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Fear, Fear, and More Fear

Fear, Fear, and More Fear

What are phobias?
Where do they come from?
What is a specific phobia?
What is agoraphobia?
What is social phobia?
Is social phobia the same as shyness?
What is the treatment for phobia?
Does medication help?
Does anything else help?

What are phobias?
If you've ever climbed to the top of a mountain or taken the elevator up to the top floor of a skyscraper, you may have gotten a queasy feeling in the pit of your stomach—especially if you looked down.
  • But if your heart started to beat so fast that you were sure you would explode.
  • If your palms began to sweat, and your head began to swim.
  • If you couldn't catch your breath, and your throat began to close.
Then you may have more than just a fear of heights. You may have a phobia. A phobia is an emotional and physical reaction to an object or a situation that makes you afraid—for no logical reason. For the people who suffer from phobias, it's like being in the worst horror movie imaginable. Just thinking about the thing that terrifies them brings on their symptoms. back to top

Where do they come from?
Phobias are more than just a case of "bad nerves." You can't overcome a phobia through willpower. You can't just ignore the symptoms and hope they'll go away. Phobias can make you feel anxious most of the time. They can make some everyday situations so uncomfortable that you may avoid them entirely. Some phobias can keep you from enjoying your life altogether.

Phobias affect people of all ages and backgrounds. They are the most common mental disorder among women of all ages, and the second most common disorder among adult men. No one knows for sure how phobias develop in the first place. In some cases, there seems to be no reason for the fear. In other cases, a person can remember an event, such as being chased by a dog or being trapped in an elevator, that triggered the phobia. So why do some people who experience such an event develop a phobia, and others don't? That's a puzzle that scientists are still trying to understand. Their best guess is that phobias hit people who have a mix of certain kinds of genes and certain kinds of life experiences. back to top

What is a specific phobia?
A specific phobia is one of the three different kinds of phobias. Specific phobias are also called "simple" phobias—even though they don't feel simple to the people who suffer from them! A person can develop a specific phobia of absolutely anything at all, but some phobias are more common than others. And long ago, doctors decided to give all of them fancy names. Here are some of the more common ones:
  • acrophobia: the fear of heights
  • claustrophobia: the fear of being in a tight space
  • zoophobia: the fear of all animals
  • arachnophobia: the fear of spiders
  • cynophobia: the fear of dogs
  • equinophobia: the fear of horses
  • ophidiophobia: the fear of snakes
  • pterygophobia: the fear of flying
  • odontiatophobia: the fear of dentists
Again, a phobia is very different from a fear or a dislike. For instance, you may not like spiders. In fact, you may even be a bit afraid of them. But for someone with arachnophobia, just the thought of having to look at a spider brings on feelings of terror and panic. Even if a person knows that the spider won't hurt her, she has an irrational fear that makes her want to run away or hide.

Most specific phobias do not get in the way of having a normal life. That's why some people who suffer from phobias never get professional help. Instead, they find ways to avoid the things that trigger their phobia. But this can make life complicated. For instance, if you have cynophobia, you may have to change the way you walk home from school every day to avoid the neighbor's dog. If you have claustrophobia, you may have to stay away from crowded parties. Someone with odontiatophobia might literally let her teeth rot to avoid the dentist.

Specific phobias strike more than 1 in 10 people. No one knows exactly what causes them. But they seem to run in families, and they seem to be more common in women. Specific phobias usually begin in adolescence or adulthood. They usually start suddenly and can hang on for a long time. Children sometimes develop simple phobias, but they often go away as they get older. That's not usually the case for adolescents and adults who have phobias. They almost always need treatment. back to top

What is agoraphobia?
The word agoraphobia comes from the Greek word that means "fear of the marketplace." People with this phobia are terrified of open spaces and of being someplace where they will not be able to escape. Agoraphobia strikes mostly adult women. It can happen to them gradually or suddenly, and is similar to something known as panic disorder. A person with a panic disorder gets panic attacks for no apparent reason. One minute everything is fine. The next, her body is shaking with fear.

People who suffer from agoraphobia are afraid of going places where they might have a panic attack. It could be anywhere—the supermarket, the shopping mall, a busy street, a movie theater, church. Pretty soon, they feel safe in only a few places. In extreme cases, someone with agoraphobia may even be afraid to leave her home. Or she may go outside only when she is with a friend or a family member. This phobia is the one that makes it most difficult to lead a normal life. back to top

What is social phobia?
A person with social phobia (also called social anxiety disorder) is especially afraid of being watched, criticized, or humiliated while doing something in front of other people. It could be something as simple as writing a check, eating or drinking in public, using public restrooms, or buttoning a coat. Some people who suffer from social phobia are especially afraid of being in front of large groups. You've probably heard the term stage fright, when actors get all kinds of emotional and physical symptoms before they perform. People with social phobia get those same symptoms when they speak in public. They often go to great lengths to avoid those situations. There are lots of stories about people with social phobia turning down great jobs and other opportunities because of their fear.

People with social phobia tend to be highly sensitive to criticism, and they often think that other people are trying to make them uncomfortable in public. Even though they realize that their fears are exaggerated, they can't stop worrying about embarrassing themselves. Some people with social phobia may decide not to get into any conversations. If they do, they may criticize themselves harshly for a long time afterward.

As you might expect, people with social phobia tend to stay away from parties. Sometimes they can't even go to class. Or if they do go to class, they don't speak up because they're afraid they'll get the wrong answer. Fear overtakes them even before they leave the house. They get sick to their stomach, they sweat, and their hearts pound. If they walk into a room of people, they turn red. They feel as if everyone's eyes are on them.

Social phobia usually begins around early adolescence, or even younger sometimes. No one knows exactly what causes the disorder. Lately scientists have been looking at a small part of the brain called the amygdala. They suspect that the amygdala is the part of the brain that controls fear. Once scientists learn more about the amygdalas of people with social phobia, then perhaps they can figure out how to treat the disorder.

Social phobia often runs in families. Many people who suffer from social phobia also suffer from depression or alcohol abuse. back to top

Is social phobia the same as shyness?
That is an excellent question—one that has motivated many researchers to study the differences between shyness and social phobia. What they've learned recently is that they are not the same thing. It may surprise you to know that many people with social phobia are not shy at all. They may actually enjoy being with other people most of the time. But certain activities—like making a speech, or going on a date, or talking to the principal—may make them extremely anxious. They can worry about these situations days and weeks ahead of time. back to top

What is the treatment for phobia?
Luckily, phobias are very treatable. In fact, most people who go for treatment get rid of their phobias forever. The two major ways of treating phobias are cognitive-behavioral therapy and medication.

Probably the best way to get rid of a phobia is to face your fear directly. Of course, you can't do that all at once—and you certainly can't do it by yourself. In cognitive-behavioral therapy, you meet for about 12 sessions (although social phobia may take more) with a trained mental health professional. He or she will ask you to confront whatever it is that you fear in a carefully planned way. First your mental health professional may ask you to see the object or situation in your imagination. Then he or she will ask you to look at pictures of what you fear. And finally, you will actually come into direct contact with the object or situation. By facing your fear, instead of running away from it, you get accustomed to it. In the process, you lose the anxiety and dread that plagued you. Sometimes this method of treatment is also called "exposure therapy." You may see some improvement within just a few sessions.

Cognitive-behavioral therapy also teaches you how to react differently to situations and to recognize the sensations in your body that cause anxiety. Your mental health professional will help you understand your own thought patterns. And he or she will try to help you replace your negative thoughts with positive ones.

Relaxation and breathing techniques may also help you manage your anxiety. Often when people are anxious, their breathing gets very shallow. This alone can make you light-headed and kind of shaky. Taking slow, deep breaths may not take away all your symptoms right away, but it will make you feel much better. back to top

Does medication help?
Medication can be very effective in treating phobias, especially social phobia and agoraphobia.

Social phobia is usually treated with antidepressants such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and benzodiazepines. Drugs called beta-blockers help people who are particularly afraid of performing in front of groups.

Agoraphobia is often treated with antidepressant or antianxiety medications, or both.

There is no proven medication for specific phobias, but certain medications may reduce symptoms of anxiety before you go into a stressful situation. back to top

Does anything else help?
Scientists have been trying to use computers to treat phobias. Instead of having a person with a phobia confront her fear in reality, they ask her to confront it in "virtual reality." In one experiment, for instance, a woman who has a fear of heights puts on a special helmet. This takes her into a computer-animated world that makes it seem as if she is experiencing her fear directly. She is on a glass elevator ride. And even though it looks like a cartoon, she feels all her usual phobic symptoms. But after she repeats the experience seven or eight times, she eventually becomes much less fearful. Scientists hope that, one day, this kind of "virtual" therapy may be able to treat all kinds of phobias. back to top

Last Modified Date: 3/28/2001
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