Understanding Phobias: Simple to Social and Agoraphobia

A phobia is an excessive or unreasonable fear of an object, place or situation. Simple phobias are fears of specific things such as insects, infections, flying. Agoraphobia is a fear of being in places where one feels "trapped" or unable to get help, such as in crowds, on a bus, or standing in a queue. A social phobia is a marked fear of social or performance situations.

Phobias are extremely common. Sometimes they start in childhood for no apparent reason; sometimes they emerge after a traumatic event; and sometimes the develop from an attempt to make sense of an unexpected and intense anxiety or panic (e.

g. "I feel fearful, therefore I must be afraid of something").

When the phobic person actually encounters, or even anticipates being in the presence of the feared object or situation, she/he experiences immediate anxiety. The physical symptoms of anxiety may include a racing heart, shortness of breath, sweating, chest or abdominal discomfort, trembling, etc.

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and the emotional component involves an intense fear - of losing control, embarrassing oneself, or passing out.

Commonly people try to escape, and then to avoid the feared situation wherever possible. This may be fairly easy if the feared object is rarely encountered (e.g. fear of snakes) and avoidance will not therefore restrict the person's life very much. At other times (e.g. agoraphobia, social phobia) avoiding the feared situation limits their life severely. Escape and avoidance also make the feared object/situation more frightening.

With some phobias the person may have specific thoughts, which attribute some threat to the feared situation.

This is particularly true for social phobia where there is often a fear of being negatively evaluated by others, and for agoraphobia when there may be a fear of collapsing and dying with no one around to help, or of having a panic attack and making a fool of oneself in front of other people.

With some phobias there may be accompanying frightening thoughts (this plane might crash; I'm trapped; I must get out). However with other phobias it is more difficult to identify any specific thoughts, which could be associated with the anxiety (e.g. it is unlikely that a spider phobic is afraid of making a fool of themselves in front of the spider). With these phobias the cause seems to be explained more as a conditioned (learned) anxiety response, which has become associated with the feared object.

The most common of the various phobias is simple phobia, the unreasonable fear of some object or situation. Bees, germs, heights, odors, illness, and storms are examples of the things commonly feared in simple phobias. If you have a simple phobia, it might have begun when you actually did face a risk that realistically provoked anxiety. Perhaps, for example, you found yourself in deep water before you learned to swim. Extreme fear was appropriate in such a situation. But if you continue to avoid even the shallow end of a pool, your anxiety is excessive and may be of phobic proportions.

Simple phobias, especially animal phobias, are common in children, but they occur at all ages. The best evidence to date suggests that between 5 and 12 percent of the population have phobic disorders in any 6-month period. The recognition by most phobic that their fears are unreasonable doesn't make them feel any less anxious. Simple phobias do not often interfere with daily life or cause as much subjective distress as most other anxiety disorders.

The person with a social phobia is intensely afraid of being judged by others. Even at a gathering of many people, the social phobic expects to be singled out, scrutinized, and found wanting. Thus, the person with a social phobia feels compelled to avoid social situations with such apprehensions.

If you have a social phobia, you might be afraid to go to a party because you fear that other people will laugh at your clothing or think you are hopelessly stupid because you won't be able to think of anything to say. Like people with simple phobias, you work hard to avoid these anxiety-provoking situations.

People with social phobias are usually most anxious over feeling humiliated or embarrassed by showing fear in front of others. Ironically, they are often so crippled by the inhibitions resulting from such fears that they, in fact, may have difficulty thinking clearly, remembering facts, or expressing themselves in words. Even success in social situations fails to make them feel more confident. They are likely to think something like, "Next time I'll fall on my face."

Although studies of the incidence of social phobias are so far only preliminary, most experts believe social phobias are not as common as simple phobias. But because they result in considerable distress, people who suffer from them are more likely to seek treatment than are people with simple phobias. Social phobias tend to begin between the ages of 15 and 20 and, if left untreated, continue through much of the person's life. Often, social phobias suffer from symptoms of depression, and many also become dependent on alcohol.

Millions of Americans are afflicted with phobias or panic disorder. They suffer intensely. To escape their fear, they go to great lengths to avoid the object, place, or situation that provokes it. They change jobs merely to avoid an elevator ride, for example, or cut back their social life. Some wear down their families with their clinging dependency. Nearly all lose out on much of life.

Many people to from doctor to doctor seeking cures for the physical symptoms that accompany their phobias. Often, even the doctor fails to recognize that stomach pains, high blood pressure, rapid heartbeat, and other symptoms may be related to intense fear. Unless questioned, patients may not think to mention their fears.

The many phobic people who think their fears are silly, childish, or trivial often try to conceal them. While hiding from their fears, they hide their phobias from others, further limiting their experience of life. About one out of ten people suffer a severe fear of specific objects, activities or settings.

Even though the causes of phobia and panic are not well understood, treatments for these disorders are often very effective. Therapists use a variety of techniques, their choice usually linked to their beliefs about the cause of the disorder. But, upon examination, it turns out that many of these techniques share a common feature: They all seem to require that patients confront the source of their discomfort. Some therapists ask their patients to confront a feared situation in imagination, while others require a real-life confrontation. Some therapists define the source of fear as the external object or situation the patient identifies as fearful, while others find a deeper source within the patient - in the unconscious, in thoughts, or in physical sensations.

Still another difference is that one therapist might set up an explicit program for confronting feared objects and situations, while another might use drugs or psychotherapy to prepare the patient to confront fearful situations in everyday life. Whether phobias cause depression or depression causes phobias are unknown. Panic and anxiety can wear down a person until he or she feels demoralized. Alternatively, phobia and panic might result from depression and its symptoms - difficulties with sleep, appetite, and concentration, fatigue, lack of pleasure, and feelings of worthlessness

Some people can sidestep the thing they fear without much difficulty. Some, especially adults, can hide their distress and conceal their phobias. Even those who usually adjust their lives to fit their phobias are sometimes able to confront what they fear, "toughing it out," suffering all the while. While children may outgrow their phobias, adults usually do not get rid of them unless they receive treatment.

Recognized even in ancient times, phobias and panic are known around the world, probably in every human culture. The most recent and thorough studies show that, in the United States, phobias are the most common of all mental disorders. Seven out of every hundred Americans have phobias. Eight out of every thousand have panic disorder. Compared to men, women more often suffer from most types of phobia and panic disorder. The reason that phobias and panic are more common in women is now known. Investigators speculate that men may be more likely to drown their fears, since alcohol abuse is more common in men than women. This is just one of many possible explanations, however. Differences in biological makeup or social and psychological experiences may also be responsible.