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3/13/2013

PHOBIAS
As Part of Anxiety Disorders

Several types of phobias exist.


Some people fear large, open
spaces. Others are unable to
tolerate certain social situations.
And still others have a specific
phobia, such as a fear of snakes,
elevators or flying.
Not all phobias need treatment, but
if a phobia affects your daily life, a
number of therapies are available
that can help you overcome your
fears often permanently.

Social phobia. More than just shyness,


social phobia involves a combination of
excessive self-consciousness, a fear of
public scrutiny or humiliation in
common social situations, and a fear of
negative evaluation by others.
Fear of open spaces (agoraphobia).
Most people who have agoraphobia
develop it after having one or more
panic attacks. Agoraphobia is a fear of a
place, such as a mall, an elevator or a
room full of people, with no easy means
of escape if a panic attack should occur.

A phobia is an overwhelming and


unreasonable fear of an object or
situation that poses little real
danger. Unlike the brief anxiety
most people feel when they give a
speech or take a test, a phobia is
long-lasting, causes intense
physical and psychological
distress, and can affect your ability
to function normally at work or in
social settings.

Phobias are divided into three main


categories:
Specific phobias. These include a fear
of enclosed spaces (claustrophobia);
animals, particularly spiders, snakes or
mice; heights (acrophobia); flying
(pterygophobia); water (hydrophobia);
storms; dentists; injections; tunnels;
bridges; and not being able to get off
public transportation quickly enough.
There are many other specific phobias.

No matter what type of phobia you have, it's likely to


produce the following reactions:
A feeling of uncontrollable anxiety when you're
exposed to the source of your fear sitting on an
airplane, for instance, or walking into a large party
The feeling that you must do everything possible
to avoid what you fear
The inability to function normally because of your
anxiety
Often, the knowledge that your fears are
unreasonable or exaggerated but feeling powerless
to control them
Physical as well as psychological reactions,
including sweating, rapid heartbeat, difficulty
breathing, a feeling of panic and intense anxiety
In some cases, anxiety just thinking about what
you fear

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When to see a Doctor?


An unreasonable fear can be an
annoyance having to take the stairs
instead of an elevator, for instance
but it isn't considered a phobia unless it
seriously disrupts your life. If anxiety
affects your ability to function at work
or socially, consider seeking medical or
psychological treatment. Most people
can be helped with the right therapy.

Causes
Much is still unknown about the actual
cause of phobias. Studies seem to show
a strong correlation between your own
phobias and the phobias of your
parents, however. Children may learn
phobias by observing a family
member's phobic reaction to an object
or a situation for example, a fear of
snakes or spiders.
Brain chemicals, genetics and traumatic
experiences also appear to influence the
development of phobias.

Complications

Tests and Diagnosis

Having a phobia may cause other problems, including:

There are no laboratory tests for phobias.


Instead, the diagnosis is based on a
thorough clinical interview and rigorous
diagnostic guidelines. Your doctor will
ask questions about your symptoms
and take a medical, psychiatric and
social history.
To be diagnosed with a phobia, you must
meet certain criteria spelled out in the
Diagnostic and Statistical Manual of
Mental Disorders (DSM), published by
the American Psychiatric Association.

Social isolation. If you have a phobia, you


may find that you avoid social situations and
public places. Financial, professional and
interpersonal problems often result from
social phobia and agoraphobia.
Depression. The avoidance of many activities
that other people find enjoyable in their
personal and professional lives may lead you
to become depressed.
Substance abuse. Some people with phobias
turn to alcohol or other drugs to deal with
stress. This unwise and unhealthy choice can
lead to abuse of alcohol or other drugs.

Specific Phobias
The diagnostic criteria for specific phobias include:

A persistent and intense fear triggered by an


object or situation, such as snakes, spiders or
storms.
An immediate anxiety response when you confront
the source of your fear.
Knowing that your fear is irrational or exaggerated
but feeling powerless to control it. This doesn't
apply to children, who often don't have the
maturity to recognize that their fear is
unreasonable.
Avoiding what you fear at all costs, or enduring it
with extreme distress.
No other explainable reason for your symptoms,
including medical conditions and other anxiety
disorders.
In children and teens, symptoms lasting at least
six months.

Social Phobia

The diagnostic criteria for social phobia include:

A persistent and intense fear of humiliating or


embarrassing yourself in one or more social
situations usually with unfamiliar people or
when you're under close scrutiny.
Exposure to the situations you fear creates
intense anxiety, which may take the form of a
panic attack.
Knowing that your fear is unreasonable or
exaggerated but feeling powerless to control it.
Avoiding the social or performance situations
that you fear or enduring them with extreme
distress.
The phobia and its complications severely affect
your life, including your job, social activities and
relationships.

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No other explainable reason for your symptoms,


including health problems, medication or other
psychological disorder.

Agoraphobia

The criteria for a diagnosis of agoraphobia include:

In children, additional diagnostic criteria


for social phobia include:
Fear and social anxiety with other
children, not just with adults.
Anxiety expressed by crying, tantrums,
freezing or shrinking from social
situations with unfamiliar people.
Often, an inability to realize that their
fears are unreasonable.
Phobia lasting at least six months.

An irrational fear of being alone in a place or


situation where you would be unable to find
help or to escape easily if you were to have a
panic attack. People with agoraphobia might
fear being in a large crowd, standing in line, or
traveling on a bus, train or automobile. In the
most severe cases, they may never leave the
house.
The avoidance of anxiety-provoking situations
whenever possible. Having to face these
situations causes extreme distress.
No other explainable reason for your
symptoms, such as a medical condition,
medication or other psychological disorder.

Treatments and Drugs

Medications

Your doctor or a mental health provider


may suggest medications or behavior
therapy or both to treat phobias. Most
adults don't get better on their own and
may require some type of treatment.
The goal of phobia treatment is to
reduce your anxiety and fear and to
help you better manage your reactions
to the object or situation that causes
them.

Sedatives. Medications called


benzodiazepines help you relax by
reducing the amount of anxiety that
you feel. They include lorazepam
(Ativan), diazepam (Valium),
alprazolam (Xanax) and
chlordiazepoxide (Librium). Sedatives
need to be used with caution because
they can be addictive, and should be
avoided if you have a history of alcohol
or drug dependence.

Beta blockers. These medications work by blocking


the stimulating effects of adrenaline on your body,
such as increased heart rate, elevated blood
pressure, pounding heart, and shaking voice and
limbs. Beta blockers can be very effective for
people who have severe stage fright.
Antidepressants. The most commonly used
antidepressants are selective serotonin reuptake
inhibitors (SSRIs). These medications act on the
chemical serotonin, a neurotransmitter in your
brain that's believed to influence mood. SSRIs
include citalopram (Celexa), escitalopram
(Lexapro), fluoxetine (Prozac), paroxetine (Paxil)
and sertraline (Zoloft). If SSRIs aren't effective or
cause intolerable side effects, your doctor may
prescribe another type of antidepressant, such as
a monoamine oxidase inhibitor (MAOI).

Behavior Therapy
Desensitization or exposure therapy
focuses on changing your response to
the object or situation that you fear.
Gradual, repeated exposure to the
cause of your phobia may help you
learn to conquer your anxiety. For
example, if you're afraid of flying, your
therapy may progress from simply
thinking about flying to looking at
pictures of airplanes, to going to an
airport, to sitting in an airplane, and
finally to taking a flight.

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Cognitive behavioral therapy is a more


comprehensive form of therapy. It
involves working with a therapist to
learn ways to view and cope with the
feared object or situation differently.
You learn alternative beliefs about your
fears and the impact they have on your
life. There's special emphasis on
learning to develop a sense of mastery
and control of your thoughts and
feelings.

Coping and Support


Childhood fears, such as fear of the dark,
of monsters or of being left alone, are
common, and most children outgrow
them. But if your child has a persistent,
excessive fear that's limiting his or her
ability to function in daily life, talk to
your doctor.

Treatment Choices

Specific phobias usually are treated


with behavioral therapy. Social phobias
may be treated with antidepressants or
beta blockers, along with behavior
therapy. Agoraphobia, especially when
it's accompanied by a panic disorder, is
usually treated with SSRIs and behavior
therapy.

To help your child cope with fears:


Talk openly about fears. Don't trivialize the
problem or belittle your child for being afraid.
Instead, let your child know that you're there
to listen, and to help.
Don't reinforce phobias. Instead, take
advantage of opportunities to help children
overcome their fears. If your child is afraid of
the neighbor's friendly dog, for example, don't
go out of your way to avoid the animal.
Instead, help your child cope when confronted
with the dog. For example, you might offer to
be your child's home base, waiting and
offering support while your child steps a little
closer to the dog and then returns to you for
safety. Over time, encourage your child to
keep closing the distance.

Pursue positive approaches. Help your


child learn to breathe deeply and repeat
positive statements such as "I can do this"
when facing something scary. Your child also
may benefit from rating the fear on a scale of
1 to 10. Recognizing that the fear rates only a
5 on the scale, for example, may help your
child see the feeling as being less
overwhelming.

Prevention
If you have unreasonable fears, consider
getting psychological help. By dealing
with your own fears, you won't pass
them on to your children.