What are phobias?
Phobias are anxiety disorders characterized by an intense, irrational and disproportionate fear of situations or objects in which real danger is not so extreme. It is a severe fearful reaction, difficult to control, that can interfere with daily life.
Fear is a natural and adaptative response to events or things that could be dangerous. Some fears are usual in children, and they disappear in adulthood, not requiring any treatment. However, this fear can become a phobia when it stops being adaptative and becomes unreasonable and intensely impacts the individual.
Types of phobia
There can be as many types of phobia as people, as each individual can develop a phobia of anything. Nevertheless, some types are more frequent than others.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), consider phobias as a subtype of anxiety disorder and categorize them into three classifications:
Fear of a particular stimulus, such as objects or social situations. People with a specific phobia tend to be affected by the activation of the sympathetic nervous system and can have a flight or fight response.
Specific phobias can be subdivided into four types:
- Fear of animals or insects (e.g., dogs or spiders).
- Fear of elements of the natural environment (e.g., storms or heights).
- Fear of particular situations, such as flying or confined spaces (e.g., lifts, tunnels or trains).
- Fear of blood, injections or injuries (e.g., needles or medical surgery)
Agoraphobia is a fear of open spaces, spaces without clear limits or situations where the spaciousness would prevent the person from leaving or receive help in case of a panic attack. It is a fear of suffering a panic attack outside of the home or a safe area. Therefore, this phobia is related to panic attack disorder, and both can manifest simultaneously, reinforcing each other.
People with agoraphobia can also fear fainting, suffering a heart attack or losing control in a public space.
Social phobia or social anxiety disorder
Social phobia is also known as social anxiety disorder and refers to the fear of being seen or judged by others in social situations. The person behaves in a shy and anxious way in social settings, which makes it difficult to engage or interact with other people, which can have a tangible impact on their daily lives.
Some of the worries or thoughts that cause the anxiety are:
- Worry or desire to avoid being the centre of attention.
- Fear of be seen eating or drinking in public.
- Fear of talk in front of other people or even with friends.
- Fear of suffer embarrassment in public.
The ones above are the main categories of phobias, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Additionally, each phobia had a specific name. Some of them are:
- Claustrophobia: fear of confined spaces.
- Arachnophobia: fear of spiders.
- Trypophobia: fear of closely-packed holes.
- Sexophobia: fear of sexual organs or sexual activities.
- Tokophobia: fear of pregnancy.
- Nyctophobia: fear of night or darkness.
- Philophobia: fear of falling in love.
- Thanatophobia: fear of death.
- Emetophobia: fear of vomiting or seeing vomit.
- Autophobia: fear of being alone or lonely.
- Thalassophobia: fear of the ocean.
- Megalophobia: fear of large objects.
- Kakorrhaphiophobia: fear of failure.
- Cryophobia: fear of extreme cold.
- Glossophobia: fear of public speaking.
Many factors remain unknown, but these are some of the causes of phobias:
- Negative or traumatic experiences: many phobias develop due to negative experiences suffered during childhood or adulthood. Events such as suffering a panic attack in a particular context, being attacked by an animal, or getting stuck in a lift are examples of situations that can trigger a phobia. These experiences and the negative sensations are recorded in the brain, and the person can feel them again in similar contexts.
- Social learning and environment: it is possible to acquire a phobia by social learning. Watching other people, like your parents, having a fearful reaction to something or suffering some negative consequences can trigger the same fear in you.
- Information: you can fear something by getting information about the adverse outcomes, such as being told that you can suffer electroshock if touching an electrical wire.
The phobias can have some of the following symptoms:
- Catastrophizing: thoughts about the worst-case scenario. For example, you may think that you won’t be able to breathe if you leave your house or that an animal that gets close to you will attack you. This catastrophic thinking can be modified by exposure to the feared situation. However, if not faced, these ideas can be permanent and become an obsession.
- Anxiety and intense generalized fear: fear disproportionate to the real danger, and that is not adaptative. For instance, you may feel symptoms of anxiety when taking the tube.
- Feeling anguish or shame: knowing that the phobia is irrational can cause feelings of blame or shame that is hard to control.
- Psychosomatic responses: the person can experience a higher heart rate, blood pressure, or muscle tension at a physical level. Other physical reactions include nausea, excessive sweating, dizziness, weakness, blurry vision, lack of breath or chest pressure.
- Avoidance of the feared object or situation: to prevent the symptoms and the expected catastrophic consequences, people may avoid contact with the object or situation feared. However, this avoidance is detrimental, as it reinforces the fear by sending a message to the brain that the situation is hazardous and needs to be avoided for protection.
The best way to prevent a fear of becoming a phobia is by facing that fear and challenging the unhelpful worry thoughts that make us believe there is a real danger.
If you notice that something not dangerous triggers fear in you, try exposing yourself to that fear. This way, you can test and prove your brain wrong.
As the NHS explains, phobias are not officially diagnosed. Most individuals would be aware of their fears and know when it has become a phobia, negatively impacting their daily lives.
The most successful treatment for phobias is exposure therapy, a cognitive-behavioural therapy (CBT) technique that uses behavioural methods. In some cases, the GP may prescribe medication.
The treatment goal for phobias is to improve the person’s quality of life and stop the phobia from interfering in daily life. Treatment focuses on one phobia at a time, but it is possible to treat several fears.
Cognitive-behavioural therapy (CBT) with exposure therapy
- Exposure therapy: the aim is to modify the way you respond to the object or situation feared. Exposure therapy works with the idea that the anxiety doesn’t last forever, there is a peak where anxiety is higher, but then it reduces. Gradual exposure to the stimulus increases this anxiety, but over time, this anxiety will reduce and go away even in the presence of the object or situation. What happens is that the person habituates to the feared stimulus by repeatedly being exposed to it until it doesn’t cause an increase in anxiety. The person test with its behaviour that the worst-case scenario doesn’t happen.
- Cognitive-behavioural therapy (CBT): exposure therapy is combined with other more cognitive techniques that teach the patient to evaluate and challenge the catastrophizing thoughts. By analyzing these thoughts, the patient can question their validity and alter them for more helpful and realistic ones. The person learns more about phobias’ mechanisms and becomes aware of the impact of the thoughts in his feelings of psychical reactions.
Exposure therapy and CBT have been proven very successful in treating phobias. Nonetheless, in the most severe cases, medication can reduce the anxiety and panic symptoms and help you to better engage in exposure therapy.
Your doctor may decide to prescribe you:
- Beta-blockers: this medication blocks the stimulating effects of adrenaline, such as the high heart rate or blood pressure.
- Sedatives: benzodiazepines are the most widely used group of sedative drugs. They reduce the levels of anxiety and help you to relax. These drugs should be used carefully, as they can cause addiction.