Fears And Phobias

Fear is a strong emotional response to danger, real or imagined. A phobia the Greek word for fear is a persistent, irrational fear that is out of all proportion to its cause. People with phobias recognize that their fears are excessive and constraining, but they feel powerless to confront them and often go to great lengths to avoid the dreaded object or situation. According to the American Psychiatric Association, up to 24 million Americans suffer from one or more phobias, making this the country’s most common psychological disorder. Psychiatrists classify phobias according to the following categories:

Specific phobia

Fear of a specific object, situation, or event. Common examples include fears of animals, insects, the dark, germs, storms, heights, illness, and death. From 5 to 12 percent of the population suffers from such phobias at some point in life; women are more likely than men to be affected. Specific phobias often arise during childhood. Although most disappear as a child matures, a few may persist for life. Some feared situations are easy enough to avoid, but others, such as a fear of flying or of enclosed spaces (claustrophobia), can interfere with an individual’s lifestyle and work.

Social phobia

A compelling desire to avoid situations in which it’s necessary to face the scrutiny of others. People with this disorder fear being embarrassed or humiliated. For example, some persons are terrified of engaging in casual conversation; others cannot tolerate eating in a public place, using public restrooms, or interacting with a member of the opposite sex. Typically, a social phobia begins in adolescence and often lasts for life. About 3 to 5 percent of the population suffers from some type of a social phobia. Men and women have the disorder in roughly equal numbers.

Fears Phobias


An intense fear of being alone or trapped in a public place. (Agoraphobia is the Greek term for fear of a marketplace.) This is the most limiting of all phobias, causing some people literally to become prisoners in their own homes. As per 0.6 percent of Americans have agoraphobia, with women outnumbering men. Some two thirds of people with agoraphobia experience panic attacks periods of intense anxiety characterized by chest pains, a rapid heartbeat, sweating, difficulty in breathing, and other symptoms easily mistaken for a heart attack.

Diagnostic Studies And Procedures

The most important diagnostic criterion is a person’s instant feeling of extreme anxiety when encountering the feared object or circumstance. A doctor or mental health professional can easily diagnose a specific phobia simply by having the person describe the fears. The patient usually takes great pains to avoid the dreaded object or situation, even while admitting that the fear is unreasonable and seeking professional help to overcome it. Some people, however, engage in what is called counter phobic behavior in an attempt to counteract their fears. They deliberately, and often irrationally, seek out the object of their phobia. Thus, a person afraid of heights may take up parachute jumping or rock climbing. Such individuals are unlikely to seek help for their phobias. People with social phobias often go to great lengths to conceal their fears, although the resulting isolation may prompt them to consult a psychotherapist. Friends and family members should suspect social phobia in a loved one who consistently finds excuses to avoid specific social activities. For example, someone who fears eating in public may invariably develop a stomachache or plead loss of appetite when invited out for a meal. In reality, the person is afraid of spilling food or committing some other embarrassing act. The anxiety may perpetuate a vicious cycle; for instance, nervousness may prompt the person to spill some food, thus reinforcing the fear. When a physician or family member suspects agoraphobia, a review of recent behavior usually reveals a typical pattern of increasing constriction of activities. Eventually, the avoidance behavior takes on a life of its own. In severe cases, the agoraphobic may venture away from home only in the company of a friend or family member. Even then, the person will probably check constantly for an escape route and may make a sudden exit, especially if symptoms of a panic attack develop. Some people with severe agoraphobia actually remain in one room at all times.

Medical Treatments

Drug Therapy

Most phobia sufferers are able to cope with their fears without medication. The exceptions are people with severe agoraphobia accompanied by panic attacks; they may require a prescription medication. Possible medications include antidepressant drugs, especially MAG inhibitors such as phenelzine (Nardil) and isocarboxazid (Marplan), or tricyclic antidepressants, such as imipramine and A fear of crowds, a common aspect of agoraphobia, can manifest itself as a panic attack or a strong desire to flee when surrounded by people. desipramine . Other potential drugs are beta blockers, usually propranolol , or antianxiety agents such as alprazolam .

Psychological Treatments

For most phobias, various forms of psychotherapy can help alleviate the fear. Even in severe cases that require drugs, a doctor will still recommend psychotherapy to get at the root of the problem. The specific approach will depend on the phobia and the degree to which it is limiting the person’s life. One to one cognitive therapy often helps an agoraphobic. Group therapy is also beneficial in most cases, because it provides mutual support from others who have similar problems.

Alternative Therapies

Alternative therapies that emphasize stress management through relaxation skills are the most helpful in overcoming phobic reactions.

Behavior Modification

This is a key therapy employed by both psychiatrists and alternative therapists in treating phobias. The person gradually learns to overcome the fears through a process called desensitization. For example, a homebound agoraphobic might be instructed to start by opening the front door and spending several minutes looking outside. When the person can do this without anxiety or panic, he goes on to the next assignment, which might be to walk to the end of the driveway. The eventual goal is to enter a public place without experiencing fear. Practitioners also use similar desensitization exercises in treating simple and social phobias.

Biofeedback Training

With guidance from a qualified therapist, an individual can learn to normalize certain physical responses for instance, a racing heartbeat and elevated blood pressure of a phobic reaction.


This alternative therapy can be especially effective in overcoming simple phobias, such as a fear of flying or heights. While hypnotized, the patient is given instructions on how to respond when confronting the fear. For example, a person who fears flying may be told to imagine himself in the pilot’s seat with complete control over the situation. He may also be taught self hypnosis techniques to practice when in such fearful situations.

Meditation and Visualization

These techniques allow people with phobias to become detached observers rather than victims, permitting them to face their fears instead of trying to avoid them. Slow breathing exercises during meditation or visualization are an important part of these disciplines.

Self Treatment

Although some of the therapies just described require initial guidance from a professional, once mastered, they can be applied on your own. Also, communicating your fears to close friends and family members instead of hiding them can elicit the support you need for dealing with them. Other self help strategies include.

Breathing Exercises

You can learn to control hyperventilation and the onset of a panic attack by focusing all your attention on taking slow, deep breaths, inhaling through your nose, and exhaling slowly through your mouth. For best results, make this part of a 10 minute daily stress reduction program.

Self desensitization

Desensitization is a part of behavior modification, but you can also try it on your own. For example, if family members are eager

to adopt a cat but you are terrified of these animals, start by learning more about them from a distance. Look at cat picture books and visit a zoo to watch the lions and other big cats. Then observe a friend stroking her cat, listen to it purr, and imagine yourself stroking it. When you feel comfortable with your visual images of yourself with a cat, try petting a kitten that someone else is holding Eventually, you may be able to overcome your fear.

Support Groups

There are many organizations YMCAs, YWCAs, mental health clinics, and churches, among others that sponsor support groups to help people overcome their fears. These include groups for people with specific phobias, such as agoraphobia.

Other Causes of Fears

The use of alcohol, crack cocaine, and hallucinogenic drugs can give rise to intense fear. Also, fears may be part of other psychiatric disorders, especially schizophrenia, depression, and post traumatic stress syndrome, which follows a particularly disturbing event or experience. In unusual cases, the development of fears may be traced to a brain tumor or exposure to LSD and other toxic substances.

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