Fears and Phobias

Fear is a reaction to danger that involves both the mind and body. It can serve a protective purpose, signaling us of danger and preparing us to deal with it, or it can be disruptive.

Fear is a built-in survival mechanism with which we are all equipped. Fear is a normal human emotional reaction. Even as babies, we possess the survival instincts necessary to respond when we sense danger.

A fear reaction happens whenever we sense danger or when we are confronted with something new or unknown that seems potentially dangerous. Most people tend to avoid the things they feel afraid of. There are, of course, exceptions such as people who seek out the thrill of extreme sports because the rush of fear can be exciting. We all experience fear slightly differently and with more or less intensity.

Some normal fears seem pretty much like a worry, or something you feel generally afraid of or uneasy about. However, at other times, fear comes as a sudden reaction to a sudden confrontation with danger. It's that sudden fear response that triggers the body's survival mechanism known as the fight or flight reaction. The fear reaction is known as "fight or flight" because that is exactly what the body is preparing itself to do - to fight off the danger or to run to get away. 

When faced with danger, our sympathetic nervous system produces adrenaline. This excess adrenaline prepares us to fight or to flee the physical threat. The fight-or-flight response includes an increase in heart rate and blood flow to our large muscles, better enabling us to react to the emergency. Blood sugar also increases, providing us with more energy. With our bodies and minds alert and ready for action, we are able to respond quickly and protect ourselves.

Although it is normal and even helpful to experience fear in dangerous situations, with phobias the fear and danger are greatly exaggerated or imagined. For example, it is only natural to be afraid of a snarling dog, but it is irrational to be terrified of a small, tail wagging puppy.

Fears become a reason for concern when they are persistent and interfere with your daily functioning. When a fear reaches this level of intensity, it is often identified as a phobia.  For a fear to be considered a phobia it has to be so extreme and cause so much distress that it gets in the way of a person's normal activities.

Fear is a reaction to an actual danger signal - it involves physical and mental tension that helps you spring into action to protect yourself from something that is happening. The body suddenly gears up into fight or flight mode when, for example, the car in front of you swerves and you just miss it. Once you know the danger has passed, the fear goes away.

The physical and mental tension of anxiety is very similar to fear but with one important difference. With anxiety, there isn't usually anything actually happening right then and there to trigger the feeling. The feeling is coming from the anticipation of future danger or something bad that could happen, but there is no danger happening now.

Everyone experiences anxiety from time to time. It can be mild or intense or somewhere in between. A little anxiety helps us to stay on our toes and motivates us to do our best. For example, some anxiety about the possibility of doing poorly on a test can motivate you to study a little harder. A moderate amount of anxiety helps the body and mind get prepared to cope with something stressful or frightening. Sometimes anxiety can get out of proportion and become too intense or too lasting, and it can interfere with a person's ability to do well.

A phobia is an intense, unreasonable fear of situations, objects, activities, or persons where the fear is far out of proportion to the actual danger or harm that is possible. The fear and distress is so intense that the person will do whatever they can to avoid coming into contact with the object of their fear, and often spend time thinking about whether they're likely to encounter it in a given situation. In fact, if you have a phobia, you probably realize that your fear is unreasonable, yet you still can’t control it. If you are exposed to the thing you’re afraid of, you become overwhelmed with extreme feelings of anxiety, fear, and even panic. This experience is so unpleasant that you will go to great lengths to avoid the object or situation you fear. The main symptom of this disorder is the excessive, unreasonable desire to avoid the feared subject.

Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer only relatively mild anxiety over that fear. Others suffer fully-fledged panic attacks with all the associated disabling symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override their initial panic reaction.

Phobias (in the clinical meaning of the term) are the most common form of anxiety disorders.  Approximately 8% to 18% of Americans suffer from phobias. Broken down by age and gender, the phobias are generally one of the most common mental illness among women in all age groups and the second most common illness among men older than 25.

Some people may be more likely to develop phobias than others. Anxiety problems often run in families and children and teens who tend to be fearful and who worry often have parents who have these traits. Anxiety that runs in families can partly be explained by biology and genetics. Both learning and genetics can play a part in the development of phobias.

When someone develops a phobia, they quickly learn that they feel anxious when they are near the object or situation they fear - and that they feel relief when they avoid it. They learn that avoidance can reduce their anxiety (at least for the moment) and increase the likelihood that they will avoid the feared situation or object next time. The difficulty is that these avoidance behaviors have to keep increasing and happening even sooner to provide the same relief. Pretty soon, a person finds himself spending time worrying about the possibility of encountering the feared situation and avoiding anything that might bring him into contact with it. With a phobia, the pattern of anxiety, avoidance, and worry about the possibility of contact tends to grow bigger and interferes more with life over time.

The word phobia is used in a non-medical sense for aversions of all sorts. A phobia can be linked to almost any behavior by using the suffix -phobia. However, when used in a clinical setting, many psychologists and psychiatrists classify most phobias into one of three categories:

1) Specific phobias such as fear of heights (acrophobia)

A specific phobia can develop when a person has an encounter with an object or situation that involves or provokes fear.  Specific phobias fear of a single specific panic trigger such as spiders, dogs, snakes,closed-in places, heights, escalators, tunnels, highway driving, water, flying, catching a specific illness, dogs and blood. Such phobias aren't just extreme fear, they are are an extreme and irrational fear.  Many of the specific phobias are extensions of fears that a lot of people have. People with these phobias specifically avoid the entity they fear.  Many specific phobias can be traced back to a specific triggering event, usually a traumatic experience at an early age.

Specific phobias can be broken into one of 5 types: (1) Animal phobias. Animal phobias are fears caused by an animal or insect. Examples include fear of snakes, fear of spiders, fear of rodents, and fear of dogs: (2) Natural environment phobias. Natural environment phobias are fears cued by objects found in nature. Examples include fear of heights, fear of storms, fear of water, and fear of the dark; (3) Situational phobias. Situational phobias are fears triggered by a specific situation. Examples include fear of enclosed spaces (claustrophobia),  fear of a specific situation such as public transportation, tunnels, bridges, elevators, flying, elevators, driving, fear of dentists or enclosed places; (4) Blood-Injection-Injury phobia. Blood-injection-injury phobia involves fear of blood, fear or injury, or a fear of shots or another medical procedure; and (5) Other phobias. This subtype should be specified if the fear is cued by other stimuli that don’t fall into one of the first four categories. Examples include fear or avoidance of situations that might lead to choking, vomiting, or contracting an illness, fear of choking, fear of injury, fear of death, "space" phobias (i.e., the individual is afraid of falling down if away from walls or other means of physical support), fears of loud sounds or of costumed characters.

2) Social phobias

A social phobia is a fear involving other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others, such as eating in public or fear of public speaking.

If you have social phobia you may be excessively self-conscious and afraid of embarrassing or humiliating yourself in front of others. The symptoms may extend to psychosomatic manifestation of physical problems. Social phobias and agoraphobia typically have a more complex cause than a specific phobia. It is believed that heredity, genetics, and brain chemistry combine with life-experiences to play a major role in the development of social phobias and agoraphobia.

3) Agoraphobia

Agoraphobia is a generalized fear of leaving a home or a small familiar 'safe' area, and of possible panic attacks that might follow. Traditionally thought to involve a fear of public places and open spaces, it is now believed that agoraphobia develops as a complication of panic attacks. Afraid that they may have another panic attack, people with agoraphobia become anxious about being in situations where escape would be difficult or embarrassing, or where help would not’t be immediately available. If you have agoraphobia, you are likely to avoid crowded places such as shopping malls and movie theaters. Standing in line is another situation that can be panic provoking. You may also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.  In Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), social phobia, specific phobia, and agoraphobia are sub-groups of anxiety disorder.

Shortness of breath or smothering sensation
Palpitations, pounding heart, or accelerated heart rate
Chest pain or discomfort
Trembling or shaking
Feeling of choking
Numbness or tingling sensations
Hot or cold flashes
Sweating
Nausea or stomach distress
Feeling unsteady, dizzy, lightheaded, or faint
Feelings of unreality or of being detached from yourself
Feelings of losing control, going crazy, or dying

In addition to the physical symptoms, people with phobias do everything they can to avoid their phobic stimulus. If you have a phobia, your avoidance of the feared situation may disrupt your life and be a source of tremendous stress and anxiety.

Mental health professionals use the following criteria to diagnose phobias:

You suffer from intense and unreasonable fear triggered by the presence or anticipation of a specific object or situation.
Exposure to the feared situation or thing causes immediate feelings of anxiety of panic.
You recognize that your fear is excessive and unreasonable.
You avoid the feared stimulus, or endure it with intense anxiety.
Your avoidance of the object or situation you fear interferes significantly with your normal routine or causes significant distress.
If you’re under 18 years old, you have had the phobia for at least 6 months.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is a guide to the diagnosis of mental disorders in the United States. The following are a list of the criteria for Specific Phobia.  Please note: although these criteria are designed to provide a guideline to diagnosis, they cannot substitute a visit to a psychologist, physician, or other mental health practitioner. These guidelines are provided for information purposes only.

Diagnostic criteria for specific phobia are:

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

Although phobias are common, they do not necessarily cause significant disruption of everyday activities. For example, if you have a snake phobia, it may cause no problems in your daily life if you live in a city where you are not likely to run into one. On the other hand, if you have a severe phobia, it may impact every area of your life, from your relationships to your occupational functioning. If you have claustrophobia you might turn down a lucrative job offer if you have to ride the elevator to get to the office. If you have a fear of heights you might drive an extra twenty miles in order to avoid a tall bridge. When avoidance of the object, activity, or situation that triggers your phobia interferes with your normal functioning or keeps you from doing things you would otherwise enjoy, it is time to seek help.

The most frequently used form of therapy for the treatment of specific phobias is a type of cognitive behavioral therapy (CBT) called systematic desensitization or exposure therapy. According to the National Institute of Mental Health, about 75% of people with specific phobias overcome their fears through cognitive-behavioral therapy. 

In desensitization or exposure therapy, you are exposed in a safe and controlled way to the object or situation you fear. The most commonly used exposure therapy involves gradual encounters with the fear-producing object, first in the imagination and then in reality. Through repeated experiences facing your fear, you begin to realize that the situation, while possibly unpleasant, is not harmful. With each exposure, you feel an increasing sense of control over your phobia. This sense of control over the situation and yourself is the most important benefit of exposure therapy. As you become desensitized to your fear, you no longer react with uncontrollable panic when confronted by it.

Hypnotherapy can be very effective for specific phobias.  This usually consists of systematic desensitization and other therapeutic techniques conducted under hypnosis by a clinical hypnotherapist.

Relaxation and stress relief techniques are frequently an accompaniment to other therapeutic approaches.  Relaxation techniques may include things like specific ways of breathing, muscle relaxation training, guided mental imagery, or soothing self-talk. Pairing a relaxing sensation with an object that has triggered fear can help the brain to neutralize the fear the object used to be associated with.

Medication can also be used in the treatment of phobias both as an adjunct to other types of treatment, and as a treatment on its own.

For more information about fear, phobias, and other mental health problems, please click on the linked websites listed below.

For a list of the many phobias please visit the page List of Phobias.

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