for fear of experiencing a panic attack.

Causes and symptoms

Experts don't really know why phobias develop, although research suggests the tendency to develop phobias may be a complex interaction between heredity and environment. Some hypersensitive people have unique chemical reactions in the brain that cause them to respond much more strongly to stress. These people also may be especially sensitive to caffeine, which triggers certain brain chemical responses.

Advances in neuroimaging have also led researchers to identify certain parts of the brain and specific neural pathways that are associated with phobias. One part of the brain that is currently being studied is the amygdala, an almond-shaped body of nerve cells involved in normal fear conditioning. Another area of the brain that appears to be linked to phobias is the posterior cerebellum.

While experts believe the tendency to develop phobias runs in families and may be hereditary, a specific stressful event usually triggers the development of a specific phobia or agoraphobia. For example, someone predisposed to develop phobias who experiences severe turbulence during a flight might go on to develop a phobia about flying. What scientists don't understand is why some people who experience a frightening or stressful event develop a phobia and others do not.

Social phobia typically appears in childhood or adolescence, sometimes following an upsetting or humiliating experience. Certain vulnerable children who have had unpleasant social experiences (such as being rejected) or who have poor social skills may develop social phobias. The condition also may be related to low self-esteem, unassertive personality, and feelings of inferiority.

A person with agoraphobia may have a panic attack at any time, for no apparent reason. While the attack may last only a minute or so, the person remembers the feelings of panic so strongly that the possibility of another attack becomes terrifying. For this reason, people with agoraphobia avoid places where they might not be able to escape if a panic attack occurs. As the fear of an attack escalates, the person's world narrows.

While the specific trigger may differ, the symptoms of different phobias are remarkably similar: e.g., feelings of terror and impending doom, rapid heartbeat and breathing, sweaty palms, and other features of a panic attack. Patients may experience severe anxiety symptoms in anticipating a phobic trigger. For example, someone who is afraid to fly may begin having episodes of pounding heart and sweating palms at the mere thought of getting on a plane in two weeks.

Diagnosis

A mental health professional can diagnose phobias after a detailed interview and discussion of both mental and physical symptoms. Social phobia is often associated with other anxiety disorders, depression, or substance abuse.

Treatment

People who have a specific phobia that is easy to avoid (such as snakes) and that doesn't interfere with their lives may not need to get help. When phobias do interfere with a person's daily life, a combination of psychotherapy and medication can be quite effective. While most health insurance covers some form of mental health care, most do not cover outpatient care completely, and most have a yearly or lifetime maximum.

Medication can block the feelings of panic, and when combined with cognitive-behavioral therapy, can be quite effective in reducing specific phobias and agoraphobia.

Cognitive-behavioral therapy adds a cognitive approach to more traditional behavioral therapy. It teaches patients how to change their thoughts, behavior, and attitudes, while providing techniques to lessen anxiety, such as deep breathing, muscle relaxation, and refocusing.

One cognitive-behavioral therapy is desensitization (also known as exposure therapy), in which people are gradually exposed to the frightening object or event until they become used to it and their physical symptoms decrease. For example, someone who is afraid of snakes might first be shown a photo of a snake. Once the person can look at a photo without anxiety, he might then be shown a video of a snake. Each step is repeated until the symptoms of fear (such as pounding heart and sweating palms) disappear. Eventually, the person might reach the point where he can actually touch a live snake. Three fourths of patients are significantly improved with this type of treatment.

Another more dramatic cognitive-behavioral approach is called flooding. It exposes the person immediately to the feared object or situation. The person remains in the situation until the anxiety lessens.

Several drugs are used to treat specific phobias by controlling symptoms and helping to prevent panic attacks. These include anti-anxiety drugs (benzodiazepines ) such as alprazolam (Xanax) or diazepam (Valium). Blood pressure medications called beta blockers, such as propranolol (Inderal) and atenolol (Tenormin), appear to work well in the treatment of circumscribed social phobia, when anxiety gets in the way of performance, such as public speaking. These drugs reduce overstimulation, thereby controlling the physical symptoms of anxiety.

In addition, some antidepressants may be effective when used together with cognitive-behavioral therapy. These include the monoamine oxidase inhibitors (MAO inhibitors) phenelzine (Nardil) and tranylcypromine (Parnate), as well as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox).

A medication that shows promise as a treatment for social phobia is valproic acid (Depakene or Depakote), which is usually prescribed to treat seizures or to prevent migraine headaches. Researchers conducting a twelve-week trial with 17 patients found that about half the patients experienced a significant improvement in their social anxiety symptoms while taking the medication. Further studies are underway.

In all types of phobias, symptoms may be eased by lifestyle changes, such as:

  • eliminating caffeine
  • cutting down on alcohol
  • eating a good diet
  • getting plenty of exercise
  • reducing stress

Treating agoraphobia is more difficult than other phobias because there are often so many fears involved, such as open spaces, traffic, elevators, and escalators. Treatment includes cognitive-behavioral therapy with antidepressants or anti-anxiety drugs. Paxil and Zoloft are used to treat panic disorders with or without agoraphobia.

Prognosis

Phobias are among the most treatable mental health problems; depending on the severity of the condition and the type of phobia, most properly treated patients can go on to lead normal lives. Research suggests that once a person overcomes the phobia, the problem may not return for many yearsif at all.

Untreated phobias are another matter. Only about 20% of specific phobias will go away without treatment, and agoraphobia will get worse with time if untreated. Social phobias tend to be chronic, and will not likely go away without treatment. Moreover, untreated phobias can lead to other problems, including depression, alcoholism, and feelings of shame and low self-esteem.

A group of researchers in Boston reported in 2003 that phobic anxiety appears to be a risk factor for Parkinson's disease (PD) in males, although it is not yet known whether phobias cause PD or simply share an underlying biological cause.

While most specific phobias appear in childhood and subsequently fade away, those that remain in adulthood often need to be treated. Unfortunately, most people never get the help they need; only about 25% of people with phobias ever seek help to deal with their condition.

Prevention

There is no known way to prevent the development of phobias. Medication and cognitive-behavioral therapy may help prevent the recurrence of symptoms once they have been diagnosed.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, DC: American Psychiatric Association, 2000.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Phobic Disorders." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Kinrys, G., M. H. Pollack, N. M. Simon, et al. "Valproic Acid for the Treatment of Social Anxiety Disorder." International Clinical Psychopharmacology 18 (May 2003): 169-172.

Ploghaus, A., L. Becerra, C. Borras, and D. Borsook. "Neural Circuitry Underlying Pain Modulation: Expectation, Hypnosis, Placebo." Trends in Cognitive Science 7 (May 2003): 197-200.

Rauch, S. L., L. M. Shin, and C. I. Wright. "Neuroimaging Studies of Amygdala Function in Anxiety Disorders." Annals of the New York Academy of Sciences 985 (April 2003): 389-410.

Weisskopf, M. G., H. Chen, M. A. Schwarzschild, et al. "Prospective Study of Phobic Anxiety and Risk of Parkinson's Disease." Movement Disorders 18 (June 2003): 646-651.

ORGANIZATIONS

Agoraphobics Building Independent Lives. 1418 Lorraine Ave., Richmond, VA 23227.

Agoraphobics In Motion. 605 W. 11 Mile Rd., Royal Oak, MI 48067.

American Psychiatric Association (APA). 1400 K Street, NW, Washington, DC 20005. (888) 357-7924. http://www.psych.org.

Anxiety Disorders Association of America. 11900 Parklawn Dr., Ste. 100, Rockville, MD 20852. (301) 231-9350.

National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272-7166. http://www.lexington-on-line.com/naf.html.

National Institute of Mental Health (NIMH) Office of Communications. 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (866) 615-NIMH or (301) 443-4513. http://www.nimh.nih.gov.

OTHER

Anxiety Network Homepage. http://www.anxietynetwork.com.

National Institute of Mental Health (NIMH). Anxiety Disorders. NIH Publication No. 02-3879. Bethesda, MD: NIMH, 2002.

KEY TERMS

Agoraphobia An intense fear of being trapped in a crowded, open, or public space where it may be hard to escape, combined with the dread of having a panic attack.

Benzodiazepine A class of drugs that have a hypnotic and sedative action, used mainly as tranquilizers to control symptoms of anxiety.

Beta blockers A group of drugs that are usually prescribed to treat heart conditions, but that also are used to reduce the physical symptoms of anxiety and phobias, such as sweating and palpitations.

Monoamine oxidase inhibitors (MAO inhibitors) A class of antidepressants used to treat social phobia.

Neuroimaging The use of x ray studies and magnetic resonance imaging (MRIs) to detect abnormalities or trace pathways of nerve activity in the central nervous system.

Selective serotonin reuptake inhibitors (SSRIs) A class of antidepressants that work by blocking the reabsorption of serotonin in the brain, raising the levels of serotonin. SSRIs include Prozac, Zoloft, and Paxil.

Serotonin One of three major types of neurotransmitters found in the brain that is linked to emotions.

Social phobia Fear of being judged or ridiculed by others; fear of being embarrassed in public.

Phobias

views updated May 23 2018

Phobias

Definition

A phobia is an intense and unrealistic fear brought on by an object, event, or situation, which can interfere with the ability to socialize, work, or go about everyday life.

Description

Almost all children develop specific fears at some age. Sometimes the fear is a result of a particular event, but some fears arise on their own. Many fears are associated with certain age groups. Very young children (through age two) tend to fear loud noises, strangers, large objects, and being away from their parents. Preschoolers often have imaginary fears, such as monsters who might eat them, strange noises, being alone in the dark, or thunder. School-age children have concrete fears, such being hurt, doing badly in school, dying, or natural disasters. When the child is afraid of something past the age at which it is normal, when the fear interferes with the child's ability to function normally, then the fear ranks as a phobia.

Phobias belong to a large group of mental problems known as anxiety disorders that include obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder. Phobias themselves can be divided into three specific types:

  • specific phobias (formerly called simple phobias, most common in children)
  • social phobia
  • agoraphobia (not common in children)

Specific phobias

As its name suggests, a specific phobia is the fear of a particular situation or object, for example, flying on an airplane or going to the dentist. Found in one out of every 10 Americans, specific phobias seem to run in families and are roughly twice as likely to appear in women. If the person rarely encounters the feared object, the phobia does not cause much harm. However, if the feared object or situation is common, it can seriously disrupt the person's everyday life. Common examples of specific phobias, which can begin at any age, include fear of insects, snakes, and dogs; escalators, elevators, and bridges; high places; and open spaces. Children often have specific phobias that they outgrow over time, and they can learn specific fears from adults or other children around them, or even from television.

Social phobia

People with social phobia have deep fears of being watched or judged by others and being embarrassed in public. This may extend to a general fear of social situations. They may be more specific or circumscribed, such as a fear of giving speeches or of performing (stage fright). More rarely, people with social phobia may have trouble using a public restroom, eating in a restaurant, or signing their name in front of others. Young children often have a fear of strangers that is quite normal; social phobia is not usually diagnosed until a child reaches adolescence and has crippling fears that interfere with normal function.

Social phobia is not the same as shyness . Shy people may feel uncomfortable with others, but they do not experience severe anxiety, they do not worry excessively about social situations beforehand, and they do not avoid events that make them feel self-conscious. On the other hand, people with social phobia may not be shy; they may feel perfectly comfortable with people except in specific situations. Social phobias may be only mildly irritating, or they may significantly interfere with daily life. It is not unusual for people with social phobia to turn down job offers or avoid relationships because of their fears.

Agoraphobia

Agoraphobia is the intense fear of being trapped and having a panic attack in a public place. It usually begins between ages 15 and 35 and affects three times as many women as men or approximately 3 percent of the population.

An episode of spontaneous panic is usually the initial trigger for the development of agoraphobia. After an initial panic attack, the person becomes afraid of experiencing a second one. People are literally fearful of fear. They worry incessantly about when and where the next attack may occur. As they begin to avoid the places or situations in which the panic attack occurred, their fear generalizes. Eventually the person completely avoids public places. In severe cases, people with agoraphobia can no longer leave their homes for fear of experiencing a panic attack.

Demographics

Approximately one person in five (18 percent) of all Americans experience phobias that interfere with their daily lives. Almost all children experience some specific fears at some point, but not many rise to the level of phobia or require professional treatment.

Causes and symptoms

Experts do not really know why phobias develop, although research suggests the tendency to develop phobias may be a complex interaction between heredity and environment. Some hypersensitive people have unique chemical reactions in the brain that cause them to respond much more strongly to stress. These people also may be especially sensitive to caffeine , which triggers certain brain chemical responses.

Advances in neuroimaging have also led researchers to identify certain parts of the brain and specific neural pathways that are associated with phobias. One part of the brain that was as of 2004 being studied is the amygdala, an almond-shaped body of nerve cells involved in normal fear conditioning. Another area of the brain that appears to be linked to phobias is the posterior cerebellum.

While experts believe the tendency to develop phobias runs in families and may be hereditary, a specific stressful event usually triggers the development of a specific phobia or agoraphobia. For example, someone predisposed to develop phobias who experiences severe turbulence during a flight might go on to develop a phobia about flying. What scientists do not understand is why some people who experience a frightening or stressful event develop a phobia and others do not.

Social phobia typically appears in childhood or adolescence , sometimes following an upsetting or humiliating experience. Certain vulnerable children who have had unpleasant social experiences (such as being rejected) or who have poor social skills may develop social phobias. The condition also may be related to low self-esteem , unassertive personality, and feelings of inferiority.

A person with agoraphobia may have a panic attack at any time, for no apparent reason. While the attack may last only a minute or so, the person remembers the feelings of panic so strongly that the possibility of another attack becomes terrifying. For this reason, people with agoraphobia avoid places where they might not be able to escape if a panic attack occurs. As the fear of an attack escalates, the person's world narrows.

While the specific trigger may differ, the symptoms of different phobias are remarkably similar: feelings of terror and impending doom, rapid heartbeat and breathing, sweaty palms, and other features of a panic attack. People may experience severe anxiety symptoms in anticipating a phobic trigger. For example, someone who is afraid to fly may begin having episodes of pounding heart and sweating palms at the mere thought of getting on a plane in two weeks.

When to call the doctor

A doctor, mental health professional, or counselor should be consulted when irrational fears interfere with a child's normal functioning.

Diagnosis

A mental health professional can diagnose phobias after a detailed interview and discussion of both mental and physical symptoms. Children are often less able to accurately describe their symptoms or discuss their fears, and so should be encouraged to talk about them with parents. Social phobia is often associated with other anxiety disorders, depression, or substance abuse.

Treatment

People who have a specific phobia that is easy to avoid (such as snakes) and that does not interfere with their lives may not need to get help. When phobias do interfere with a person's daily life, a combination of psychotherapy and medication can be quite effective. Medication is used less often in young children, but more frequently in older children or adolescents with severe phobias and associated depression. While most health insurance covers some form of mental health care, most do not cover outpatient care completely, and most have a yearly or lifetime maximum.

Medication can block the feelings of panic and, when combined with cognitive-behavioral therapy, can be quite effective in reducing specific phobias and agoraphobia.

Cognitive-behavioral therapy adds a cognitive approach to more traditional behavioral therapy. It teaches individuals how to change their thoughts, behaviors, and attitudes, while providing techniques to lessen anxiety, such as deep breathing, muscle relaxation, and refocusing.

One cognitive-behavioral therapy is desensitization (also known as exposure therapy), in which people are gradually exposed to the frightening object or event until they become used to it and their physical symptoms decrease. For example, someone who is afraid of snakes might first be shown a photo of a snake. Once the person can look at a photo without anxiety, he might then be shown a video of a snake. Each step is repeated until the symptoms of fear (such as pounding heart and sweating palms) disappear. Eventually, the person might reach the point where he can actually touch a live snake. Three-fourths of affected people are significantly improved with this type of treatment.

Another, more dramatic, cognitive-behavioral approach is called flooding. It exposes the person immediately to the feared object or situation. The person remains in the situation until the anxiety lessens.

Several drugs are used to treat specific phobias by controlling symptoms and helping to prevent panic attacks. These include anti-anxiety drugs (benzodiazepines) such as alprazolam (Xanax) or diazepam (Valium). Blood pressure medications called beta blockers, such as propranolol (Inderal) and atenolol (Tenormin), appear to work well in the treatment of circumscribed social phobia, when anxiety gets in the way of performance, such as public speaking. These drugs reduce over-stimulation, thereby controlling the physical symptoms of anxiety.

In addition, some antidepressants may be effective when used together with cognitive-behavioral therapy. These include the monoamine oxidase inhibitors (MAO inhibitors) phenelzine (Nardil) and tranylcypromine (Parnate), as well as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox).

In all types of phobias, symptoms may be eased by lifestyle changes, such as the following:

  • eliminating caffeine
  • cutting down on alcohol
  • eating a good diet
  • getting plenty of exercise
  • reducing stress

Treating agoraphobia is more difficult than other phobias because there are often so many fears involved, such as fear of open spaces, traffic, elevators, and escalators. Treatment includes cognitive-behavioral therapy with antidepressants or anti-anxiety drugs. Paxil and Zoloft are used to treat panic disorders with or without agoraphobia.

Prognosis

Phobias are among the most treatable mental health problems; depending on the severity of the condition and the type of phobia, most properly treated people can go on to lead normal lives. Research suggests that once a person overcomes the phobia, the problem may not return for many years, if it returns at all. Children most often outgrow their specific phobias, with or without treatment.

Untreated phobias are another matter. In adults, only about 20 percent of specific phobias go away without treatment, and agoraphobia gets worse with time if untreated. Social phobias tend to be chronic and are not likely go away without treatment. Moreover, untreated phobias can lead to other problems, including depression, alcoholism , and feelings of shame and low self-esteem. Therefore, specific phobias that persist into adolescence should receive professional treatment.

A group of researchers in Boston reported in 2003 that phobic anxiety appears to be a risk factor for Parkinson's disease (PD) in males, although as of 2004 it is not known whether phobias cause PD or simply share an underlying biological cause.

While most specific phobias appear in childhood and subsequently fade away, those that remain in adulthood often need to be treated. Unfortunately, most people never get the help they need; only about 25 percent of people with phobias ever seek help for their condition.

Prevention

There was, as of 2004, no known way to prevent the development of phobias. Medication and cognitive-behavioral therapy may help prevent the recurrence of symptoms once they have been diagnosed.

Nutritional concerns

Unless a phobia involves fear of eating a needed food, there are no nutritional concerns associated with phobias.

Parental concerns

Parents should be observant to ensure that unusual fears or phobias do not interfere in the lives of their children. Parents should recognize that a child's fears are real, and encourage the child to talk about his or her feelings, without trivializing the fear. Parents should be sympathetic, but not allow the child to avoid situations in which the child must encounter the feared object or events. If a school-age child has fears that interfere with the child's education, ability to make friends, or participate in other normal activities, a professional should be consulted.

KEY TERMS

Agoraphobia Abnormal anxiety regarding public places or situations from which the person may wish to flee or in which he or she would be helpless in the event of a panic attack.

Benzodiazepine One of a class of drugs that has hypnotic and sedative action, used mainly as tranquilizers to control symptoms of anxiety. Diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium) are all benzodiazepines.

Beta blockers The popular name for a group of drugs that are usually prescribed to treat heart conditions, but that also are used to reduce the physical symptoms of anxiety and phobias, such as sweating and palpitations. These drugs, including nadolol (Corgard) and digoxin (Lanoxin), block the action of beta receptors that control the speed and strength of heart muscle contractions and blood vessel dilation. Beta blockers are also called beta-adrenergic blocking agents and antiadrenergics.

Monoamine oxidase (MAO) inhibitors A type of antidepressant that works by blocking the action of a chemical substance known as monoamine oxidase in the nervous system.

Neuroimaging The use of x-ray studies and magnetic resonance imaging (MRI) to detect abnormalities or trace pathways of nerve activity in the central nervous system.

Selective serotonin reuptake inhibitors (SSRIs) A class of antidepressants that works by blocking the reabsorption of serotonin in the brain, thus raising the levels of serotonin. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

Serotonin A widely distributed neurotransmitter that is found in blood platelets, the lining of the digestive tract, and the brain, and that works in combination with norepinephrine. It causes very powerful contractions of smooth muscle and is associated with mood, attention, emotions, and sleep. Low levels of serotonin are associated with depression.

Social phobia An anxiety disorder characterized by a strong and persistent fear of social or performance situations in which the individual might feel embarrassment or humiliation.

Resources

BOOKS

Diagnostic and Statistical Manual of Mental Disorders,4th edition. Washington, DC: American Psychiatric Association, 2000.

"Phobic Disorders." Section 15, chapter 187 in The Merck Manual of Diagnosis and Therapy. Edited by Mark H. Beers, and Robert Berkow. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Stafford, Brian, et al. "Anxiety Disorders." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 813.

PERIODICALS

Birk, L. "Pharmacotherapy for performance anxiety disorders: occasionally useful but typically contraindicated." Journal of Clinical Psychology 60, no. 8 (2004): 86779.

Hofmann, S. G. "Cognitive mediation of treatment change in social phobia." Journal of Consulting and Clinical Psychology 72, no. 3 (2004): 3939.

Ilomaki, R., et al. "Temporal relationship between the age of onset of phobic disorders and development of substance dependence in adolescent psychiatric patients." Drug and Alcohol Dependence 75, no. 3 (2004): 32730.

Izquierdo, I., et al. "The inhibition of acquired fear." Neurotoxicity Research 6, no. 3 (2004): 17588.

Krijn, M., et al. "Virtual reality exposure therapy of anxiety disorders: a review." Clinical Psychology Review 24, no. 3 (2004): 25981.

ORGANIZATIONS

ABIL Incorporated. 400 West 32nd Street, Richmond, Virginia 23225. Web site: <www.anxietysupport.org/b001menu.htm>.

Agoraphobics in Motion. 1719 Crooks, Royal Oak, MI 48067. Web site: <www.aim-hq.org/>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 662112672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 600071098. Web site: <www.aap.org/>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Web site: <www.psych.org/>.

American Psychological Association. 750 First Street NW, Washington, DC, 200024242. Web site: <www.apa.org/>.

Anxiety Disorders Association of America. 8730 Georgia Avenue, Suite 600, Silver Spring, MD 20910. Web site: <www.adaa.org/>.

National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. Web site: <www.lexington-on-line.com/naf.html>.

National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 208929663. Web site: <www.nimh.nih.gov/home.cfm>.

WEB SITES

"Anxiety Disorders (Phobias)." National Mental Health Association. Available online at <www.nmha.org/infoctr/factsheets/35.cfm> (accessed November 2, 2004).

"Coping with Anxiety, Fears, and Phobias." Kids Health for Parents. Available online at <http://kidshealth.org/parent/emotions/feelings/anxiety.html> (accessed November 2, 2004).

"Phobias." American Psychiatric Association. Available online at <www.psych.org/public_info/phobias.cfm> (accessed November 2, 2004).

"Phobias." National Library of Medicine. Available online at <www.nlm.nih.gov/medlineplus/phobias.html> (accessed November 2, 2004).

L. Fleming Fallon, Jr., MD, DrPH

Phobias

views updated Jun 27 2018

Phobias

What Are Phobias?

What Causes Phobias?

What Are the Symptoms of Specific Phobias?

How Are Specific Phobias Treated?

Resources

Phobias (FO-bee-az) are unrealistic, long-lasting, intense fears of certain objects or situations. These fears can be so strong that people go to great lengths to avoid the object of their dread.

KEYWORDS

for searching the Internet and other reference sources

Anxiety

Fear

Social anxiety disorder

Specific phobias

Sigmund Freud (18561939), one of the greatest psychological thinkers in history, was a psychiatrist and the founder of psychoanalysis (SY-koa-NAL-i-sis), a treatment method that focuses on deeply hidden fears and internal conflicts. One of Freuds most famous cases involved Little Hans, a 5-year-old boy who had a great fear of white horses with black mouths. After learning more about Hans and his family, Freud concluded that the horse actually stood for, or represented, the boys father, a white man with a black mustache. Freud believed the boy was secretly resentful of his father but was too afraid to show his feelings. Instead, he displaced these feelings and developed an unreasonable fear of being bitten by a white horse. Freud theorized that phobias were actually displaced fears or conflicts. Modern researchers believe that the tendency for phobias may run in families and that many phobias are learned.

What Are Phobias?

People have long been fascinated by phobias, unreasonable, long-lasting fears of particular objects or situations. These fears can be so serious that people will severely limit their lives to avoid the object of their dread. Phobias can affect people of both sexes and all ages, although they are a little more common in women than men. About 8 percent of adults in the United States experience this problem, and many report that their phobias started in childhood. There are three main types of phobias: specific phobias, social phobia (also called social anxiety (ang-ZY-et-tee) disorder), and agoraphobia (a-gore-ra-FO-bee-a), which can be described as a fear of fear.;

Greek Speak

The word phobia comes from the Greek word phobos, meaning fear. The tongue-twister names for a number of specific phobias have Greek roots as well. For example:

  • Acrophobia (AK-ro-fo-bee-a): an abnormal fear of heights. The word comes from the Greek akron, meaning height.;
  • Ailurophobia (ay-LOOR-o-fo-bee-a): an abnormal fear of cats. The word comes from the Greek ailouros, meaning cat.;
  • Algophobia (AL-go-fo-bee-a): an abnormal fear of pain. The word comes from the Greek algos, meaning pain.;
  • Autophobia (AW-to-fo-bee-a): an abnormal fear of being alone. The word comes from the Greek autos, meaning self.;
  • Cynophobia (SY-no-fo-bee-a): an abnormal fear of dogs. The word comes from the Greek kyon, meaning dog.;
  • Erythrophobia (e-RITH-ro-fo-bee-a): an abnormal fear of the color red or of blushing. The word comes from the Greek erythros, meaning red.;
  • Gynephobia (GUY-neh-fo-bee-a): an abnormal fear of women. The word comes from the Greek gyne, meaning woman.;
  • Hemophobia (HE-mo-fo-bee-a): an abnormal fear of blood. The word comes from the Greek haima, meaning blood.;
  • Mysophobia (MI-so-fo-bee-a): an abnormal fear of dirt and germs. The word comes from the Greek mysos, meaning uncleanness.;
  • Nosophobia (NOS-o-fo-bee-a): an abnormal fear of sickness. The word comes from the Greek nosos, meaning disease.;
  • Pedophobia (PE-do-fo-bee-a): an abnormal fear of children. The word comes from the Greek pais, meaning child.;
  • Xenophobia (ZEN-o-fo-bee-a): an abnormal fear of strangers. The word comes from the Greek xenos, meaning foreign.;

A woman walking over a bridge is seized by intense fear. Owen Franken/Corbis

Specific phobias

People with specific phobias have a deep, unreasonable fear of specific objects or situations. Some common phobias include closed spaces, dogs, heights, escalators, tunnels, water, flying, and blood. The fear is not only extreme but also irrational. For example, a woman who is phobic about walking over a bridge may feel extreme panic in that situation, even though it poses no actual danger. Teenagers and adults with phobias realize that their extreme fears do not make sense, yet they are unable to control how they feel. Children with phobias usually dont realize that their fear is unfounded, and may believe, for example, that thunder is actually dangerous. No matter what someones age, facing, or even thinking about facing, the feared object or situation brings on severe anxiety, an unpleasant feeling of fear or nervousness. To fend off anxiety, people often avoid what they fear. If the object or situation is a common one, this can limit their activities. To make matters worse, the more people avoid what they fear, the greater the anxiety becomes the next time they are faced with it.

Social phobia or social anxiety disorder

People with social phobia (also called social anxiety disorder) have an extreme fear of being judged harshly, being embarrassed, or being criticized by others, which leads them to avoid social situations. Social phobia is much more than normal shyness. For example, people with social phobia may be afraid to eat in a restaurant, go to a party, answer a question in class, or give a speech. Some people have a broad form of the disorder, in which they fear and avoid almost any interaction with other people. This makes it hard for them to go to school or work or to have any friends at all!

Agoraphobia

People with agoraphobia are terrified of having a panic attack in a public situation from which it would be hard to escape. For example, they may be frightened of busy streets or crowded stores. If left untreated, the anxiety can become so severe that people refuse to leave their homes. If they do go out, they may be willing to do so only with a family member or friend, and they may still feel great distress.

What Causes Phobias?

Classical conditioning

Freud thought that phobias were caused by deeply hidden conflicts in the mind. One of his chief critics was John B. Watson (18781958), a psychologist and the founder of behaviorism, a school of psychology that focuses on how behaviors are learned and influenced by the environment. Watson answered Freuds case of Little Hans with his own case of Little Albert, an 11-month-old baby.

Watson wanted to prove that the fear of a particular object could be learned, so he showed the baby a white rat at the same time that he made a loud bang on a metal pipe. Before this, the baby had not been afraid of the white rat and had reached for it playfully when it was presented without the noise. Albert had, however, shown a fear response to the loud noise, as most children his age will do. After seeing the rat and hearing the loud sound together several times, though, Little Albert learned to fear the rat, even without the noise. This is an example of classical conditioning, in which people learn to associate a certain response (fear) with a previously unrelated situation or object (the rat). Given enough pairings of a fear response with a neutral, ordinary object, the object can become feared.

Biological causes

Much research has focused on finding biological causes of phobias. A tendency to have phobias seems to run in families, as does the tendency to have anxiety in other forms. Studies have shown that genes* may play a role in some cases. In other cases, anxious family members may unknowingly teach others to be fearful or avoidant. Other studies have looked at the part played by the bodys fear response, which is rooted in a part of the brain called the amygdala*.

* genes
are chemicals in the cells of the human body that help determine a persons characteristics, such as hair or eye color. They are inherited from a persons parents.
* amygdala
(a-MIG-da-la) is a small almond-shaped structure in the brain that plays a part in processing emotions.

When faced with real or imagined danger, the body sends signals to the amygdala, a part of the brain that connects memory with emotion. The amygdala remembers the fear associated with this situation or object and sets in motion the fight or flight reaction, physical changes that ready the body to react to a threat. The heart starts to pound and send more blood to the muscles for quick action, while stress hormones* and blood sugar flood the bloodstream to provide extra energy. In people with phobias, a scary experience, even one involving a harmless situation, can create a deeply etched memory of fear. With the help of the amygdala, this memory can trigger an automatic fear response when similar situations come up again, even if the fear is unwarranted.

* hormones
are chemicals produced by different glands in the body. A hormone is like the bodys ambassador: it is created in one place and sent through the body to have effects in different places.

The psychologist John B. Watson (1878;1958) is considered to be the father of behaviorism. He believed that human behavior depends not on the mind or feelings, but instead on our environment and experiences and how we learn to react to them. Archives of the History of American Psychology, Photograph FileThe University of Akron

What Are the Symptoms of Specific Phobias?

Specific phobias cause intense, lasting fear that is excessive or unreasonable. The categories of specific phobias include:

  • Animals: for example, dogs, snakes, or bugs
  • Natural world: for example, storms, heights, or water
  • Blood or injuries: for example, seeing a person who has been hurt in an accident or giving blood at the Red Cross
  • Situations: for example, traveling through tunnels, crossing bridges, or flying in airplanes
  • Others: for example, loud noises, choking, or getting a particular illness.

Phobias can start at any age. While it is normal for children to have several fears, occasionally childhood fears become so intense they are considered phobias. Some specific phobias that are common in early childhood (the dark, ghosts) disappear with time. Specific phobias that affect teens and young adults tend to be longer lasting. Only about one in five adult phobias goes away without treatment.

How Are Specific Phobias Treated?

If the phobic object or situation is easy to avoid, people with phobias may not feel the need to seek treatment. When phobias interfere with peoples lives, however, treatment can become necessary and often is very helpful. The usual treatment for specific phobias is exposure therapy, in which people are gradually introduced to what frightens them until the fear begins to fade. At least three-fourths of people with phobias improve with exposure therapy. Some may be reluctant to try this at first, since it involves facing fear rather than avoiding it. Relaxation and breathing exercises also can help reduce anxiety, making it easier for people to participate in exposure therapy and face the object or situation they fear. In addition, medications to relieve anxiety sometimes may be prescribed.

See also

Agoraphobia

Anxiety and Anxiety Disorders

Medications

Panic

Social Anxiety Disorder

Resources

Organizations

Anxiety Disorders Association of America, 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. This group is for people with an interest in phobias and other anxiety disorders. Telephone 301-231-9350 http://www.adaa.org

Anxiety Disorders Education Program, National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. This government program provides a wide range of information about phobias and other anxiety disorders. Telephone 888-8ANXIETY http://www.nimh.nih.gov/anxiety

www.healthfinder.gov, a resource affiliated with the U.S. Department of Health and Human Services, has an article printed in full called Fighting Phobias, The Things that go Bump in the Mind by Lynne L. Hall. http://www.fda.gov/fdac/features/1997/297_bump.html

Phobias

views updated May 11 2018

Phobias

A phobia is a persistent irrational fear that causes a person to feel extreme anxiety. When people have a phobic reaction to a situation, a condition, or a thing, they may experience sweating, increased heart rate, difficulty in breathing, and an overwhelming desire to run away. Sometimes they even fear that they are in imminent danger of dying.

Phobias are the most common of anxiety disorders, and they affect men and women of all ages, income levels, and ethnic groups. A phobia may develop from an unpleasant childhood memory. For example, an individual may feel uneasy around cats because of being bitten or scratched as an infant. If over the years such an uneasiness develops into an unreasoning fear of cats that causes the person to scream, run, or faint at the very presence of a cat, that person has ailurophobia (from the Greek words ailuro for cat, phobia for fear). Those individuals who have this phobia may take some comfort in knowing that a fear of cats also troubled such military conquerors as Alexander the Great, Julius Caesar, and Napoleon Bonaparte.

Psychologists have categorized as many as 500 phobias, and according to the estimates of some health professionals, as many as 50 million individuals in the United States suffer from some kind of phobia. While the causes of phobias remain unknown and open to much speculation, some of the most frequent theories name biological, chemical, cultural, and psychological originsor a mix of the four. Health care professionals stress that the most important thing for people with phobias to remember is that phobic disorders respond well to treatment and a phobia is not something that they must continue to endure.

Among the most common phobias is a fear of flying, aviophobia (avio, Latin for bird; avion, French for airplane). In 1980, a study conducted by Boeing Aircraft Corporation found that 25 million Americans readily expressed a fear of getting on board an airplane. Many individuals who suffer from this phobia break out into cold sweat and suffer from difficulty in breathing even while boarding the aircraft. Nearly all are consumed by an overwhelming conviction that the aircraft will crash and they will die in the ensuing disaster. Such a phobia can make life extremely difficult for those professionals who must travel for their work, and many refuse to fly regardless of the consequences to their livelihood. The "First Lady of Soul," singer Aretha Franklin, refuses to fly, even if it means canceling a concert date. Academy Award-winning screenwriter Billy Bob Thornton refuses to commit to any appearance that requires him to board an airplane. Although science fiction author Ray Bradbury has taken his readers to outer space on numerous occasions, he avoids airplanes. Actors Tony Curtis, Whoopi Goldberg, and Cher are also aviophobes. Prescription tranquilizers and other medications have proven effective for most individuals who suffer from aviophobia.

Agoraphobia is considered the most disabling of all the phobias. Treatment is difficult because those who suffer from this phobia fear being someplace outside of their home where they will not be able to escape if they should experience a panic attackand that can be anywhere from a supermarket, the office, or a crowded street. Usually defined as a fear of open spaces and unfamiliar places, the phobia takes its name from agora, the Greek word for marketplace, and literally translates as "fear of the marketplace." Some people develop this phobia so severely that they choose to leave their home and familiar surroundings as seldom as possible. Interestingly, Sigmund Freud (18561939), the famous psychotherapist who sought to unravel the phobias of his patients, suffered from agoraphobia. The wealthy and extremely eccentric aviator and investor Howard Hughes numbered agoraphobia among his fears. Academy Award-winning actress Kim Basinger is another agoraphobic. Treatment generally consists of behavioral therapy combined with antianxiety or antidepressant medications.

Psychologists generally agree that it is common for children to have extreme fear reactions before the age of seven and to learn to distinguish between actual dangers and legitimate fears as they mature. Those researchers who delve into the origins of phobic responses have theorized that as many as 40 percent of all those who suffer from specific phobias have inherited those fears from their parents or close relatives. Whether one's mother jumped up on a chair and screamed at a spider, one's father went into a frenzy at the sight of a rat, or one's aunt fainted at the sight of blood, the child who perceives such dramatic demonstrations of fear is likely to remember them forever and to enact them in his or her own life experiences.

Other experts state that childhood traumas, such as being bitten by a cat, being stung by a bee, or becoming lost for a time in a dark, wooded area, create more than enough memories of fears to be lodged in the brain as phobic responses to cats, bees, and forests. Individual sensitivity may also play an important role in the development of a trauma. Two individuals may experience a similar trauma as children, but only the more emotionally sensitive person will develop a phobia because of the incident.

Most experts identify phobias as falling into one of three basic kinds of fears: social phobias, in which the individual suffers from a paralyzing dread of social or professional encounters; panic disorders, in which the sufferer is periodically assailed by a sudden overwhelming fear for no apparent reason; and specific phobias, in which the person has a horror of a single thing, such as spiders, snakes, air travel, and so forth. Of the three, psychologists generally agree that specific phobias are the easiest to treat because they are the easiest to comprehend. In addition, there are understandable reasons why individuals might not wish to encounter a poisonous snake or spider or why they might be fearful of flying after the media has publicized a number of airline crashes. Because some phobias have developed out of an appropriate response to a legitimate fear, it is sometimes difficult to draw clear distinctions between phobic reactions and normal responses to danger that may have become exaggerated by imagination.

Many experts believe that it is no coincidence that specific phobias most often fall into one of four categories: fear of insects and animals; fear of the natural environment, such as dreading what lies in the dark; fear of dangerous situations, such as being trapped in a tight place or falling from a high place; and fear of blood or being injured. Each of these categories reflect fears that have enabled the human species to survive.

Because of a keen development of the fear and flight response of humankind's ancient ancestors over many centuries, millions of contemporary men and women have inherited fears that may no longer be as valid and as life-threatening as they once were. The common fear of snakes is an example of survival learning that has been passed on from generation to generation. Although the number of modern people who live in an environment threatened by poisonous reptiles has been vastly reduced, millions of individuals retain an unreasoning fear of snakes.


Of those who suffer from a specific phobia, researchers state that as many as 90 percent are women. According to the National Institute of Mental Health, phobias were the most common psychiatric illness among women in all age groups and the second most common illness among men over 25. Perhaps more women than men admit to having a phobia because of hormones, genes, and being reared in a culture in which men are not encouraged to acknowledge mental or physical problems.

Psychologists have made great strides in understanding the nature of phobias and helping those vulnerable to such fears to overcome them. There are depressant or stimulant medications that phobics can take to help overcome their fears, and there are many kinds of treatment programs. There are exposure therapies that habituate phobic individuals to become nonresponsive to the thing that once terrorized them; virtual-reality programs that simulate the thing the phobic person most fears in a safe environment; and various drugs to treat anxiety that have been approved by the U.S. Food and Drug Administration.

There are a number of other phobias that are quite common:

Acrophobia, a fear of heights, may have developed in an individual because of a childhood fear of falling. Some individuals are unable to ascend to the upper floors of buildings or are even unable to climb up on ladders to hang pictures in their home because of such a dread of falling. The name of this phobia is derived from the Greek word acro to denote a great height.

Arachnophobia, a fear of spiders, is an extremely common fear that undoubtedly has its basis in the reality that some spiders are poisonous or inflict painful bites. The name for this phobia comes from the Greek word for spider, arachne. There is also the Greek myth of Arachne, a woman from the ancient city of Lydia, who had the boldness to challenge the goddess Athena to a weaving contest. As a punishment, Arachne was changed into a spider.

Claustrophobia, a fear of being enclosed in a small or tight place, was experienced by the great escape artist Houdini, who often accepted the challenge of freeing himself from very small and tight boxes and trunks. Disciplining himself to conquer his phobia was one of his greatest feats. The name of this phobia comes from the Latin word claustro, to shut or to close. The word is also very close to cloister, in which individuals voluntarily shut themselves off from the world. The singer-actor Dean Martin tried to avoid elevators whenever possible because of his claustrophobia. Edgar Allan Poe (18091849), the writer and poet, was a claustrophobic, and he is said to have drawn on such fears when he wrote such stories as "Premature Burial" (1844).

Glossophobia, a fear of public speaking, is one of the most common of phobias and one that must be overcome by many individuals who find themselves in the position of having to make a speech to a group of people for business, professional, or educational reasons. From the Greek word for tongue, glosso, many people find themselves tongue-tied, feeling faint, their heart pounding when they are placed in the position of speaking in public. Even professional entertainers can experience cold sweat, nausea, vomiting, and light-headedness when they step before an audience. Extreme stage fright kept singer-songwriter Carly Simon from performing live for many years.

Hemaphobia, a fear of blood, is likely encouraged by the reverence that was placed upon the shedding of blood in religious sacrifices for thousands of years. Although medical science has added knowledge to the definition of what constitutes a fully functioning human body, on the unconscious level it is likely that many people still regard blood as the physical expression of the life force. Reinforcing such an ancient belief is the importance that is given to samples of blood in diagnosing illnesses and in identifying everything from culpability in a crime to responsibility in parenthood. The word comes from the Greek haima, meaning blood.

Mysophobia, a fear of germs or dirt, originates from the Greek myso, filth. This phobia is an environmental one that causes the sufferers constantly to wash their hands, to cleanse the area around them, and to avoid any type of dirt or any source that might breed bacteria. Many people with this disorder become housebound and often cause dermal harm to themselves by constantly scrubbing and washing their skin. Singer-songwriter Michael Jackson has become well-known for his phobia regarding germs. Millionaire-eccentric Howard Hughes and actress Joan Crawford were among those who shared this fear.

Necrophobia, a fear of dead people or animals, is likely one of those phobias that has its roots in humankind's earliest taboos and reflects such commonsense reasoning as the danger of contracting diseases from the deceased. All of the world's religions have strict rules about how the dead should be handled and how a proper burial should be conducted. And all world cultures have superstitions and legends about vampires, zombies, and other members of the undead who seek the blood of the living. Tales of the dead returning to communicate with their relatives or exact revenge on their enemies are known to every society. With such a heritage of fear of the dead lurking in the unconscious, it is to be expected that some individuals would develop such a crippling dread of a deceased person that therapy or medications must be prescribed. The word comes from the Greek nekros, meaning dead body or deceased person.

Scotophobia, a fear of the dark, is another basic human response to centuries of concern for the dangers in venturing out after nightfall where wild animals or savage people may lie in ambush, waiting to attack the vulnerable. While even in modern times it seems only an exercise of common sense to be cautious while out walking after dark, an unreasoning fear and overwhelming dread of dark places can cause individuals to be confined to their homes after nightfall. The word comes from the Greek scoto, darkness.

Xenophobia, fear of strangers or foreigners and their customs, can be especially troublesome in modern times when the globe shrinks more every year, and cultures once far removed from one another become closely involved in trade, tourism, or international tension. In primitive times when people encountered individuals from different tribes, a caution or fear of strangers was the most primitive kind of protective device. Although few areas of the world remain isolated from the technology of modern communications and few people are so isolated as to remain ignorant of people outside of their own tribal boundaries, ancient beliefs, superstitions, and fears concerning those different from themselves perpetuate xenophobia (from the Greek xenos, for stranger or foreigner) even among certain individuals living in modern society. Education and an encouragement to learn about and to appreciate the similarities, rather than the differences, among all people is the only cure for xenophobia.


Delving Deeper

Beck, Aaron, and G. Emery. Anxiety Disorders & Phobias: A Cognitive Perspective. New York: Basic Books, 1985.

Dumont, Raenn. The Sky Is Falling: Understanding and Coping with Phobias, Panic, and Obsessive-Compulsive Disorders. New York: W. W. Norton, 1996.

Hovanec, Erin M. Everything You Need to Know About Phobias. New York: Rosen Publishing Group, 2000.

Kahn, Ada P. Facing Fears: The Sourcebook for Phobias, Fears, and Anxieties. New York: Bantam Books, 1999.

Kluger, Jeffrey. "Fear Not!" Time, April 2, 2001, 5162.

Olshan, Neal, and Julie Wang. Everything You Wanted to Know About Phobias But Were Afraid to Ask. New York: Beaufort Books, 1981.

Online List of Phobias. [Online] http://www.phobialist.com.

Stern, Richard. Mastering PhobiasCases, Causes and Cures. New York: Penguin, 1995.

Phobias

views updated May 14 2018

PHOBIAS

Phobias are intense, persistent, unadaptive fears that are irrational/excessive. They are commonly classified into three groups: complex phobias, including agoraphobia (fear of public places, travel); social phobias (fear of social situations/scrutiny); and circumscribed phobias, including intense fears of insects, animals, heights, and enclosed spaces.

There are biological contributions to the development of some phobias, but the main determinants appear to be learned. Three main pathways to the acquisition of phobias have been identified. The conditioning acquisition of a phobia results from exposure to a traumatic stimulation or from repeated exposures to aversive sensitizing conditions. The second pathway is vicarious acquisition: direct or indirect observations of people, or of other animals, displaying fear. Among humans the transmission of fear-inducing verbal information is the third pathway. For a considerable time, explanations of the acquisition of phobias were dominated by the conditioning theory, which emphasized the importance of exposure to traumatic stimulation; recognition that fears can be acquired vicariously and/or by the direct transmission of information has led to a fuller account of the causes of phobias.

Important advances have been made in our ability to reduce phobias. Under controlled conditions, it is now possible to produce substantial and lasting reductions of phobias within a few sessions. It requires greater effort and far more time to reduce the complex and intense phobias, such as agoraphobia, but even these respond moderately well to treatment programs. There have been several attempts to explain how and when these methods of fear reduction achieve their effects, but each explanation has limitations.

Despite the many opportunities and circumstances in which phobias might develop, people acquire comparatively few; a satisfactory explanation of phobias must accommodate this fact as well as the appearance of phobias in a significant minority of the human population. It has also become apparent that people are more resilient than most psychologists have implied. Phobic patients who behave courageously during the course of treatment and soldiers who perform dangerous acts are notable examples of resilience.

Causes

The major features of the conditioning theory of phobias are as follows. Fears are acquired by a process of conditioning. Neutral stimuli that often are associated with a fear-producing or pain-producing state of affairs develop fearful qualities. They become conditioned phobic stimuli. The strength of the phobia is determined by the number of repetitions of the association between the pain/fear experienced and the stimuli, and by the intensity of the pain or fear experienced in the presence of the stimuli. Stimuli that resemble the fear-evoking ones also acquire phobic properties; that is, they become secondary conditioned stimuli. The likelihood of a phobia's developing is increased by confinement, by exposure to intensely painful or frightening situations, and by frequent associations between the new conditioned stimulus and the pain/fear. In an important extension, it has also been proposed that once objects or situations acquire phobic qualities, they develop motivating properties. A secondary fear drive emerges. Behavior that successfully reduces fear, notably avoidance behavior, will increase in strength.

Supporting evidence for the theory was drawn from six sources: research on the induction of fear in laboratory animals, the development of anxiety states in combat soldiers, experiments on the induction of fear in a small number of children, clinical observations (e.g., dental phobias), incidental findings from the use of aversion therapy, and a few experiments on the effects of traumatic stimulation.

The strongest and most systematic evidence was drawn from a multitude of experiments on laboratory animals. It is easy to generate conditioned fear reactions in animals by exposing them to a conjunction of neutral and aversive stimuli, usually electric shock. These fear reactions can be intense and persistent. Phobias can result from traumatic experiences in combat. In clinical practice, it is not uncommon for patients to give an account of the development of their phobias that can be construed in conditioning terms, and sometimes they can date the onset of the phobias to a specific conditioning experience (e.g., Lautch, 1971, on thirty-four cases of dental phobia). Di Nardo et al. (1988) found that nearly two-thirds of their subjects who were phobic toward dogs had experienced a conditioning event in which a dog featured, and in over half the dog had inflicted pain. It is important, however, that over two-thirds of a comparable group of subjects who were not frightened of dogs reported that they, too, had experienced a conditioning event, and that in over half of these instances the animal had inflicted pain.

These reports provide some support for the conditioning theory but also illustrate the fact that conditioning experiences, even those of a painful nature, do not necessarily give rise to a phobia or even to fear. Here, as in other instances, there was less fear than an unqualified conditioning theory would lead us to expect. Presumably the people who experienced conditioning events but failed to acquire a fear or phobia were "protected" by a history of harmless contacts with dogs. The roles that phobic patients attribute to direct and indirect experiences in generating their phobias differ with the content of the phobia, and of course the accuracy of their reports cannot be assured. In their analysis of 183 phobic patients, divided into six groups. Ost and Hugdahl (1985) found a range of attributions. For example, 88 percent of the agoraphobic patients attributed the onset of the phobia to a conditioning experience, but only 50 percent of those who were frightened of animals attributed the onset of their phobias to such an experience. Among the animal phobics, 40 percent traced the origin of the phobia to indirect experiences; such attribution was uncommon among the agoraphobics.

Although the importance of the phenomenon of acquired food aversions was not made evident until 1966, it is sometimes used to buttress the conditioning theory. The findings on this aversion also served to prompt radical rethinking of the concept of conditioning. Garcia and his colleagues were the first to demonstrate that strong and lasting aversive reactions can be acquired with ease when the appropriate food stimulus is associated with illness, even if the illness occurs many hours after eating (Garcia, Ervin, and Koelling, 1966). Given that the genesis of food aversions is a form of conditioning, if we also allow an equation between the acquisition of a food aversion and the acquisition of a fear, this phenomenon may have a bearing on the effect of the phobias.

If the acquisition of aversions is used to support the conditioning theory of phobias, it will have to take into account the temporal stretch of the phenomenon—that is, the delay that can intervene between the tasting of the food and the onset of the illness. Classical conditioning is expedited by temporal proximity between the stimuli, but food aversions can be easily and rapidly established even when there are long delays between the events. Hence, if the food aversion phenomenon provides support for a new or a revised conditioning theory of phobias, the temporal qualities of the conditioning processes must be deemphasized.

There are various arguments against acceptance of the conditioning theory of phobias as a comprehensive explanation. People fail to acquire phobias in what should be fear-conditioning situations, such as air raids. It is difficult to produce stable phobic or fear reactions in human subjects even under controlled laboratory conditions. The theory rests on the untenable equipotentiality premise (Seligman, 1972). The distribution of fears and phobias in normal and neurotic populations is difficult to reconcile with the theory. A significant number of people with phobias recount histories that cannot be accommodated by the theory. We also know that fears and phobias can be acquired vicariously, and that fears can be acquired by the reception of threatening verbal information. Fears, and possibly phobias as well, can be acquired even when the causal events are temporally separated (see Rachman, 1990).

Neoconditioning Concepts

The traditional insistence on the contiguity of the conditioned stimulus and the unconditioned stimulus as a necessary condition for the establishment of a conditioned response is mistaken. Rescorla has observed that "although conditioning can sometimes be slow, in fact most modern conditioning preparations routinely show rapid learning. One trial learning is not confined to flavor-aversion" (1988, p. 154). Apparently the associative span of animals "is capable of bridging long temporal intervals" (Mackintosh, 1983, p. 172). However, the learning must be selective; otherwise, animals would collect what Mackintosh has referred to as a "useless clutter of irrelevant associations." According to Mackintosh, the functioning of conditioning is to allow organisms to discover "probable causes of events of significance."

Given this new view, that conditioning is far more flexible and wide-ranging than was previously supposed, many of the objections to the conditioning theory of fear and phobias are weakened or eliminated. Although the application of neoconditioning concepts can shore up the conditioning theory, at the present stage the new view is too liberal. It lacks limits, and there is little left to disallow. In theory, almost any stimulus can become a conditioned signal for fear; but in practice people develop comparatively few phobias, and those we do acquire are confined to a limited range of stimuli. Phobias are not normally distributed.

Several sources of evidence suggest that phobias and fears can be acquired vicariously. Reports given by phobic patients, wartime observations, correlations between the phobias displayed by parents and children, laboratory demonstrations of conditioned fears, and research on animals have all provided some support for this view.

Verbal information can also generate a fear, and it is possible that in limited circumstances, it can even induce a phobia. Clinical evidence, especially that accumulating on the nature of panic disorders, suggests that phobias can be generated by information that is slightly or not at all threatening but is catastrophically misinterpreted by the recipient as being threatening.

Biological Determinants

The nonrandom distribution of human phobias, the high incidence of phobias of snakes and spiders and the low incidence of fears/phobias of motor travel, the remarkable speed with which certain objects can be transformed into objects of fear, and the common occurrence of irrational fears all point to the operation of nonlearned processes in the acquisition of fears and phobias. The main explanations fall into two classes: Some human fears and phobias are innately determined, or people are innately disposed rapidly to acquire phobias of certain specifiable objects or situations.

The most influential explanation is that set out by Martin Seligman, who argued, "The great majority of phobias are about objects of natural importance to the survival of the species … (human phobias are largely restricted to objects that have threatened survival, potential predators, unfamiliar places, and the dark)" (1972, p. 450). He postulates that certain kinds of fears are readily acquired because of an inherited biological preparedness. These phobias are highly prepared to be learned and, like other highly prepared relationships, "they are selective and resistant to extinction, and probably non-cognitive" (1972, p. 455).

The main features of prepared phobias are that they are very easily acquired (even by watered-down representations of the actual threat), selective, stable, biologically significant, and probably noncognitive. After some encouraging early laboratory demonstrations of fear preparedness in human subjects, subsequent research was disappointing because the phenomenon appeared to be too fragile. The laboratory effects appeared to be weak, transient, and difficult to reproduce. The plausibility of the concept has been weakened but not seriously damaged, and more powerful stimuli and more appropriate measures of fear responding are needed before the theory can be subjected to rigorous testing. The demonstration of preparedness in the development of phobias among laboratory monkeys encourages the belief that Seligman's theory retains considerable value. Mineka (1988) has shown that the fears induced in monkeys in laboratory conditions are intense, vivid, and lasting. The animals readily developed fears of snakes but showed little or no propensity to develop fears of biologically insignificant stimuli such as flowers.

Fear Reduction

Three powerful and dependable methods for reducing fear have been developed since the 1970s: desensitization, flooding, and therapeutic modeling. The common element in all three methods is the repeated and/or prolonged exposure of the fearful person to the stimulus or situation that provokes the fear (the exposure method). The selection of the appropriate fear-reducing technique depends on the nature of the phobia and the preference of the fearful subject, but all three methods are reliably robust. Fears of circumscribed stimuli, such as snakes or spiders, can be reduced fairly rapidly, even if they are intense and well established. The reduction or elimination of more complex fears, such as agoraphobia, requires greater effort and time. Despite these important practical advances, there still is no widely accepted explanation for the effects of these techniques.

See also:BEHAVIOR THERAPY; CONDITIONING, CLASSICAL AND INSTRUMENTAL; OBSERVATIONAL LEARNING; TASTE AVERSION AND PREFERENCE LEARNING IN ANIMALS

Bibliography

Di Nardo, P. A., Guzy, L. T., Jenkins, J. A., Bak, R. M., Tomasi, S. F., and Copland, M. (1988). Etiology and maintenance of dog fears. Behaviour Research and Therapy 26, 245-252.

Garcia, J., Ervin, F., and Koelling, R. (1966). Learning with prolonged delay of reinforcement. Psychonomic Science 5, 121-122.

Lautch, H. (1971). Dental phobia. British Journal of Psychiatry 119, 151-158.

Mackintosh, N. J. (1983). Conditioning and associative learning. New York: Oxford University Press.

Mineka, S. (1988). A primate model of phobic fears. In H. Eysenck and I. Martin, eds., Theoretical foundations of behaviour therapy. New York: Plenum Press.

Ost, L. G., and Hugdahl, K. (1985). Acquisition of blood and dental phobia and anxiety response patterns in clinical patients. Behaviour Research and Therapy 23, 27-34.

Rachman, S. J. (1990). Fear and courage, 2nd edition. New York: W. H. Freeman.

Rescorla, R. A. (1988). Pavlovian conditioning. American Psychologist 43, 151-160.

Seligman, M. E. P. (1972). Phobias and preparedness. Behavior Therapy 2, 307-320.

Stanley J.Rachman

Phobia

views updated Jun 11 2018

Phobia

BIBLIOGRAPHY

Phobias are morbid, irrational fear reactions to specific objects and situations. Phobias are among the most prevalent mental disorders worldwide. The term phobia comes from the name Phobos, the son of Aries, the Greek war god. Phobos was so fearsome-looking that enemies on the battlefield became panic-stricken when they saw him. Specific phobias are named by combining the Greek word for the object or situation with phobia. Thus, fear of thunder becomes brontophobia, and fear of closed spaces becomes claustrophobia. Phobias have been described for at least 2,500 years, going back to the ancient Greek physician Hippocrates (c. 460377 BCE), the father of medicine.

Table 1: List of Phobia Names
arachnophobiaspiders
astraphobialightning and stars
belonephobianeedles
catagelophobiaridicule
ophidiophobiasnakes
ereuthophobiablushing
kyklonasophobiatornadoes
mysophobiacontamination
ornithophobiabirds
pediophobiadolls
scriptophobiawriting
tichophobiahair
xenophobiastrangers

Phobias are classified as types of anxiety disorders by the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM -IV-TR, 2000). The major diagnostic characteristics of a phobia are that an individual consistently reacts to some object or situation with intense fear and seeks to escape or avoid that stimulus; this fear is sufficiently strong that it interferes with the persons normal functioning. Three types of phobias are differentiated by the nature of the circumstances that precipitate the strong fear reaction: specific phobia, social phobia, and agoraphobia.

Specific phobias include fears of clearly identifiable objects or situations, such as looking down from a tall building or seeing a snake. There are four basic subtypes of specific phobia: natural environment (water, storms); animals (snakes, spiders); situations (enclosed places, bridges); and blood, injections, and injuries (dentistry). Specific phobias that do not fall into these four subtypes are classified as other.

Social phobia, also called social anxiety disorder, is defined by a persistent and intense fear reaction and avoidance of social and performance situations in which one might be embarrassed or negatively evaluated by others. Common social phobic situations include public speaking, meeting strangers or persons of the opposite sex, using public restrooms, and writing ones name in public. Social phobias typically begin in adolescence or young adulthood.

Agoraphobia, literally fear of open spaces, is more accurately the fear of having a panic attack in a public place, such as a shopping mall or a theater, from which one might have difficulty escaping to safety. Due to this fear, agoraphobics avoid public situations and, in many cases, become totally housebound.

Phobias share many characteristics with other anxiety disorders. For example, a person with panic disorder experiences intense panic attacks that are similar to what phobics experience, except that these attacks seem to come out of nowhere and are not clearly attached to specific circumstances. The majority of agoraphobics will be diagnosed as having panic disorder with agoraphobia. Posttraumatic stress disorder is also similar to phobias in that following a severely traumatic experience in which people believe that they or someone else might die (such as war or rape), some people continue to react with intense fear and avoidance when reminded of the original trauma.

Although the exact details of how phobias develop are not clear, there is a broad consensus that classical or Pavlovian conditioning-like processes are involved, in which an individual experiences a strong fear reaction in the presence of a specific object or situation, forming an associative link. Subsequently, when the object is reexperienced, it triggers a panic attack. Recent theories suggest that cognitive or thinking processes contribute to some phobia development. For example, the mere observation of another person being injured or frightened can initiate a phobia. Although most phobias develop via conditioning or observation, a considerable number of phobics have no recollection of having been frightened or injured in the presence of their phobic stimulus, either directly or vicariously.

Evolutionary theory enters in as well to explain why some objects are more frequently found to be phobic stimuli than others. American psychologist Martin Seligmans theory of biological preparedness hypothesizes that due to their evolutionary significance as potential dangers, we are prone (prepared) to develop conditioned responses more readily to objects that were dangers in our evolutionary past, such as small, poisonous animals (e.g., snakes). We are less prone to develop conditioned responses to more modern but equally dangerous stimuli, such as guns.

Specific phobias are the most successfully treated of the anxiety disorders. The basic paradigm guiding most successful treatment follows from the conceptualization of the phobias origin as a conditioning-like process. To overcome or to extinguish a conditioned fear reaction, the phobic must engage the stimulus that elicits the panic reaction. With repeated exposure to the triggering stimulus, the panic reaction diminishes progressively until it is extinguished. The engagement with the triggering stimulus can be done gradually in small increments, or the phobic can be immersed or confronted with the stimulus full-strength. When presented in small increments, an anxiety hierarchy can be constructed that consists of a series of graded representations of the feared stimulus. Starting at the bottom, each item is presented to the phobic, who tolerates the fear until it diminishes, after which the phobic moves up to the next item in the hierarchy. Alternately, a phobic might be immersed in the feared stimulus through a procedure called flooding. Here the stimulus is presented at full strength, eliciting a strong fear reaction that diminishes over time.

These exposures can be accomplished with direct, live confrontation with the feared stimulus or through a procedure in which the patient brings elements of the anxiety hierarchy to mind as mental images. In a version of this treatment, called systematic desensitization, patients learn deep relaxation, which helps them remain relaxed as each item of the hierarchy is imagined. With repetition, each item is progressively mastered. Although systematic desensitization was the first method found to be truly efficacious in treating phobias, it requires an average of eleven one-hour treatment sessions. Live, direct exposure to the stimulus elements extinguishes the fear reaction more quickly. Swedish psychologist Lars-Goran Öst has shown that a single five-hour session of live exposure is highly effective for treating many phobias. More recently, computer-generated stimuli presented as virtual reality have been shown to be effective for treating phobias.

In practice, several of these approaches are often combined with cognitive mechanisms that help phobics believe that they can tolerate the feared stimulus. One method, called modeling, is particularly effective with children. Dog-fearful children, for example, observe nonfearful children playing safely with dogs, and this exposure by observation diminishes the phobic childs fear.

Similar methods using live or imagined exposure to a feared situation are also effective for social phobia and agoraphobia. However, in contrast to specific phobias, where psychotropic drugs are generally ineffective, some medications can assist in the treatment of social and agoraphobia. A class of antianxiety drugs called benzodiazepines can be useful adjuncts to exposure treatments, but such drugs must be used with caution because they are addictive. Another class of medication, selective serotonin reuptake inhibitors, can also assist in some cases by diminishing the number of panic attacks among social phobics and agoraphobics. Although effective, the exact psychological mechanisms underlying these phobia treatments remain unclear.

SEE ALSO Anxiety; Post-Traumatic Stress

BIBLIOGRAPHY

American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders (DSM -IV-TR). 4th ed., text rev. Washington, DC: Author.

Craske, Michelle G. 2003. Origins of Phobias and Anxiety Disorders: Why More Women than Men? London: Elsevier.

Craske, Michelle G., Martin M. Antony, and David H. Barlow. 1997. Mastery of Your Specific Phobia. Boulder, CO: Graywind.

Rachman, Stanley J. 1990. Fear and Courage. 2nd ed. New York: Freeman.

Ronald A. Kleinknecht