Phobias: A Fear for All Reasons

More than 12% of the population will experience a phobia at some point in their life, making this disorder the most common mental illness in the United States.


Agoraphobia is a fear of being someplace, with no easy means of escape or help if a panic attack should occur. Agoraphobia is the most disabling of all the phobias, and treatment is difficult because there are so many associated fears (crowds, elevators, traffic, bridges). People who suffer agoraphobia avoid places and situations associated with previous panic experiences. As the fear of panic attacks increase, the agoraphobic's world narrows to only a few places where he/she feels safe. In some cases, this is limited to the home. Symptoms of agoraphobia usually develop between late adolescence and the mid thirties.

Specific (also called simple) phobias are the most common form of phobias. Specific phobias produce an intense and disproportionate fear of a particular object or situation. People who suffer from specific phobias are aware that their fear is irrational, but the thought of facing the object or situation often brings on anxiety symptoms including panic attacks. Specific phobias are very common. They usually begin in childhood or adolescence and as many as 50% subside on their own within five years. There are five subtypes of specific phobias: animal phobias (snakes, spiders, rodents, dogs, etc); natural environment phobias (heights, storms, water, darkness, etc); situational phobias (enclosed spaces, elevators, flying, dentists, tunnels, etc); blood injection/injury phobias; and everything that doesn't fall in the above four categories (clowns, death, vomit, choking, etc)

Signs and Symptoms

People with phobias experience immediate anxiety-related symptoms when exposed to their feared object or situation. Often the individual knows that his/her fears are out of proportion with the actual threat. However, their reactions are automatic and uncontrollable. These symptoms of phobias are identical to those that occur in the fight-or-flight response to genuine danger. The associated anxiety can range from mild feelings of apprehension to dread, horror, terror, or a panic attack. The closer you are to the thing you're afraid of, the greater your reaction to the fear will be. Your reaction will be further intensified if escape from the feared object or situation is difficult.

Common phobia symptoms and feelings include: shortness of breath or smothering sensation; palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort; trembling or shaking; feeling of choking; sweating; nausea, diarrhea; feeling unsteady, dizzy, lightheaded, or faint; feelings of unreality or of being detached from yourself; fear of losing control or going crazy; fear of dying; numbness or tingling sensations; hot or cold flashes; jelly legs; dry throat; restricted or blurry vision or hearing.

Causes

Much is still unknown about what causes phobias. However, research has shown a strong correlation between an individual's phobias and the phobias of their parents; indicating that children may learn fears by observing a family member's phobic reaction to an object or a situation. Sometimes the start of a phobia may be triggered by a stressful life event, such as bereavement, illness or divorce. Additionally, some people can trace back their phobia to a certain frightening event during their childhood.

Treatment

Any phobia that significantly interferes with daily living should be treated. With appropriate treatment, most phobic individuals can completely overcome their fears and be symptom-free for years, if not for life. Effective relief can usually be gained through cognitive behavior therapy, medication, or a combination of both.

In cognitive therapy the individual works with the therapist to confront the feared object in a gradual and planned way, while learning skills to control their physical and emotional reactions.

Medications are prescribed to control panic and reduce anticipatory anxiety associated with agoraphobia and social phobia. SSRI antidepressants (specifically Cipramil, Cipralex, and Seroxat) are usually the drug of choice. Benzodiazepines (Valium, Xanax, Ativan, and Tranzene) are prescribed for severe anxiety. There is a strong potential for dependence on these medications, and should not be taken for longer than four months. Additionally, beta-blockers (cardiovascular drugs) may be prescribed to reduce the physical symptoms of anxiety such as palpitations, elevated blood pressure, and increased heart rate.

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